Improving the preregistration experience: the New Zealand approach

There is currently much debate about how to improve undergraduate medical education, and in particular on how best to prepare students for clinical responsibility. For 20 years a period of trainee internship has formed part of New Zealand medical students' undergraduate training, and the model could have much to offer the United Kingdom. Students take their final examinations at the end of the second clinical year; they spend their final year in a series of eight clinical attachments, during each of which they shadow a preregistration house officer or senior house officer. As trainee interns they are paid 60% of a house officer's salary for their clinical work, which is supervised by the firm's registrars and consultants under the overall responsibility of the head of the academic department. The order of the attachments is determined on educational, not service, grounds, and trainees have to attend educational sessions and pass assessments on each attachment. The trainee internship, funded jointly by the education and health departments, offers a more seamless transition from student to house officer and aims at improving both general medical education and clinical training.

The current discussions on medical education in Britain, in particular the undergraduate course, combined with the widespread concerns about the quality of education and experience of preregistration house officers, have lead to debate about the most appropriate arrangement for the continuum of undergraduate education through to full registration.*RF 1-3* Medical educationalists in New Zealand have given much thought to the problem of providing a challenging final year to the undergraduate course while providing a seamless transition from student to doctor. Little has been published on the New Zealand solution to this dilemma, but it merits careful consideration in the present debate …