Preparation for practice

The transition from medical student to newly qualified doctor can be a challenging experience. Well trained, prepared, compassionate and competent newly qualified doctors are essential for the safe and effective running of our health system. However, medical students often report they feel underprepared for entering the world of clinical practice, with particular emphasis on clinical reasoning, emergency management, multidisciplinary team working and understanding of ethical issues. (Monrouxe et al., 2017).

However, the literature in this area remains limited, with scales and ratings often used to measure students preparedness as they enter the clinical workplace. There is an urgent need to reconsider how curriculum, assessments, mentorship, supervision and the medical school learning environment can better support students for their transition to becoming a doctor.

Longitudinal learning is one educational approach to address this challenge, involving students spending a longer time immersed within a clinical team, where they form meaningful relationships with patients, staff and their peers. Students take an active role with their patients, often advocating for them and guiding them through their healthcare journey. Clinical learning occurs in an authentic manner, synergistically with patient care, with continuity with patients, curriculum and supervision as a core guiding principles (Hirsh et al, 2007).

Innovation and research

MEdIC has led the way nationally in the implementation and innovation of longitudinal integrated clerkships (LICs), a model of curriculum design using longitudinal learning.  

Following the experience and expertise gained from running a number of successful longitudinal pilots, MEdIC will be launching LIA in 2021 which will be rolled out to all medical students at Imperial in their 5^th year of study. Students on these courses act as ‘paraprofessionals’ advocating for their patients and contributing to their care, supporting their transition from student to doctor.

MEdIC more broadly is interested in exploring innovation and research related to students preparedness for practice from a variety of perspectives, using a mixture of research methodologies. Qualitatively, MEdIC has explored students’ perceptions around preparedness for practice through a virtual on call simulation. We explored the cognitive and emotional challenges students experience as they take on the roles and responsibility of a qualified doctor in a simulated environment. Quantitatively, we have investigated whether longitudinal models of learning can affect professional student attributes, which have been shown to impact future clinical practice. 

We are also interested in understanding the theoretical underpinning of preparedness for practice and have explored areas including authenticity, communities of practice, transformational learning and student belonging. With the rapid transformation of the medical curriculum from the COVID-19 pandemic, MEdIC is exploring how service learning may be incorporated within clinical placements to support the healthcare system and promote authentic experience for our students as they prepare to become doctors.

MEdIC founded UKLIC (UK think tank of LICs) bringing together UK institutions interested in developing longitudinal learning, to share experiences and learn from each other. 

If you’re interested in discussing a project or collaboration on this theme please contact Dr Ravi Parekh r.parekh@imperial.ac.uk