Junior doctors' opinions about the transition from medical school to clinical practice: a change of environment.

INTRODUCTION: Concerns have been growing about the effects of the working environment on junior doctors and the learning opportunities available to them. In order to identify problems and opportunities for improvement, we explored junior doctors' opinions about the transition from student to practitioner.
METHOD: Seventeen recent graduates in four focus groups discussed the transition. DATA ANALYSIS: Related comments were combined in the report of the discussions, which was approved by the participants.
RESULTS: The transition was perceived as a major change, particularly the increased responsibility and workload and contacts with other health care workers and patients. Preparation during undergraduate training was adequate as regards knowledge, communication, history taking and physical examination skills but not for pharmacological knowledge and patient management skills. Problems were connected with practical procedures and feelings of uncertainty. There was little formal education. Proposals to ease the transition were earlier patient contacts, more involvement in patient management and growing responsibility during clerkships. DISCUSSION: Although the sample was small, the uniform opinion in all groups supports the validity of the findings. Junior doctors felt confident with regard to knowledge and skills, but experienced difficulties with patient management, practical matters and their role on the team. Contrary to the idea of an educational continuum, formal learning appeared to be very limited in the hospital environment.
CONCLUSIONS: Preparation for medical practice may benefit from active involvement of clerks in patient management decisions and a gradual increase in responsibilities. An effective medical education continuum would require more attention for house officers' learning.