Perspectives of Clinical Teaching Fellows on preparedness for practice: a mixed-methods exploration of what needs to change

ABSTRACT

Supporting medical students in their transition to newly qualified doctor is an important educational priority. Clinical Teaching Fellows (CTFs), as both recent graduates and trained educators, are uniquely positioned to suggest curricular enhancements to support preparedness for practice. Our mixed-methods approach involved CTFs across eight UK teaching hospitals. We conducted five activity-oriented focus groups to explore what CTFs felt needed to change to increase preparedness for practice. We analysed these focus groups to create a dataset of their suggestions followed by a survey. The survey invited CTFs to rate and rank these suggestions in relation to their own self-rated preparedness for practice, with qualitative insights into their choices. We explored commonalities and differences between high and low confidence participants, with findings qualitatively illuminated. 24 CTFs attended focus groups from which we identified 28 curriculum items and 10 curriculum agendas. We collected 23 complete survey responses. All confidence groups rated communicating with colleagues and managing working life as unmet needs, whereas core clinical competencies such as history and examination were well met. Participants with low confidence identified more complex clinical competencies including clinical decision making, task prioritisation and end-of-life care as unmet needs, with decision making and prioritisation being the most important. Confident graduates rated higher professional competencies such as quality improvement, career planning and education as unmet needs but of low importance. Graded transition of responsibility was the highest ranked curriculum agenda. Qualitative insights included suggestions for how learning in clinical environments could be enhanced. Our findings suggest that transitioning from student to newly qualified doctor could be supported by graded entrustment and enhanced shadowing opportunities. Other recommendations include prioritising more complex clinical competencies, identifying wellbeing as part of preparedness for practice, equipping students to communicate with colleagues and aligning higher professional competencies with learners’ needs.

KEYWORDS:

• Clinical Teaching Fellow
• medical education - undergraduate
• preparedness
• medical curriculum
• transition

Author’s Contributions

KLG performed the activity-led focus groups. RM, OB and KLG analysed the data from activity-led focus groups and created the sets of curriculum items and curriculum agendas. RM and OB designed, tested and distributed the Qualtrics Survey. KLG, RM and OB analysed the data from survey responses. All authors made significant contributions to the write-up of the manuscript and read and approved the final manuscript.

Consent for Publication

All identifiable data was removed prior to publication. Consent was obtained within the Qualtrics survey for use of data in research publication.

Disclosure statement

All authors declare that they have no competing interests.

Ethics approval and consent to participate

Ethical approval was provided by Imperial College London Education Ethics Review Process EERP1819-006. Written information and consent were obtained within the Qualtrics survey. Responses were collected anonymously and any potentially identifying information redacted prior to analysis.

Availability of Data and Materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.