The do’s, don’t and don’t knows of supporting transition to more independent practice
Tóm tắt
Introduction Transitions are traditionally viewed as challenging for clinicians. Throughout medical career pathways, clinicians need to successfully navigate successive transitions as they become progressively more independent practitioners. In these guidelines, we aim to synthesize the evidence from the literature to provide guidance for supporting clinicians in their development of independence, and highlight areas for further research. Methods Drawing upon D3 method guidance, four key themes universal to medical career transitions and progressive independence were identified by all authors through discussion and consensus from our own experience and expertise: workplace learning, independence and responsibility, mentoring and coaching, and patient perspectives. A scoping review of the literature was conducted using Medline database searches in addition to the authors’ personal archives and reference snowballing searches. Results 387 articles were identified and screened. 210 were excluded as not relevant to medical transitions (50 at title screen; 160 at abstract screen). 177 full-text articles were assessed for eligibility; a further 107 were rejected (97 did not include career transitions in their study design; 10 were review articles; the primary references of these were screened for inclusion). 70 articles were included of which 60 provided extractable data for the final qualitative synthesis. Across the four key themes, seven do’s, two don’ts and seven don’t knows were identified, and the strength of evidence was graded for each of these recommendations.
Từ khóa
Tài liệu tham khảo
Teunissen PW. Experience, trajectories, and reifications: an emerging framework of practice-based learning in healthcare workplaces. Adv Health Sci Educ Theory Pract. 2015;20:843–56. (donates inclusion in the scoping review).
Prince KJAH, Boshuizen HPA, van der Vleuten CPM, Scherpbier AJJA. Students’ opinions about their preparation for clinical practice. Med Educ. 2005;39:704–12.
Bellini LM, Baime M, Shea JA. Variation of mood and empathy during internship. JAMA. 2002;287:3143–6. (donates inclusion in the scoping review).
Brennan N, Corrigan O, Allard J, et al. The transition from medical student to junior doctor: today’s experiences of tomorrow’s doctors. Med Educ. 2010;44:449–58. (donates inclusion in the scoping review).
Brown JM, Ryland I, Shaw NJ, Graham DR. Working as a newly appointed consultant: a study into the transition from specialist registrar. Br J Hosp Med. 2009;70:410–4. (donates inclusion in the scoping review).
Brown J, Chapman T, Graham D. Becoming a new doctor: a learning or survival exercise? Med Educ. 2007;41:653–60. (donates inclusion in the scoping review).
Hurst C, Kahan D, Ruetalo M, Edwards S. A year in transition: a qualitative study examining the trajectory of first year residents’ well-being. BMC Med Educ. 2013;13:96. (donates inclusion in the scoping review).
Lui C, Tang W, Lin Y, Chen C. The process of coping with stress by Taiwanese medical interns: a qualitative study. BMC Med Educ. 2016;16:10. (donates inclusion in the scoping review).
Morrow G, Burford B, Redfern N, Briel R, Illing J. Does specialty training prepare doctors for senior roles? A questionnaire study of new UK consultants. Postgrad Med J. 2012;88:558–65. (donates inclusion in the scoping review).
Wilkie G, Rafaelli D. In at the deep end: making the transition from SpR to consultant. Adv Psychiatr Treat. 2005;11:107–14. (donates inclusion in the scoping review).
Mylopoulos M, Regehr G, Ginsburg S. Exploring residents’ perceptions of expertise and expert development. Acad Med. 2011;86:46–9. (donates inclusion in the scoping review).
Westerman M, Teunissen PW, Fokkema JP, et al. New consultants mastering the role of on-call supervisor: a longitudinal qualitative study. Med Educ. 2013;47:408–16. (donates inclusion in the scoping review).
Westerman M, Teunissen PW, Jorgensen RL, et al. The transition to hospital consultant: Denmark and the Netherlands compared on preparedness for practice, perceived intensity and contextual factors. Med Teach. 2013;35:481–9. (donates inclusion in the scoping review).
Dijksterhuis MG, Voorhuis M, Teunissen PW, et al. Assessment of competence and progressive independence in postgraduate clinical training. Med Educ. 2009;43:1156–65. (donates inclusion in the scoping review).
Kennedy TJ, Regehr G, Baker GR, Lingard LA. Progressive independence in clinical training: a tradition worth defending? Acad Med. 2005;80:s106–s11.
McKinley RK, Scheele F. Do, don’t and don’t know: guidelines for medical education with a difference. Perspect Med Educ. 2015;4:275–6.
Lefroy J, Watling C, Teunissen PW, Brand P. Guidelines: the do’s, don’ts and don’t knows of feedback for clinical education. Perspect Med Educ. 2015;4:284–99.
Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8:19–32.
Teunissen PW, Westerman M. Opportunity or threat: the ambiguity of the consequences of transitions in medical education. Med Educ. 2011;45:51–9.
Abernethy B, Poolton JM, Rich SW, Niv G. Implications of an expertise model for surgical skills training. ANZ J Surg. 2008;78:1092–5.
Taherian K, Shekarchian M. Mentoring for doctors. Do its benefits outweigh its disadvantages? Med Teach. 2008;30:e95–e9.
Sambunjak D, Straus SE, Murusic A. Mentoring in academic medicine: a systematic review. JAMA. 2006;296:1103–15.
Entezami P, Franzblau LE, Chung KC. Mentorship in surgical training: a systematic review. Hand. 2012;7:30–6.
Frank JR, Snell LS, Cate OT, et al. Competency-based medical education: theory to practice. Med Teach. 2010;32:638–45.
Frank JR. Towards a definitions of competency-based education in medicine: a systematic review of published definitions. Med Teach. 2010;32:631–7.
Cameron A, Millar J, Szmidt N, et al. Can new doctors be prepared for practice? A review. Clin Teach. 2014;11:188–92.
Monrouxe LV, Grundy L, Mann M, John Z, et al. How prepared are UK medical graduates for practice? A rapid review of the literature 2009–2014. BMJ Open. 2017;7:e13656. https://doi.org/10.1136/bmjopen-2016-013656 .
Yardley S, Teunissen PW, Dornan T. Experiential learning: AMEE guide No. 63. Med Teach. 2012;34:E102–E15. (donates inclusion in the scoping review).
Ker JS, Hesketh A, Anderson F, Johnston DA. PRHO views on the usefulness of a pilot ward simulation exercise. Hosp Med. 2005;66:168–70. (donates inclusion in the scoping review).
Ker JS, Hesketh EA, Anderson F, Johnston DA. Can a ward simulation exercise achieve the realism that reflects the complexity of everyday practice junior doctors encounter? Med Teach. 2006;28:330–4. (donates inclusion in the scoping review).
Illing JC, Morrow GM, Rothwell nee Kergon CR, et al. Perceptions of UK medical graduates’ preparedness for practice: a multi-centre qualitative study reflecting the importance of learning on the job. BMC Med Educ. 2013;13:34. (donates inclusion in the scoping review).
Jones A, Willis SC, McArdle PJ, O’Neill PA. Learning the house officer role: reflections on the value of shadowing a PRHO. Med Teach. 2006;28:291–3. (donates inclusion in the scoping review).
Matheson C, Matheson D. How well prepared are medical students for their first year as doctors? The views of consultants and specialist registrars in two teaching hospitals. Postgrad Med J. 2009;85:582–9. (donates inclusion in the scoping review).
van der Vleuten CPM, Schuwirth LWT, Driessen EW, et al. A model for programmatic assessment fit for purpose. Med Teach. 2012;34:205–14.
Kilminster S, Zukas M, Quinton N, Roberts T. Preparedness is not enough: understanding transitions as critically intensive learning periods. Med Educ. 2011;45:1006–15. (donates inclusion in the scoping review).
Roberts T. Learning responsibility? Exploring doctors’ transitions to new levels of medical responsibility: full research report. Swindon: ESRC; 2009. (donates inclusion in the scoping review).
Sturman N, Tan Z, Turner J. ‘A steep learning curve’: junior doctor perspectives on the transition from medical student to the health-care workplace. BMC Med Educ. 2017;17:92. (donates inclusion in the scoping review).
Hashimoto DA, Bynum WE, Lillemoe KD, Sachdeva AK. See more, do more, teach more: surgical resident autonomy and the transition to independent practice. Acad Med. 2016;91:757–60. (donates inclusion in the scoping review).
Tallentire VR, Smith SE, Skinner J, Cameron HS. Understanding the behaviour of newly qualified doctors in acute care contexts. Med Educ. 2011;45:995–1005. (donates inclusion in the scoping review).
Ginsburg S, Gold W, Cavalcanti RB, Kurabi B, McDonald-Blumer H. Competencies “plus”: the nature of written comments on internal medicine residents’ evaluation forms. Acad Med. 2011;86:S30–S4. (donates inclusion in the scoping review).
Inui TS. The charismatic journey of mastery learning. Acad Med. 2015;90:1442–4. (donates inclusion in the scoping review).
Kellett J, Papageorgiou A, Cavenagh P, Salter C, Miles S, Leinster SJ. The preparedness of newly qualified doctors—views of foundation doctors and supervisors. Med Teach. 2015;37:949–54. (donates inclusion in the scoping review).
Lempp H, Cochrane M, Rees J. A qualitative study of the perceptions and experiences of pre-registration house officers on teamwork and support. BMC Med Educ. 2005;5:10. (donates inclusion in the scoping review).
Morrow G, Johnson N, Burford B, et al. Preparedness for practice: the perceptions of medical graduates and clinical teams. Med Teach. 2012;34:123–35. (donates inclusion in the scoping review).
Kennedy TJT, Lingard L, Baker GR, Kitchen L, Regehr G. Clinical oversight: conceptualizing the relationship between supervision and safety. J Gen Intern Med. 2007;22:1080–5. (donates inclusion in the scoping review).
de Feijter JM, de Grave WS, Dornan T, Koopmans RP, Scherpbier AJ. Students’ perceptions of patient safety during the transition from undergraduate to postgraduate training: an activity theory analysis. Adv Health Sci Educ Theory Pract. 2011;16:347–58. (donates inclusion in the scoping review).
Nikendei C, Kraus B, Schrauth M, Briem S, Junger J. Ward rounds: how prepared are future doctors? Med Teach. 2008;30:88–91. (donates inclusion in the scoping review).
McKinstry B, Macnicol M, Elliot K, Macpherson S. The transition from learner to provider/teacher: the learning needs of new orthopaedic consultants. BMC Med Educ. 2005;5:17. (donates inclusion in the scoping review).
MacMillan TE, Rawal S, Cram P, Liu J. A journal club for peer mentorship: helping to navigate the transition to independent practice. Perspect Med Educ. 2016;5:312–5. (donates inclusion in the scoping review).
Westerman M. Mind the gap: the transition to hospital consultant. Perspect Med Educ. 2014;3:219–21. (donates inclusion in the scoping review).
Lefroy J, Yardley S, Kinston R, Gay S, McBain S, McKinley R. Qualitative research using realist evaluation to explain preparedness for doctors’ memorable ‘firsts’. Med Educ. 2017;51:1037–48.
Antonoff MB, Swanson JA, Green CA, Mann BD, Maddaus MA, D’Cunha J. The significant impact of a competency-based preparatory course for senior medical students entering surgical residency. Acad Med. 2012;87:308–19. (donates inclusion in the scoping review).
Memon B, Memon MA. Mentoring and surgical training: a time for reflection! Adv Health Sci Educ Theory Pract. 2010;15:749–54. (donates inclusion in the scoping review).
Cave J, Woolf K, Jones A, Dacre J. Easing the transition from student to doctor: how can medical schools help prepare their graduates for starting work? Med Teach. 2009;31:403–8. (donates inclusion in the scoping review).
Caldwell J. Assessing the impact of stressors on performance: observations on levels of analyses. Biol Psychol. 1995;40:197–208. https://doi.org/10.1016/0301-0511(95)05115-5
Bleakley A, Brennan N. Does undergraduate curriculum design make a difference to readiness to practice as a junior doctor? Med Teach. 2011;33:459–67. (donates inclusion in the scoping review).
Blencowe NS, Van Hamel C, Bethune R, Aspinall R. ‘From scared to prepared’: targeted structured induction training during the transition from medical school to foundation doctor. Perspect Med Educ. 2015;4:90–2. (donates inclusion in the scoping review).
Kassim SS, McGowan Y, McGee H, Whitford DL. Prepared to practice? Perception of career preparation and guidance of recent medical graduates at two campuses of a transnational medical school: a cross-sectional study. BMC Med Educ. 2016;16:56. (donates inclusion in the scoping review).
Chittenden EH, Henry D, Saxena V, Loeser H, O’Sullivan PS. Transitional clerkship: an experiential course based on workplace learning theory. Acad Med. 2009;84:872–6. (donates inclusion in the scoping review).
Lempp H, Cochrane M, Seabrook M, Rees J. Impact of educational preparation on medical students in transition from final year to PRHO year: a qualitative evaluation of final-year training following the introduction of new year 5 curriculum in a London medical school. Med Teach. 2015;26:276–8. (donates inclusion in the scoping review).
Groves M, O’Rourke P, Alexander H. The clinical reasoning characteristics of diagnostic experts. Med Teach. 2003;25:308–13.
Muthaura PN, Khamis T, Ahmed M, Hussain SR. Perceptions of the preparedness of medical graduates for internship responsibilities in district hospitals in Kenya: a qualitative study. BMC Med Educ. 2015;15:178. (donates inclusion in the scoping review).
Wilkinson TJ, Harris P. The transition out of medical school—a qualitative study of descriptions of borderline trainee interns. Med Educ. 2002;36:466–71. (donates inclusion in the scoping review).
Kumagai AK. Commentary: forks in the road: disruption and transformation in professional development. Acad Med. 2010;85:1819–20. (donates inclusion in the scoping review).
Westerman M, Teunissen PW, van der Vleuten CP, et al. Understanding the transition from resident to attending physician: a transdisciplinary, qualitative study. Acad Med. 2010;85:1914–9. (donates inclusion in the scoping review).
Paice E, Hard S, Moss F. How important are role models in making good doctors? BMJ. 2002;325:707–10. (donates inclusion in the scoping review).
Sheehan D, Wilkinson TJ, Bowie E. Becoming a practitioner: workplace learning during the junior doctor’s first year. Med Teach. 2012;34:936–45. (donates inclusion in the scoping review).
Urquhart LM, Rees CE, Ker JS. Making sense of feedback experiences: a multi-school study of medical students’ narratives. Med Educ. 2014;2:189–203. (donates inclusion in the scoping review).
Franzese CB, Stringer SP. The evolution of surgical training: perspectives on educational models from the past to the future. Otolaryngol Clin North Am. 2007;40:1227–35. (donates inclusion in the scoping review).
Hernadez JM. Mentoring medical students: a resident’s perspective. Bull Am Coll Surg. 2009;94:27–9. (donates inclusion in the scoping review).
Straus SE, Graham ID, Taylor M, Lockyer J. Alberta mentorship working group. J Contin Educ Health Prof. 2008;28:117–112. (donates inclusion in the scoping review).
Straus SE, Straus C, Tzanetos K. Career choice in academic medicine: systematic review. J Gen Intern Med. 2006;21:1222–9.
Straus SE, Chatur F, Taylor M. Issues in the mentor-mentee relationship in academic medicine: a qualitative study. Acad Med. 2009;84:135–9.
Berridge EJ, Freeth D, Sharpe J, Roberts CM. Bridging the gap: supporting the transition from medical student to practising doctor—a two-week preparation programme after graduation. Med Teach. 2007;29:119–27. (donates inclusion in the scoping review).
Hoifodt TS, Talseth AG, Olstad R. A qualitative study of the learning processes in young physicians treating suicidal patients: from insecurity to personal pattern knowledge and self-confidence. BMC Med Educ. 2007;7:21. (donates inclusion in the scoping review).
Matheson CB, Matheson DJ, Saunders JH, Howarth C. The views of doctors in their first year of medical practice on the lasting impact of a preparation for house officer course they undertook as final year medical students. BMC Med Educ. 2010;10:48. (donates inclusion in the scoping review).
Westerman M, Teunissen PW, Fokkema JP, et al. The transition to hospital consultant and the influence of preparedness, social support, and perception: a structural equation modelling approach. Med Teach. 2013;35:320–7. (donates inclusion in the scoping review).
Hobfoil SE. Conservation of resources: a new attempt at conceptualizing stress. Am Psychol. 1989;44:513–24. (donates inclusion in the scoping review).
Schafer M, Pander T, Pinilla S, et al. A prospective, randomized trial of different matching procedures for structured mentoring programmes in medical education. Med Teach. 2016;38:921–9. (donates inclusion in the scoping review).
Passi V, Doug M, Peile E, Thistlethwaite J, Johnson N. Developing medical professionalism in future doctors: a systematic review. Int J Med Educ. 2010;1:19–29.
Cruss SR, Cruess RL, Steinert Y. Role modelling making the most of a powerful teaching strategy. BMJ. 2008;336:718–21.
Warnock GL. Developing a culture of mentoring. Can J Surg. 2006;49:164–5. (donates inclusion in the scoping review).