Medical students’ sentiment regarding inadequate preparation for practice has been highlighted as a key issue facing medical education for over a decade. A variety of studies of differing designs, including mixed methods research and systematic reviews, have been conducted with the conclusion that a large proportion of senior medical students feel inadequately prepared to work as a junior doctor.1–4
Preparedness for practice has been defined as “possessing the knowledge, skills and behaviours expected of [new doctors], and… knowing limitations, prioritisation, managing stress, engendering patient trust and generally being a safe doctor.”5 The UK General Medical Council (GMC) states clearly that it is the responsibility of the medical school to ensure that graduates are well-equipped with the knowledge and skills required of a new doctor.6 However, from the definition above, it could be argued that preparedness for practice encompasses more than medical knowledge and clinical skills, and that the factors contributing to adequate preparedness are highly complex. A systematic review of new doctor preparation for practice revealed that aside from specific knowledge and skills deemed to be essential for practice, a number of institutional or workplace factors, individual factors and university-specific factors had an influence on feelings of preparedness.3
Focusing on the institutional or workplace factors that can contribute to preparedness; these factors should be encompassed within the undergraduate medical education.7 The hidden curriculum can be defined as “the set of influences that function at the level of organisational structure and culture including, for example, implicit rules to survive the institution such as customs, rituals, and taken for granted aspects.”8 Applying this definition to working as a new doctor in the UK’s National Health Service (NHS), it is thought that there are certain implicit behaviours that dictate success as a new doctor in the NHS, however these have not yet been explored in great detail in the literature.8–9
The GMC’s 2019 report titled ‘The state of medical education and practice in the UK’ states that while their research found that majority of new Foundation Year One (FY1) doctors feel well prepared for the role, this proportion has been steadily declining over the past five years (Fig. 1).6
Interestingly, this report also highlighted their analysis of how preparedness for practice can influence long-term risk of burnout. It was found that those who felt less prepared to start working as a foundation doctor were at an increased risk of burnout further in their career and more likely to suffer with issues surrounding wellbeing.6 This further reiterates why this is a problem that requires attention, research and action.
In recent times, the COVID-19 pandemic has further exacerbated the issue of transition to practice with the cancellations of clinical placements, student assistantships and final year examinations. A national survey of medical student perceptions of how COVID-19 has impacted their final year education, found that the majority of respondents felt unprepared for FY1 as a result of the changes from COVID-19.10 Additionally, final year medical students in 2020 were encouraged to graduate ahead of schedule and join the workforce through the creation of Interim Foundation Year One (FiY1) posts.11 Unfortunately, this meant that many final year students were being given the roles and responsibilities of a doctor without having completed all of the components of their final year assessment, including a student assistantship, which has been identified as a key factor contributing to preparedness for practice.3,10,12
In order to tackle this issue, an online teaching programme titled “F1 Survival Guide” was created to cover aspects of the hidden curriculum.. The secondary aims of this study were to gain an understanding of previous exposure to these topics through medical school teaching, and to consider the effectiveness of virtual teaching when compared with face-to-face teaching for these topics.