Papers

Preregistration house officers' views on whether their experience at medical school prepared them well for their jobs: national questionnaire survey

Michael J Goldacre, professor, Trevor Lambert, statistician, Julie Evans, social scientist, Gill Turner, research officer. 

Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Institute of Health Sciences, Oxford OX3 7LF

Correspondence to: M J Goldacre michael.goldacre{at}dphpc.ox.ac.uk

(see also p 1019)

The aims of training at medical school are to lay the educational foundations for a lifelong career in medicine and to equip junior doctors well for the first stage in their working lives. To gauge the extent to which the second objective is being achieved we sought views of doctors who graduated from medical schools in the United Kingdom in 1999 and 2000.

	Methods and results

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We regularly undertake surveys of newly qualified doctors, to establish their career choices and progression. ^{1 2} In our most recent surveys we included the statement: "My experience at medical school prepared me well for the jobs I have undertaken so far." We invited respondents to state their level of agreement on a five point scale from "strongly agree" to "strongly disagree."

We mailed questionnaires containing the statement to 5330 doctors: all 4221 qualifiers in the United Kingdom of 1999 and 1109 qualifiers (a random 25%) of 2000. Seventy three doctors were untraceable, and 14 wrote back, declining to participate. Of the remaining 5243, 3446 replied (67%; 72% (1972/2722) of women, 59% (1471/2521) of men; response rates by medical school varied from 77% at the highest to 59% at the lowest. Three hundred and sixty six of the respondents completed a shorter questionnaire, offered as an alternative to initial non-responders, that excluded the statement; of the other 3080 respondents, 3062 scored the statement.

Of the respondents, 4.3% (133) strongly agreed that their training had prepared them well for the jobs they had undertaken so far; 32.0% (978) agreed; 22.5% (689) neither agreed nor disagreed; 29.7% (908) disagreed; and 11.6% (354) strongly disagreed. Differences between men and women were small. Differences between medical schools were large (figure), ranging from 19.8% strongly agreeing or agreeing at one medical school to 73.0% at another.

View larger version (50K): [in this window] [in a new window]   Responses to the statement "Medical school prepared me well for the jobs I have undertaken so far" from graduates of 23 UK medical schools. Error bars denote 95% confidence intervals for the percentages "who strongly agreed or agreed" and who "strongly disagreed or disagreed." For each medical school, the percentage of doctors who stated "neither agree nor disagree" is the difference between 100% and the sum of the two percentages shown

At the end of the questionnaires respondents were invited to comment on any aspects of their training, career choices, or work. Comments were transcribed and coded according to topic. Of 1353 respondents (39.3%) who wrote a comment, 57 wrote about their preparation at medical school for work as a preregistration house officer (PRHO). Of these, four had felt well prepared and 53 had not. Example comments, reproduced verbatim, were that "Medical school provided excellent factual preparation for PRHO jobs but was limited in basic problems found on the wards"; "Not enough emphasis on real life situations"; "Not enough time shadowing PRHO prior to commencing work." Six also commented that, in their view, the practicalities of the job could be learnt quickly, for example: "Felt inadequately prepared for surgical house jobsbut you can pick it up very quickly."

	Comment

Top Methods and results Comment References

Differences between medical schools were large in how well their graduates felt prepared for their house jobs. The findings raise questions that we cannot answer from our survey. Are mismatches between experiences at medical school and work important, or are they a short term hindrance and easily overcome? Does the preregistration year require tasks, skills, and activities that medical schools do not expect to teach? We understand from deans of medical schools that, since the time covered by our survey, curriculum changes have placed greater emphasis on practical experience. Systematic, in-depth feedback to medical schools from their graduates is needed. Because of differences between short term and longer term educational needs, and because the education of medical students serves the generic needs of all clinical specialties, this should be done with feedback from experienced doctors as well as junior doctors. Decisions also need to be made, as the General Medical Council and Department of Health recognise, about the distribution of work and training across the time spent in medical school, the preregistration year, and the senior house officer years. ^{3 4}

	Acknowledgments

Karen Hollick administered the survey, and Janet Justice and Alison Stockford entered the data. We thank all the doctors who participated in the study.

Contributors: TL and MJG designed the survey. JE designed the free text coding scheme. GT and TWL analysed the data. MG wrote the first draft of the paper. All authors contributed to subsequent drafts and are guarantors.

	Footnotes

Funding: The UK Medical Careers Research Group is funded by the Department of Health. The Unit of Health-Care Epidemiology is funded by the NHS Executive South East.

Competing interests: None declared.

	References

Top Methods and results Comment References

1.	Lambert TW, Goldacre MJ, Edwards C, Parkhouse J. Career preferences of doctors who qualified in the United Kingdom in 1993 compared with those of doctors qualifying in 1974, 1977, 1980, and 1983. BMJ 1996; 313: 19-24[Abstract/Free Full Text].
2.	Goldacre MJ, Davidson JM, Lambert TW. Career choices at the end of the pre-registration year of doctors who qualified in the United Kingdom in 1996. Med Educ 1999; 33: 882-889[CrossRef][Web of Science][Medline].
3.	General Medical Council. Implementing the new doctor: the education committee's informal visits to UK universities, October 1998 to April 2001. London: GMC, 2002.
4.	NHS Executive. Unfinished business: proposals for reform of the senior house officer gradea paper for consultation. London: Department of Health, 2002.

(Accepted 23 December 2002)