See the published version of this article at BMC Medical Education.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
A qualitative analysis of junior doctors’ journeys to preparedness in acute care
Samuel Burridge
London North West Healthcare NHS Trust
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9417-5589
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Medical Education.
Background New doctors are expected to assess and manage acutely deteriorating patients from their first days in the hospital. However, current evidence suggests that medical graduates are not prepared for this. We aimed to explore junior doctors’ first experiences with unwell patients and how they developed preparedness over time.
Methods We conducted seven semi-structured interviews with doctors in their first postgraduate year. The interview transcripts underwent inductive thematic analysis using consensual qualitative research approaches. Themes identified were categorised into early experiences of unpreparedness, first experiences of genuine preparedness, and making sense of how they became prepared. Reflection on how participants progressed between the two was facilitated through a sorting and ranking exercise.
Results Most participants initially felt unprepared when responding to acutely unwell patients. They described feeling overwhelmed, apprehensive and challenged. Two main challenges involved knowing when to escalate, and feeling expected to perform beyond their level of competency. A lack of acute care exposure at medical school was a common thread. All participants felt prepared to respond to unwell patients three to six months after starting work. Hands-on experience, reflection, simulation and multidisciplinary team-working were consistently ranked as the most useful learning experiences.
Conclusion Starting work as a doctor is a challenging time and preparedness to manage an acutely deteriorating patient is a common area of concern. As preparedness in acute care ranks poorly compared to other outcomes, we see this as an important area for improvement. Our findings suggest that undergraduates may lack sufficient opportunities for scaffolded decision making in acute care, and that increasing the intensity of clinical shadowing may improve preparedness and should inform future educational interventions.
Keywords
Preparedness for practice, acute care, shadowing
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 4
Posted 07 Jan, 2020
Published
On 13 Jan, 2020
No community comments so far
Editorial decision: Accept
On 06 Jan, 2020
Editor assigned
On 03 Jan, 2020
Submission checks complete
On 02 Jan, 2020
Editor invited
On 02 Jan, 2020
No comments provided
Editorial decision: Minor revision
On 26 Dec, 2019
Reviewer #2 agreed
On 23 Dec, 2019
Review #2 received
Received 23 Dec, 2019
Reviewers invited
Invitations sent on 21 Dec, 2019
Reviewer #1 agreed
On 21 Dec, 2019
Review #1 received
Received 21 Dec, 2019
Editor assigned
On 20 Dec, 2019
Submission checks complete
On 19 Dec, 2019
Editor invited
On 19 Dec, 2019
No comments provided
Review #2 received
Received 06 Dec, 2019
Editorial decision: Minor revision
On 06 Dec, 2019
Reviewer #2 agreed
On 24 Nov, 2019
Review #1 received
Received 22 Nov, 2019
Reviewers invited
Invitations sent on 21 Nov, 2019
Reviewer #1 agreed
On 21 Nov, 2019
Editor assigned
On 19 Nov, 2019
Submission checks complete
On 18 Nov, 2019
Editor invited
On 18 Nov, 2019
No comments provided
Review #2 received
Received 30 Oct, 2019
Editorial decision: Major revision
On 30 Oct, 2019
Reviewer #2 agreed
On 17 Oct, 2019
Review #1 received
Received 16 Oct, 2019
Reviewer #1 agreed
On 15 Oct, 2019
Reviewers invited
Invitations sent on 12 Oct, 2019
Submission checks complete
On 27 Sep, 2019
Editor assigned
On 26 Sep, 2019
Editor invited
On 25 Sep, 2019
First submitted
On 23 Sep, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Internal Medicine
Learn more about our company.
This preprint is under consideration at BMC Medical Education. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
A qualitative analysis of junior doctors’ journeys to preparedness in acute care
Samuel Burridge
London North West Healthcare NHS Trust
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9417-5589
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 4
Posted 07 Jan, 2020
Published
On 13 Jan, 2020
No community comments so far
Editorial decision: Accept
On 06 Jan, 2020
Editor assigned
On 03 Jan, 2020
Submission checks complete
On 02 Jan, 2020
Editor invited
On 02 Jan, 2020
No comments provided
Editorial decision: Minor revision
On 26 Dec, 2019
Reviewer #2 agreed
On 23 Dec, 2019
Review #2 received
Received 23 Dec, 2019
Reviewers invited
Invitations sent on 21 Dec, 2019
Reviewer #1 agreed
On 21 Dec, 2019
Review #1 received
Received 21 Dec, 2019
Editor assigned
On 20 Dec, 2019
Submission checks complete
On 19 Dec, 2019
Editor invited
On 19 Dec, 2019
No comments provided
Review #2 received
Received 06 Dec, 2019
Editorial decision: Minor revision
On 06 Dec, 2019
Reviewer #2 agreed
On 24 Nov, 2019
Review #1 received
Received 22 Nov, 2019
Reviewers invited
Invitations sent on 21 Nov, 2019
Reviewer #1 agreed
On 21 Nov, 2019
Editor assigned
On 19 Nov, 2019
Submission checks complete
On 18 Nov, 2019
Editor invited
On 18 Nov, 2019
No comments provided
Review #2 received
Received 30 Oct, 2019
Editorial decision: Major revision
On 30 Oct, 2019
Reviewer #2 agreed
On 17 Oct, 2019
Review #1 received
Received 16 Oct, 2019
Reviewer #1 agreed
On 15 Oct, 2019
Reviewers invited
Invitations sent on 12 Oct, 2019
Submission checks complete
On 27 Sep, 2019
Editor assigned
On 26 Sep, 2019
Editor invited
On 25 Sep, 2019
First submitted
On 23 Sep, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Internal Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Medical Education.
Background New doctors are expected to assess and manage acutely deteriorating patients from their first days in the hospital. However, current evidence suggests that medical graduates are not prepared for this. We aimed to explore junior doctors’ first experiences with unwell patients and how they developed preparedness over time.
Methods We conducted seven semi-structured interviews with doctors in their first postgraduate year. The interview transcripts underwent inductive thematic analysis using consensual qualitative research approaches. Themes identified were categorised into early experiences of unpreparedness, first experiences of genuine preparedness, and making sense of how they became prepared. Reflection on how participants progressed between the two was facilitated through a sorting and ranking exercise.
Results Most participants initially felt unprepared when responding to acutely unwell patients. They described feeling overwhelmed, apprehensive and challenged. Two main challenges involved knowing when to escalate, and feeling expected to perform beyond their level of competency. A lack of acute care exposure at medical school was a common thread. All participants felt prepared to respond to unwell patients three to six months after starting work. Hands-on experience, reflection, simulation and multidisciplinary team-working were consistently ranked as the most useful learning experiences.
Conclusion Starting work as a doctor is a challenging time and preparedness to manage an acutely deteriorating patient is a common area of concern. As preparedness in acute care ranks poorly compared to other outcomes, we see this as an important area for improvement. Our findings suggest that undergraduates may lack sufficient opportunities for scaffolded decision making in acute care, and that increasing the intensity of clinical shadowing may improve preparedness and should inform future educational interventions.