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Medical education and training
Research
How prepared are UK medical graduates for practice? A rapid review of the literature 2009–2014
  1. Lynn V Monrouxe1,
  2. Lisa Grundy2,
  3. Mala Mann3,
  4. Zoe John4,
  5. Eleni Panagoulas5,
  6. Alison Bullock6,
  7. Karen Mattick7
  1. 1Chang Gung Medical Education Research Centre (CG-MERC), Chang Gung Memorial Hospital, Taoyuan City, Taiwan
  2. 2Aberdeen Royal Infirmary, Aberdeen, UK
  3. 3Cardiff University Library Service, Cardiff, Wales, UK
  4. 4School of Social Sciences, Cardiff University, Cardiff, Wales, UK
  5. 5Cardiff University, Cardiff, Wales, UK
  6. 6CUREMeDE, Cardiff University School of Social Sciences, Cardiff, Wales, UK
  7. 7Centre for Research in Professional Learning, Graduate School of Education, University of Exeter, Exeter, UK
  1. Correspondence to Professor Lynn V Monrouxe; monrouxe{at}me.com

Abstract

Objective To understand how prepared UK medical graduates are for practice and the effectiveness of workplace transition interventions.

Design A rapid review of the literature (registration #CRD42013005305).

Data sources Nine major databases (and key websites) were searched in two timeframes (July–September 2013; updated May–June 2014): CINAHL, Embase, Educational Resources Information Centre, Health Management Information Consortium, MEDLINE, MEDLINE in Process, PsycINFO, Scopus and Web of Knowledge.

Eligibility criteria for selecting studies Primary research or studies reporting UK medical graduates' preparedness between 2009 and 2014: manuscripts in English; all study types; participants who are final-year medical students, medical graduates, clinical educators, patients or NHS employers and all outcome measures.

Data extraction At time 1, three researchers screened manuscripts (for duplicates, exclusion/inclusion criteria and quality). Remaining 81 manuscripts were coded. At time 2, one researcher repeated the process for 2013–2014 (adding six manuscripts). Data were analysed using a narrative synthesis and mapped against Tomorrow's Doctors (2009) graduate outcomes.

Results Most studies comprised junior doctors' self-reports (65/87, 75%), few defined preparedness and a programmatic approach was lacking. Six themes were highlighted: individual skills/knowledge, interactional competence, systemic/technological competence, personal preparedness, demographic factors and transitional interventions. Graduates appear prepared for history taking, physical examinations and some clinical skills, but unprepared for other aspects, including prescribing, clinical reasoning/diagnoses, emergency management, multidisciplinary team-working, handover, error/safety incidents, understanding ethical/legal issues and ward environment familiarity. Shadowing and induction smooth transition into practice, but there is a paucity of evidence around assistantship efficacy.

Conclusions Educational interventions are needed to address areas of unpreparedness (eg, multidisciplinary team-working, prescribing and clinical reasoning). Future research in areas we are unsure about should adopt a programmatic and rigorous approach, with clear definitions of preparedness, multiple stakeholder perspectives along with multisite and longitudinal research designs to achieve a joined-up, systematic, approach to understanding future educational requirements for junior doctors.

  • BASIC SCIENCES
  • EDUCATION & TRAINING (see Medical Education & Training)
  • GENERAL MEDICINE (see Internal Medicine)
  • INTENSIVE & CRITICAL CARE

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-013656

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    Footnotes

    • Twitter Follow Lynn V Monrouxe @LynnMonrouxe and Mala Mann at @SysReviews

    • Contributors LVM, MM, AB and KM conceived the idea and designed the study. LG, EP and ZJ developed the search strategy for the study and undertook the search and screening process at Time 1 under the supervision of MM, LVM and AB. LG undertook the search and screening process at Time 2 under the supervision of LVM. All authors developed the thematic coding and subsequent data analysis. LVM, LG and KM undertook the first draft of the manuscript. All authors reviewed and revised the manuscript and all authors approved the final version.

    • Funding This research was commissioned and funded by the General Medical Council who gave feedback on clarity and approved the manuscript for publication.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The raw data for this research comprise data available to others through peer-reviewed journals, some of which is copyright, we therefore are not at liberty to share.