Doctors’ transitions: critically intensive learning periods
Doctors’ transitions: critically intensive learning periods
Sue Kilminster, Miriam Zukas and Trudie E. Roberts.
In view of recent UK media reporting about the issue of increased
incidents occurring when new doctors start their F1 year in August, we
were interested to read this paper which demonstrates that there is an
increase in undesirable events at the beginning of a transition,
regardless of the level of clinical experience (1). This confirms our
findings from a recent qualitative study which demonstrated the
importance of teams and local environments for doctors’ performance in
transitions (2). Hitherto this has been implicitly, but not explicitly,
recognised.
We have suggested that every transition involves a critically intense
learning period (CILP) in which doctors engage with the specific setting
and establish working relationships with doctors and other professionals
working in that setting. This CILP can only happen in actual practice;
therefore doctors can never be fully prepared in advance of a transition.
This conflicts with current ideas about ‘preparedness’ which are dominant
in medical education and training. The extent to which the specific
learning cultures of the clinical workplace (at ward and at institutional
levels) recognise transitions as CILPs contributes to or inhibits the
performance of new doctors. This has important implications for the
regulation and management of doctors’ performance as they move from one
ward to another, from one hospital to another, and from one level of
responsibility to another. Understanding and working with the idea of
CILPs also has implications for policy, practice and research about
doctors’ transitions.
References
1. Haller G, Myles PS, Taffé P, Perneger TV, Wu CL. Rate of undesirable
events at beginning of academic year: retrospective cohort study. BMJ
2009;339:b3974. (13 October.)
2. Learning responsibility? Exploring doctors’ transitions to new
levels of medical performance (ESRC RES-153-25-0084)
Rapid Response:
Doctors’ transitions: critically intensive learning periods
Doctors’ transitions: critically intensive learning periods
Sue Kilminster, Miriam Zukas and Trudie E. Roberts.
In view of recent UK media reporting about the issue of increased
incidents occurring when new doctors start their F1 year in August, we
were interested to read this paper which demonstrates that there is an
increase in undesirable events at the beginning of a transition,
regardless of the level of clinical experience (1). This confirms our
findings from a recent qualitative study which demonstrated the
importance of teams and local environments for doctors’ performance in
transitions (2). Hitherto this has been implicitly, but not explicitly,
recognised.
We have suggested that every transition involves a critically intense
learning period (CILP) in which doctors engage with the specific setting
and establish working relationships with doctors and other professionals
working in that setting. This CILP can only happen in actual practice;
therefore doctors can never be fully prepared in advance of a transition.
This conflicts with current ideas about ‘preparedness’ which are dominant
in medical education and training. The extent to which the specific
learning cultures of the clinical workplace (at ward and at institutional
levels) recognise transitions as CILPs contributes to or inhibits the
performance of new doctors. This has important implications for the
regulation and management of doctors’ performance as they move from one
ward to another, from one hospital to another, and from one level of
responsibility to another. Understanding and working with the idea of
CILPs also has implications for policy, practice and research about
doctors’ transitions.
References
1. Haller G, Myles PS, Taffé P, Perneger TV, Wu CL. Rate of undesirable
events at beginning of academic year: retrospective cohort study. BMJ
2009;339:b3974. (13 October.)
2. Learning responsibility? Exploring doctors’ transitions to new
levels of medical performance (ESRC RES-153-25-0084)
Competing interests:
None declared
Competing interests: No competing interests