Fit for practice: Are we there yet?

Dear Sir

The transition from medical student to medical practitioner is known to be difficult. Medical education has undergone great change in recent years in an attempt to address this and to produce doctors who are fit for purpose. In spite of these changes, it appears that newly qualified medical graduates continue to describe their transition to practice as stressful, particularly in relation to issues of responsibility, uncertainty and lack of support from senior colleagues (Brennan et al. 2010).

In 2005 Finucane and O’Dowd found that 68% of interns working in Ireland felt that they had been inadequately prepared for internship by medical school. Subsequently, the Medical Council of Ireland made a number of recommendations to ensure that undergraduate training is an effective preparation for internship.

In an attempt to assess the success or otherwise of these changes and recommendations, we carried out a qualitative assessment of intern preparedness for practice in a large teaching hospital in the South of Ireland in 2010. This study found that there are still many difficulties with the transition from medical student to medical practitioner.

Although participants believed that they had good theoretical knowledge, they felt poorly prepared to apply it in practice. Particular areas of concern were the practical application of acute medicine and day-to-day issues regarding prescribing and common calls.

Challenges of the job for which the participants had felt unprepared included task overload, prioritization, and sleep deprivation. They described many negative emotions, including anxiety, uncertainty, isolation and guilt.

This study identifies that interns in Ireland continue to feel unprepared for several key aspects of practice in the first year of their medical career. This has implications for what is taught and how it is taught in the undergraduate medical curriculum, suggesting a need for change to produce graduates who are better prepared for the job they do.

Helen Hynes, Simon Smith and Patrick Henn, School of Medicine, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland. E-mail: [email protected]

John McAdoo, Advanced Southern Simulation Education and Training (ASSET) Centre, University College Cork, Cork, Ireland. Research was carried out at Cork University Hospital, Cork, Ireland. E-mail: [email protected]