UCL Discovery
UCL home » Library Services » Electronic resources » UCL Discovery

Qualitative research using realist evaluation to explain preparedness for doctors' memorable 'firsts'

Lefroy, J; Yardley, S; Kinston, R; Gay, S; McBain, S; McKinley, R; (2017) Qualitative research using realist evaluation to explain preparedness for doctors' memorable 'firsts'. Medical Education , 51 (10) pp. 1037-1048. 10.1111/medu.13370. Green open access

[thumbnail of Do you remember the first time accepted version.pdf]
Preview
Text
Do you remember the first time accepted version.pdf - Accepted Version

Download (622kB) | Preview

Abstract

Context: Doctors must be competent from their first day of practice if patients are to be safe. Medical students and new doctors are acutely aware of this, but describe being variably prepared. Objectives: This study aimed to identify causal chains of the contextual factors and mechanisms that lead to a trainee being capable (or not) of completing tasks for the first time. Methods: We studied three stages of transition: anticipation; lived experience, and post hoc reflection. In the anticipation stage, medical students kept logbooks and audio diaries and were interviewed. Consenting participants were followed into their first jobs as doctors, during which they made audio diaries to capture the lived experiences of transition. Reflection was captured using interviews and focus groups with other postgraduate trainee doctors. All materials were transcribed and references to first experiences (‘firsts’) were analysed through the lens of realist evaluation. Results: A total of 32 medical students participated. Eleven participants were followed through the transition to the role of doctor. In addition, 70 postgraduate trainee doctors from three local hospitals who were graduates of 17 UK medical schools participated in 10 focus groups. We identified three categories of firsts (outcomes): firsts that were anticipated and deliberately prepared for in medical school; firsts for which total prior preparedness is not possible as a result of the step change in responsibility between the student and doctor identities, and firsts that represented experiences of failure. Helpful interventions in preparation (context) were opportunities for rehearsal and being given responsibility as a student in the clinical team. Building self‐efficacy for tasks was an important mechanism. During transition, the key contextual factor was the provision of appropriate support from colleagues. Conclusions: Transition is a step change in responsibility for which total preparedness is not achievable. This transition is experienced as a rite of passage when the newly qualified doctor first makes decisions alone. This study extends the existing literature by explaining the mechanisms involved in preparedness for firsts.

Type: Article
Title: Qualitative research using realist evaluation to explain preparedness for doctors' memorable 'firsts'
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/medu.13370
Publisher version: https://doi.org/10.1111/medu.13370
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Social Sciences, Science & Technology, Life Sciences & Biomedicine, Education, Scientific Disciplines, Health Care Sciences & Services, Education & Educational Research, MEDICAL-STUDENT, TRANSITION, WORKPLACE, CARE, GAP
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry > Marie Curie Palliative Care
URI: https://discovery.ucl.ac.uk/id/eprint/10091633
Downloads since deposit
39Downloads
Download activity - last month
Download activity - last 12 months
Downloads by country - last 12 months

Archive Staff Only

View Item View Item