Views of junior doctors about whether their medical school prepared them well for work: questionnaire surveys

Abstract

Background: The transition from medical student to junior doctor in postgraduate training is a critical stage in career progression. We report junior doctors' views about the extent to which their medical school prepared them for their work in clinical practice.

Methods: Postal questionnaires were used to survey the medical graduates of 1999, 2000, 2002 and 2005, from all UK medical schools, one year after graduation, and graduates of 2000, 2002 and 2005 three years after graduation. Summary statistics, chi-squared tests, and binary logistic regression were used to analyse the results. The main outcome measure was the level of agreement that medical school had prepared the responder well for work.

Results: Response rate was 63.7% (11610/18216) in year one and 60.2% (8427/13997) in year three. One year after graduation, 36.3% (95% CI: 34.6, 38.0) of 1999/2000 graduates, 50.3% (48.5, 52.2) of 2002 graduates, and 58.2% (56.5, 59.9) of 2005 graduates agreed their medical school had prepared them well. Conversely, in year three agreement fell from 48.9% (47.1, 50.7) to 38.0% (36.0, 40.0) to 28.0% (26.2, 29.7). Combining cohorts at year one, percentages who agreed that they had been well prepared ranged from 82% (95% CI: 79-87) at the medical school with the highest level of agreement to 30% (25-35) at the lowest. At year three the range was 70% to 27%. Ethnicity and sex were partial predictors of doctors' level of agreement; following adjustment for them, substantial differences between schools remained. In years one and three, 30% and 34% of doctors specified that feeling unprepared had been a serious or medium-sized problem for them (only 3% in each year regarded it as serious).

Conclusions: The vast knowledge base of clinical practice makes full preparation impossible. Our statement about feeling prepared is simple yet discriminating and identified some substantial differences between medical schools. Medical schools need feedback from graduates about elements of training that could be improved.

Figure 1

Responses one year after graduation to the statement "Medical school prepared me well for the jobs I have undertaken so far" from graduates of 23 UK medical schools. Footnotes: 1. The data shown are aggregated for the UK medical graduates of 1999/2000, 2002, and 2005 surveyed one year after graduation. 2. Error bars denote 95% confidence intervals for the percentages who "Strongly agreed" or "agreed" and who "strongly disagreed" or "disagreed". For each medical school, the percentage of doctors who stated "neither agree nor disagree" is the difference between 100% and the sum of the two percentages shown.

Figure 2

Responses three years after graduation to the statement "Medical school prepared me well for the jobs I have undertaken so far" from graduates of 23 UK medical schools. Footnotes: 1. The data shown are aggregated for the UK medical graduates of 1999/2000, 2002, and 2005 surveyed three years after graduation. 2. Error bars denote 95% confidence intervals for the percentages who "Strongly agreed" or "agreed" and who "strongly disagreed" or "disagreed". For each medical school, the percentage of doctors who stated "neither agree nor disagree" is the difference between 100% and the sum of the two percentages shown.