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Medical school predictors of later perceived mastery of clinical work among Norwegian doctors: a cohort study with 10-year and 20-year follow-up
  1. Anna Belfrage1,2,
  2. Kjersti Støen Grotmol1,3,
  3. Lars Lien2,
  4. Torbjørn Moum1,
  5. Ragna Veslemøy Wiese1,
  6. Reidar Tyssen1
  1. 1 Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
  2. 2 Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
  3. 3 Department of Oncology, Regional Centre of Excellence in Palliative Care, Oslo University Hospital, Oslo, Norway
  1. Correspondence to Anna Belfrage; anna.belfrage{at}


Objective Doctors’ self-perceived mastery of clinical work might have an impact on their career and patient care, in addition to their own health and well-being. The aim of this study is to identify predictors at medical school of perceived mastery later in doctors’ careers.

Design A cohort of medical students (n=631) was surveyed in the final year of medical school in 1993/1994 (T1), and 10 (T2) and 20 (T3) years later.

Setting Nationwide healthcare institutions.

Participants Medical students from all universities in Norway.

Main outcome measures Perceived mastery of clinical work was measured at T2 and T3. The studied predictors measured at T1 included personality traits, medical school stress, perceived medical recording skills, identification with the role of doctor, hazardous drinking and drinking to cope, in addition to age and gender. Effects were studied using multiple linear regression models.

Results Response rates: T1, 522/631 (83%); T2, 390/522 (75%); and T3, 303/522 (58%). Mean scores at T2 and T3 were 22.3 (SD=4.2) and 24.5 (3.0) (t=8.2, p<0.001), with no gender difference. Adjusted associations at T2 were: role identification (β=0.16; p=0.006; 95% CI 0.05 to 0.28), perceived medical recording skills (β=0.13; p=0.02; 95% CI 0.02 to 0.24) and drinking to cope (β=–2.45; p=0.001; 95% CI –3.88 to –1.03). Adjusted association at T3 was perceived medical recording skills (β=0.11; p=0.015; 95% CI 0.02 to 0.21).

Conclusions Perceived medical recording skills and role identification were associated with higher perceived mastery. Medical schools should provide experiences, teaching and assessment to enhance students’ physician role identification and confidence in their own skills. Drinking to cope was associated with lower perceived mastery, which indicates the importance of acquiring healthier coping strategies in medical school.

  • medical education
  • perceived mastery
  • recording skills
  • role identification
  • alcohol

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  • Contributors All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The lead author affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained. Study concept and design: AB, RT. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: All authors. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: AB, RT, TM. Obtained funding: RT, LL. Administrative, technical, or material support: LL. Study supervision: RT, LL, KSG.

  • Funding The study was funded by the Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Norway. The Longitudinal NORDOC study has been founded by the Norwegian Research Council, the Norwegian Medical Association and the University of Oslo, Norway.

  • Competing interests None declared.

  • Ethics approval Regional Committee for Medical Research Ethics, Southern Norway, Section A: 2009/788a.

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

  • Data sharing statement No additional data available.