The new consultant survey 2005

Ready, or not? A qualitative study of emergency medicine senior residents' perspectives on preparing for practice

Objectives

The transition from residency to unsupervised practice challenges doctors to adapt to new environments and responsibilities. Past work has focused on how physicians acclimate to their new roles, raising questions about how residents might think proactively about transitions while still in training. This study explores senior emergency medicine (EM) residents' perspectives on preparedness for unsupervised practice and how they draw from training experiences to assess their evolving sense of preparedness.

Methods

The authors used a constructivist grounded theory approach, inviting all fourth-year EM residents from two residency programs to participate in semistructured interviews. Participants were asked to reflect on their preparedness for entering unsupervised practice and to imagine scenarios for which they felt unprepared. Two authors coded line by line using constant comparison, organizing data into codes and categories. The research team met to discuss relationships between codes, developing themes to theorize about the phenomenon of interest.

Results

Sixteen residents were interviewed. The authors identified two overarching categories of themes. First, participants described individualized conceptualizations of preparedness, constructed from past workplace experiences and those they anticipated they would have in unsupervised practice. These conceptualizations emphasized drawing confidence from experience and developing adaptability to manage the uncertainties of medical practice. The second overarching category involved participants' efforts to gauge their own preparedness. To do so, they used interactions with others to assess their readiness to manage specific problems and made holistic appraisals across multiple experiences to assess their overall preparedness for unsupervised practice.

Conclusions

Trainees draw from past experiences to forecast their abilities to manage the inevitable uncertainties of unsupervised practice. These conceptualizations of preparedness reflect a capability approach to training, with informed confidence and dynamic self-appraisal. These findings suggest potential learning goals of senior trainees and considerations for medical educators to consider when fostering trainees' capabilities for unsupervised practice.

Evaluating the Role of Mentorship in Career Advancement: A Survey of Women in Academic Hand Surgery

PURPOSE

Despite the increasing percentage of women within the American Society for Surgery of the Hand, women remain underrepresented within leadership in academic hand surgery. Although this disparity in leadership representation may be improving, we aimed to investigate the role mentorship plays in advancing women in academic hand surgery.

METHODS

This is a survey-based, mixed-methods study. A written survey assessing themes in personal and professional experiences with mentorship was sent to hand fellowship-trained women. Inclusion criteria were the completion of a hand fellowship and current affiliation with an academic institution. An evolved grounded theory framework was used to evaluate the responses. Themes were identified based on common responses.

RESULTS

Of 186 eligible participants, 144 (85.2%) received the survey. The response rate was 48.6%. Respondents indicated that residency was the stage at which mentorship was most impactful (n = 25, 37%), and half of the respondents identified their desire to work in academic hand surgery during residency (n = 35, 50%). Obstacles to finding a mentor included lack of availability (n = 46, 67.7%), hesitance in searching for a mentor (n = 16, 23.5%), and searching for a mentor within an environment that was not conducive to success for trainees (n = 7, 10.3%). Most (84%) cited instances were the ones having the advice of a woman mentor was more impactful than that of a mentor who is a man. The reported need for same-sex mentorship fell into three categories: (1) insight into shared experiences, (2) assistance with conflict/bias management, and (3) support during career navigation.

CONCLUSIONS

The findings of this study demonstrate the need for high-quality mentorship during the residency with a specific emphasis on same-sex mentorship.

CLINICAL RELEVANCE

Our findings provide clear objectives related to improving access to and quality of mentorship. This foundational understanding will enrich mentor-mentee relationships, allowing for greater personal and professional success and satisfaction for both parties.

Conceptualizing "Preparedness for Practice": Perspectives of Early-Career Family Physicians

BACKGROUND AND OBJECTIVES

Competency based medical education (CBME) aims to produce graduates prepared for independent practice. Many equate the outcome of "preparedness for practice" with acquisition of competence. As educators evaluate the outcomes of CBME, being clear on the concept of preparedness for practice will clarify the results that are measured and assessed. This study examined how preparedness for practice is conceptualized in the literature and by family physicians (FPs) in Canada.

METHODS

This multimethod qualitative descriptive study included (1) rapid review and narrative synthesis, and (2) focus groups with early-career FPs using maximum variation sampling until thematic saturation was reached. Focus groups explored the FPs' conceptualizations of preparedness for practice. Focus groups were audio-recorded, transcribed, and coded before content analysis.

RESULTS

Thirty-four articles met the inclusion criteria, and 59 early-career FPs participated in the focus groups. We found no consensus on the conceptualization of preparedness for practice in the literature; however, the concept often was described as acquiring competencies for program requirements. In the literature and focus groups, we identified four themes for the conceptualization of preparedness for practice. These themes included competence, self-confidence (self-efficacy, self-concept), capability, and adaptability.

CONCLUSIONS

Preparedness for practice involves an interplay of dynamic and complex constructs from competence, self-confidence, capability, and adaptability. Preparedness is more than possessing several competencies; it calls for integrating and applying competencies in complex and changing environments. This study aimed to start a discussion on what end point is desirable for residency education and proposed that the end point needs to move beyond competencies.

Post-CSCST fellowships: beyond subspecialization

The transition from higher training to consultanthood is a crucial point in the medical training pathway. Despite comprehensive higher training programs, studies of new consultants have reported a disparity in their sense of preparation for non-clinical and clinical duties. Post- "Certificate of Satisfactory Completion of Specialist Training" (CSCST) fellowships have traditionally been undertaken as a means to access subspecialty clinical training which is otherwise unavailable in higher training programs. However, fellowships have a role beyond this subspecialization model, particularly in meeting the non-clinical training needs of new CSCST graduates.The design and goals of fellowship posts should be considered in this context, to align them with the reported needs of new consultants. Special consideration should be given to defining roles of independence for the fellow and to the nature of the mentorship relationship, distinguishing these posts from higher specialist training. Well-designed post-CSCST fellowships have an important role in facilitating the successful transition to consultanthood.

Ready for practice? National recommendations for emergency medicine transition to practice curriculum

BACKGROUND

Transition from residency to unsupervised practice represents a critical stage in learning and professional identity formation, yet there is a paucity of literature to inform residency curricula and emergency department transition programming for new faculty.

OBJECTIVE

The objective of this study was to develop consensus-based recommendations to optimize the transition to practice phase of emergency medicine training.

METHODS

A literature review and results of a survey of emergency medicine (EM) residency program directors informed focus groups of recent (within 5 years) EM graduates. Focus group transcripts were analyzed following conventional content analysis. Preliminary recommendations, based on identified themes, were drafted and presented at the 2022 Canadian Association of Emergency Physicians (CAEP) Academic Symposium on Education. Through a live presentation, symposium attendees representing the Canadian national EM community participated in a facilitated discussion of the recommendations. The authors incorporated this feedback to construct a final set of 14 recommendations, 8 targeted toward residency training programs and 6 specific to department leadership.

CONCLUSION

The Canadian EM community used a structured process to develop 14 best practice recommendations to enhance the transition to practice phase of residency training as well as the transition period in the career of junior attending physicians.

The need for a course to complete urological education for consultant practice using a simulated 'boot camp' structure at the end of specialist training: A survey-based study

BACKGROUND AND AIMS

To obtain opinions from urology trainees and consultants regarding the need for, and structure of, a post-specialty training Urology Simulation Boot Camp (USBC) for consultant practice.

METHODS AND RESULTS

A survey-based study was conducted, and 'Google Forms' were distributed electronically via social media. Urology specialist trainees (ST) in years 5-7 (ST5-ST7), post-certification of completion of training (CCT) fellows and ST3 boot camp faculty consultants in practice for ≤5 years and >5 years were included. One hundred and seven responses were received. 97.2% of responders thought a pre-consultant USBC was worthwhile; 55.1% selected the course duration to be 2 days. 47.7% felt that the USBC should be delivered post-exam in ST7. 91.6%, 43.9%, 73.8%, 87.9% and 74.8% considered that modules in emergency operative procedures, novel uro-technologies, delivering multidisciplinary team (MDT) meetings, non-clinical consultant roles and responsibilities, stress and burnout to be important, respectively. 62.6% and 31.8% felt that the course should be wholly or part-funded by Health Education England (HEE).

CONCLUSIONS

A post-specialty training, pre-consultant, USBC delivered post-exam in ST7, is worthwhile and should include modules on emergency operative procedures, leading MDTs, non-clinical roles and responsibilities and managing stress and burnout in consultant careers. Ideally, it should be fully/part-funded by HEE.

Stress and conflict from tacit culture forges professional identity in newly graduated independent physicians

To transition successfully into independent practice, newly graduated independent physicians (new "attendings") undergo a process of professional identity formation (PIF) as a clinician within a new community of practice (CoP). PIF is crafted by socialization within a CoP including transfer of tacit knowledge. While certain tacit knowledge is critical for professional identity, we understand little how it shapes PIF. We set out to describe the tacit knowledge acquired by new attendings within a CoP and how it contributes to PIF. Informed by constructivist grounded theory, we interviewed 23 new attendings about the tacit knowledge they acquired in early practice. Data collection and analysis occurred iteratively. We identified themes using constant comparative analysis and generated a theory that underwent member checking and feedback. Implicit standards from group culture imparted high expectations on new attendings and led to internal stress. New attendings also encountered a tacit code of conduct as behavioral elements of group culture. These elements created external conflict between new attendings and group members such as departmental colleagues, consulting physicians, and other health professionals. Depending on the support they received, new attendings responded to the stress and conflict in three ways: they doubted, adjusted, or avoided. These strategies molded their professional identity, and moved them towards or away from the CoP as they navigated their transition and PIF. We describe a novel theory of how tacit group culture shaped new attending physicians' professional identity in a new community of practice. Internal stress and external conflict occurred due to high expectations and tacit culture elements. New attendings' doubt, adjust, or avoid responses, shaped by support they received, in turn crafted their professional identity. Education leaders should prepare graduating trainees to navigate aspects of transition to independent practice successfully.

Transitioning Roles from Residency to Attending Physician in Radiation Oncology

Moving from the role of resident into that of a young attending is one of the most anticipated transitions in a medical trainee's career path. Radiation oncology residency training is typically apprentice-style focused in the outpatient setting, which carries additional unique challenges. Twenty-seven junior attendings at academic institutions within their first 5 years of practice were sent an online open-ended questionnaire in 2018 regarding aspects of their practice using a snowball sampling method. Responses were collected, and a thematic analysis was conducted in which two independent reviewers coded the responses. Nineteen junior attendings (70%) from 18 institutions completed the questionnaire. General themes included the importance of cultivating relationships for peer support and to be professional and polite as confidence was gained to enable them to be seen as an attending. All respondents felt that bringing an open mind, balance, and adaptability was crucial in their transition. Respondents stayed up to date on literature and practices by subscribing to journals, courses, and participation in resident education. Forty-two percent of young attendings were matched with a mentor at their new institution through a formal mentor-mentee relationship. Respondents wished that they had more autonomy during residency to prepare for independent practice. Transitioning from residency to a junior attending provides unique stressors and challenges. Allowing for residents to have more autonomy during their training, such as a senior resident clinic, may help improve this transition by providing an opportunity for independent decision-making with guidance as appropriate.

The transition to consultant: Identifying gaps in higher specialist training

BACKGROUND

New consultants consistently feel better prepared for the clinical rather than non-clinical aspects of their role. However, deficiencies in generic competencies have been linked to burnout and patient complaints. This study explored how higher specialty training prepares doctors for the transition to consultant in genitourinary medicine.

RESULTS

New consultants felt less prepared for non-clinical aspects of their role. Prior practical experience was the greatest influencing factor in levels of preparedness, with increased responsibility and leadership driving deeper learning. Observation of others helped individuals develop a professional identity but also learn about the wider processes within their service. The learning environment positively influenced preparedness but highlighted a need for dedicated time to learn non-clinical aspects.

CONCLUSION

To ensure future trainees feel prepared for the non-clinical aspects of the consultant role, practical experience of non-clinical areas with high levels of leadership and responsibility within a supportive learning environment is essential.

On the Transition to Attendinghood

Medical education and training consists of a series of stepped transitions, each marked by increasing autonomy and responsibility. Perhaps the most formidable transition begins upon the completion of one's training and stretches well into the first year of "attendinghood." This period is often defined by colossal changes that can extend far beyond the workplace and that are largely inconceivable beforehand. These changes can have important implications for job satisfaction, well-being, and resilience, especially in oncology, where rates of work-related burnout are particularly high. Unfortunately there is no "standard of care" or evidence-based guideline on how best to approach this period. However, it must be highlighted and deliberately discussed among current fellows and recent graduates not only to stimulate further study but also to provide support and community for those approaching or going through this transition.

Practical solutions for implementation of Transition to Practice curricula in a competency-based medical education model

BACKGROUND

Although transition from residency to practice represents a critical learning stage, there is a paucity of literature to inform local curriculum development and implementation.

OBJECTIVES

To describe local curriculum development for Transition to Practice (TTP) for use within a competency-based medical education model, including important content and suitable teaching and assessment strategies.

DESIGN

We reviewed the literature to construct a definition and develop initial curriculum content for TTP. We then gathered local residency program directors' views on TTP content, teaching, and assessment via online survey and an international educational conference workshop.

RESULTS

We identified 21 important TTP content areas in the literature and analyzed 35 survey responses, representing 33 residency programs. Survey participants viewed Further sophistication of clinical skills, How to set up a practice, and Time management skills as the three most important content areas. Views on content importance varied by program. For teaching and assessment strategies, most respondents preferred: assessing what residents could do, providing real-life practice opportunities, and offering workplace-based assessments.

CONCLUSIONS

TTP curricula implementation should reflect nationally set, specialty-specific curriculum elements; locally developed priority content; and assessment and teaching strategies. Individual learner needs and imminent practice context should guide faculty approaches to curriculum delivery.Résumé.

An Advanced Boot Camp for Pediatric Anesthesiology Fellows

BACKGROUND

Managing pediatric crises necessitates the acquisition of unique skills and confidence in its execution. Our aim was to develop and assess a curriculum based on the constructivist learning environment to enhance learning, orientation, and preparation of graduating pediatric anesthesiology fellows.

METHODS

Fifty pediatric anesthesiology fellows from 9 academic institutions in the United States were recruited for an advanced boot camp over a 2-year period. Training stations were developed using high-fidelity simulation, standardized patients, self-reflection modules, and facilitated discussions. The curriculum was evaluated using an anonymous survey that assessed knowledge, self-confidence, appropriateness of case-scenario complexity, and usefulness for transitioning into an independent practitioner on a Likert scale (1 = strongly disagree to 5 = strongly agree). Data points were expressed as the median and interquartile range (IQR).

RESULTS

Ninety-eight percent of the fellows completed a survey. Fellow perceptions of the advanced boot camp was positive. The median scores (IQR) for knowledge, self-confidence, appropriateness of case complexity, and usefulness for transition in 2017 were 5 (3,5), 4.5 (3,5), 5 (3,5), and 5 (3,5), respectively, and 5 (3,5), 4.5 (3,5), 5 (4,5), and 5 (3,5), respectively, in 2018. The IQR in the assessment for an appropriate level of complexity for their level of training, narrowed in 2018 (4,5), when compared with 2017 (3,5).

CONCLUSIONS

Fellow responses support the idea that the advanced boot camp provided tools and strategies for their transition. A narrowed IQR regarding the appropriate level of complexity of scenarios in 2018, when compared with 2017, might suggest an improvement in the curriculum.

Help, I'm a specialist!-Perspectives of recently qualified geriatricians on the experiences and challenges of working as a consultant geriatrician

OBJECTIVE

To gain insights into the experience and challenges faced by Australasian geriatricians who have recently made the transition from advanced trainee to consultant.

METHODS

An interpretative exploratory qualitative study. Geriatricians with five or less years of experience as consultants were recruited by email. Data were collected through semi-structured interviews, with themes identified through open axial coding.

RESULTS

Respondents (n = 20) experienced a transition period in which they adjusted to the roles of final decision-maker and manager. Respondents felt relatively confident with their clinical skills, but under-prepared for non-clinical roles associated with becoming a consultant. Most respondents described challenges with career planning. Support networks were considered critical.

CONCLUSIONS

This is the first study in Australasia exploring the transition from trainee to consultant geriatrician. Training programs should endeavour to create "consultant-like roles" during advanced training and address non-clinical competencies. Participants perceived that there should be more emphasis on career planning and mentorship.

Defining fitness for purpose in South African anaesthesiologists using a Delphi technique to assess the CanMEDS framework

Background: Training of South African anaesthesiologists is based on the Canadian Medical Education Directives for Specialists (CanMEDS). However, the applicability of CanMEDS in this context has not been assessed. An expert panel participated in a Delphi process to create an appropriate expanded list of CanMEDS competencies that may be used in the future to assess fitness for purpose of local graduates. Methods: This descriptive study comprised a representative panel of 16 experts surveyed electronically over three rounds to assess the importance of the existing CanMEDS roles and enabling competencies and suggested additions deemed applicable locally. The primary outcome was the creation of a list of competencies applicable to South Africa. Results: There was a 100% response rate for all three rounds. Based on the existing seven CanMEDS meta-competencies (Medical Expert, Collaborator, Communicator, Leader, Scholar, Professional and Health Advocate), respondents scored the importance of 89 enabling competencies and 19 additional competencies. Seven CanMEDS enabling competencies did not achieve consensus and were excluded. Nineteen new enabling competencies and two new meta-competencies (Humaneness, Context Awareness) achieved consensus and were added. Median ratings of importance of meta-competencies showed highest scores for Medical Expert and Collaborator and lowest scores for Health Advocate. Weighting of meta-competencies revealed highest scores for Medical Expert and Professional with all others equally weighted. Conclusion: This study has formulated an adapted CanMEDS list of enabling competencies with the addition of the two new metacompetencies of Context Awareness and Humaneness for use in South African anaesthesiology. This provides a means with which future graduates may be assessed for fitness for purpose.

Ophthalmology specialist trainee survey in the United Kingdom

BACKGROUND

Currently there are a total of 780 post-graduate ophthalmology trainees in the United Kingdom (UK). Post-graduate ophthalmology training in the UK is 7 years in duration, and follows a comprehensive competency-based curriculum. Changes to training have been proposed as part of the government's Shape of Training paper.

METHODS

UK ophthalmic trainees and trainers, in partnership with the Royal College of Ophthalmologists, designed a national questionnaire to explore the confidence of trainees in different clinical and non-clinical aspects of ophthalmology. The questions and possible responses underwent a process of refinement through the Royal College of Ophthalmologists Training Committee and Trainee Group. An online survey platform was used for the questionnaire, which was sent to all ophthalmology trainees within the UK. Reminders were sent via the Royal College of Ophthalmologists and Regional Training Programme Directors. A 4-week period was allowed for responses. Quantitative data were analysed, and qualitative data analysis included collation and thematisation of free-text responses.

RESULTS

A total of 188 trainees (24.1% response rate) replied. Ninety-four percent of trainees were in full-time training posts. The most popular career choice was oculoplastics (31.4%), followed by vitreo-retina (25.1%), glaucoma (24.6%) and cornea (24.0%). One-quarter had opted out of the European working time directive (EWTD), and 54.8% agreed that their work contract reflected the number of hours actually worked. In total, 34.4% of trainees thought that ophthalmic specialist training should be shortened from the current 7-year programme. Overall, 79.9% of respondents felt confident in performing phacoemulsification cataract surgery independently. For more senior trainees in years 4-7, 100% felt confident in phacoemulsification. However, overall, only 47.9% were confident in independently performing an anterior vitrectomy (91.1% of final-year trainees). Overall, 77.6% thought that all surgical ophthalmologists should be trained to perform cataract surgery. For non-clinical skills, trainees felt least confident in 'preparing a business case', with 64.5% disagreeing that they felt confident in this task. The most confidence was felt for communication with patients: 100% of trainees (all of whom have completed at least 2 years of medical work following qualification) reported feeling confident.

CONCLUSIONS

Most doctors in post-graduate specialist training in ophthalmology in the UK aim to specialise in surgical sub-specialities. The subjective reports collected in this survey suggest targets for strengthening of the UK's highly rated training system. Further research is necessary to determine overall satisfaction with training, the effect of changing training within the recent Shape of Training review; and how recent newly imposed junior doctor contracts as well as Brexit affects training.

Transition to practice: creation of a transitional rotation for radiation oncology

BACKGROUND

Implementation of Competence by Design (CBD) will require residency training programs to develop formalized "Transition to Practice" (TTP) experiences. A multidisciplinary group of Radiation Oncology stakeholders from tertiary care centres in Atlantic Canada were surveyed regarding a proposed TTP rotation.

METHODS

The survey asked participants to quantitatively rank various learning objectives based on defined CanMEDS skills that are expected to be mastered by a graduating resident. Mean perceived importance scores were calculated for each objective as well as for their CanMEDS category. Specific written qualitative feedback was also collected.

RESULTS

The survey was circulated to 59 participants with a response rate of 73%. The three objectives with the highest mean importance score were "Independently assessing and managing patients seen in consultation," "Developing and demonstrating communication skills with patients at an advanced level," and "Independently assessing and managing follow up patients," respectively from highest to lowest. The CanMEDS roles with the highest importance score was "Communicator."

CONCLUSION

Quantitative and qualitative data from a multidisciplinary survey based on CanMEDS roles guided the implementation of a TTP rotation for PGY-5 residents at a tertiary care centre in Atlantic Canada. These results may be relevant to other training programs developing TTP experiences.

A journal club for peer mentorship: helping to navigate the transition to independent practice

The transition from residency to independent practice presents unique challenges for physicians. New attending physicians often have unmet learning needs in non-clinical domains. An attending physician is an independent medical practitioner, sometimes referred to as a staff physician or consultant. Peer mentorship has been explored as an alternative to traditional mentorship to meet the learning needs of new attendings. In this article, the authors describe how a journal club for general internal medicine fellowship graduates helped ease the transition by facilitating peer mentorship. Journal club members were asked to bring two things to each meeting: a practice-changing journal article, and a 'transition to practice' discussion topic such as a diagnostic dilemma, billing question, or a teaching challenge. Discussions fell into three broad categories that the authors have termed: trading war stories, measuring up, and navigating uncharted waters. It is likely that physicians have a strong need for peer mentorship in the first few years after the transition from residency, and a journal club or similar discussion group may be one way to fulfil this.

Preparedness for practice: a systematic cross-specialty evaluation of the alignment between postgraduate medical education and independent practice

BACKGROUND

Postgraduate medical education training programs strive to prepare their trainees optimally for independent practice. Several studies have shown, however, that new consultants feel inadequately prepared for practice, and that this increases the risk of stress and burnout.

AIM

To analyze across specialties for which tasks and themes new consultants feel inadequately prepared. And, to identify themes that need improved attention in postgraduate medical education programs or after registration.

METHODS

330 New consultants from all hospital specialities with accredited training programs who completed their training in the north-eastern educational region of The Netherlands between 2004 and 2010 received a questionnaire which was based on a previously validated generic task inventory.

RESULTS

143 respondents (43%) returned the questionnaire. They felt excellently prepared for 40 tasks, well prepared for 25 tasks, marginally sufficiently prepared for 18 tasks and insufficiently prepared for 8 tasks. Preparedness scores were lowest for tasks concerning management administration and leadership, research, end-of-life care, and patient safety-related communication. Surgical specialists felt better prepared for practice than medical specialists, which could not be explained by differences in general self-efficacy.

CONCLUSION

Although new consultants felt well prepared for medical tasks, the scores of more generic tasks indicate that the alignment between the different phases of the medical education continuum and independent practice needs improvement.

Postgraduate medical education - A time of change for physicians

Increasing hospital admissions and staffing pressures mean that most medical registrars find their workload is now heavy or unmanageable. Core medical trainees increasingly think the role of medical registrar is too unattractive or difficult, resulting in less competition for such posts. In autumn 2013, the Future Hospital Commission and Shape of Training outlined their vision to reform postgraduate medical training to better meet the needs of older patients with multiple comorbidities. The Future Hospital Commission proposes that there is a greater emphasis on internal medicine from medical school, with expansion of training opportunities and service provision. Shape of Training recommends a six-year training programme culminating in a Certificate of Specialty Training. New initiatives, such as broad-based training, credentialing and rotas with more continuity, are potential ways to increase training in internal medicine. It is clear that training to achieve generalist expertise is as important as training to achieve specialist expertise.

The transition to hospital consultant: Denmark and the Netherlands compared on preparedness for practice, perceived intensity and contextual factors

INTRODUCTION

Danish and Dutch new consultants' perceptions regarding the transition to consultant were compared to gain insight into this period, particularly the influence of contextual factors concerning the organisation of specialty training and health care therein. Preparation for medical and generic competencies, perceived intensity and burnout were compared. Additionally, effects of differences in working conditions and cultural dimensions were explored.

METHODS

All consultants registered in the Netherlands in 2007-2009 (n = 2643) and Denmark in 2007-2010 (n = 1336) received in June 2010 and April 2011, respectively, a survey about their preparation for medical and generic competencies, perceived intensity and burnout. Power analysis resulted in required sample sizes of 542. Descriptive statistics and independent t-tests were used for analysis.

RESULTS

Data were available of 792 new consultants in the Netherlands and 677 Danish new consultants. Compared to their Dutch counterparts, Danish consultants perceived specialty training and the transition less intensely, reported higher levels of preparation for generic competencies and scored lower on burnout.

CONCLUSIONS

The importance of contextual aspects in the transition is underscored and shows that Denmark appears to succeed better in aligning training with practice. Regulations regarding working hours and progressive independence of trainees appear to facilitate the transition.

The first five years: a mixed methods study investigating reflections on working as a hospital consultant

Objectives

This paper revisits the same cohort of hospital consultants approximately five years after they were first appointed to investigate their reflections on establishing themselves in their role.

Design

Mixed methods using a short survey and in-depth semistructured interviews.

Setting

The study was conducted within one Deanery in the North of England.

Participants

The same 45 hospital consultants who were invited to participate in the study in 2007 were asked to take part in the second stage of the project in February 2011. These 45 consultants started their appointments no earlier than May 2006 within 12 National Health Service (NHS) Trusts in one Deanery. A total of 16 consultants participated. Six consultants who took part in semistructured interviews in 2007–2008 were invited to be interviewed again. Four consented and participated in a further interview in 2011.

Main outcome measures

Do consultants feel they have completed their transition into their senior clinical posts? Yes, although the ever changing nature of the consultant role means new challenges are always having to be being addressed. What support mechanisms are valued by consultants? Informal support mechanisms are greatly valued by consultants and these are built up over time. Are consultants satisfied that they made the correct specialty choice? Yes, all respondents reported satisfaction in their specialty choice.

Results

After reflecting on five years in post, all agreed that Specialist training prepared them well for the clinical aspects of their role. Ten (62%) felt they were not prepared for dealing with Trust Management issues and 13 (81%) felt unprepared for financial management.

Conclusions

consultants learn on the job and eventually fulfil their potential in the role over time. However, the role is regularly changing so informal support mechanisms are valued to help deal with a highly complex role.

What are we preparing them for? Development of an inventory of tasks for medical, surgical and supportive specialties

BACKGROUND

Internationally, postgraduate medical education (PGME) has shifted to competency-based training. To evaluate the effects of this shift on the outcomes of PGME appropriate instruments are needed.

AIM

To provide an inventory of tasks specialists perform in practice, which can be used as an instrument to evaluate the outcomes of PGME across disciplines.

METHODS

Following methodology from job analysis in human resource management, we used document analyses, observations, interviews and questionnaires. Two thousand seven hundred and twenty eight specialists were then asked to indicate how frequently they performed each task in the inventory, and to suggest additional tasks. Face and content validity was evaluated using interviews and the questionnaire. Tasks with similar content were combined in a total of 12 clusters. Internal consistency was evaluated by calculating Cronbach's alpha. Construct validity was determined by examining predefined differences in task performance between medical, surgical and supportive disciplines.

RESULTS

Seven hundred and six specialists (36%) returned the questionnaire. The resulting inventory of 91 tasks showed adequate face and content validity. Internal consistency of clusters of tasks was adequate. Significant differences in task performance between medical, surgical and supportive disciplines indicated construct validity.

CONCLUSION

We established a comprehensive, generic and valid inventory of tasks of specialists which appears to be applicable across medical, surgical and supportive disciplines.

The transition to hospital consultant and the influence of preparedness, social support, and perception: A structural equation modelling approach

BACKGROUND

Insight into the transition from specialist registrar to hospital consultant is needed to better align specialty training with starting as a consultant and to facilitate this transition.

AIMS

This study investigates whether preparedness regarding medical and generic competencies, perceived intensity, and social support are associated with burnout among new consultants.

METHOD

A population-based study among all 2643 new consultants in the Netherlands (all specialties) was conducted in June 2010. A questionnaire covering preparedness for practice, intensity of the transition, social support, and burnout was used. Structural equation modelling was used for statistical analysis.

RESULTS

Data from a third of the population were available (32% n = 840) (43% male/57% female). Preparation in generic competencies received lower ratings than in medical competencies. A total of 10% met the criteria for burnout and 18% scored high on the emotional exhaustion subscale. Perceived lack of preparation in generic competencies correlated with burnout (r = 0.15, p < 0.001). No such relation was found for medical competencies. Furthermore, social support protected against burnout.

CONCLUSIONS

These findings illustrate the relevance of generic competencies for new hospital consultants. Furthermore, social support facilitates this intense and stressful stage within the medical career.

Opportunity or threat: the ambiguity of the consequences of transitions in medical education

OBJECTIVES

The alleged medical education continuum is interrupted by a number of major transitions. After starting medical school, the first transition students encounter is that from non-clinical to clinical training. The second transition is that of graduated student to junior doctor or specialist trainee, and the third concerns the specialist trainee's transition to medical specialist. As a first step towards a better understanding of the effects of transitions, this paper provides a critical overview of how these transitions have been conceptualised in the medical education domain. The findings are complemented with perspectives from the fields of transitional psychology and organisational socialisation. The transition into medical school is not reviewed.

METHODS

Using the term 'transition', six leading medical education journals were searched for relevant articles. A snowballing technique on the reference lists of the 44 relevant articles yielded 29 additional publications. Studies were reviewed and categorised as representing objectifying, clarifying, or descriptive and/or justifying research.

RESULTS

When students enter clinical training, they need to relearn what they thought they knew and they must learn new things in a more self-directed way. As junior doctors or specialist trainees, their main challenges involve handling the many responsibilities that accompany the delivery of patient care while simultaneously learning from the process of providing that care. As medical specialists, new non-medical tasks and decisions on how to delegate responsibilities become issues.

CONCLUSIONS

Research on transitions has objectified the challenges students and doctors face. Clarifying studies often lack conceptual frameworks that could help us to gain deeper insight into the observed phenomena. Psychology offers valuable theoretical perspectives that are applicable to medical education transitions. To transform a transition from a threat to a learning opportunity, medical education should assist students and doctors in developing the coping skills they need to effectively deal with the challenges presented by new environments.

Understanding the transition from resident to attending physician: a transdisciplinary, qualitative study

PURPOSE

There is a paucity of research into the processes surrounding the transition from residency to the position of attending physician. This report retrospectively investigates the question: Are attending physicians adequately prepared and trained to perform the tasks and duties of their new position? This study aimed at formulating a conceptual framework that captures the transition and is applicable beyond discipline- or location-specific boundaries.

METHOD

Individual semistructured interviews were conducted and analyzed using a qualitative, grounded theory approach. Between January and May 2009, 14 physicians were interviewed who had commenced an attending post in internal medicine or obstetrics-gynecology between six months and two years earlier, within the Netherlands. Interviews focused on the attendings' perceptions of the transition, their socialization within the new organization, and the preparation they had received during residency training. The interview transcripts were openly coded, and through constant comparison, themes emerged. The research team discussed the results until full agreement was reached.

RESULTS

A conceptual framework emerged from the data, consisting of three themes interacting in a longitudinal process. The framework describes how novel disruptive elements (first theme) due to the transition from resident to attending physician are perceived and acted on (second theme), and how this directs new attendings' personal development (third theme).

CONCLUSIONS

The conceptual framework finds support in transition psychology and notions from organizational socialization literature. It provides insight into the transition from resident to attending physician that can inform measures to smooth the intense transition.