articleStudents ' perceptions about the transition to the clinical phase of a medical curriculum with preclinical patient contacts ; a focus group study

Background: Studies have shown that medical students experience the transition between preclinical and clinical training as a stressful period. They are generally frustrated by their inability to apply their knowledge to solve clinical problems in practice. Preclinical patient contacts may offer a solution to this 'shock of practice. ' We studied how students who have had preclinical patient contacts perceive the transition from preclinical to clinical training and, more specifically, how they value these early patient contacts as preparation for learning in clinical practice. Methods: A purposive sample of 21 students participated in three focus groups which met twice during their first weeks of clinical clerkships. The interviews were recorded and transcribed literally. Qualitative content analysis of the transcriptions was performed. Results: According to the students, working in clinical practice was enjoyable, motivated them to study and helped them to develop non-analytical reasoning skills. The students experienced stress due to increased working hours and work load, uncertainty as to what was expected of them and self-perceived lack of knowledge. They did not experience a major gap between the preclinical and clinical phase and felt well prepared for the clerkships. The preclinical patient contacts were considered to be instrumental in this. Conclusions: Early patient contacts seem to ameliorate the shock of practice and prepare students for clinical work. The problems mentioned by the students in this study are mainly related to the socialisation process. The results of this study have to be validated by quantitative research. Background The transition between the theoretical and the clinical phase of undergraduate medical education has often been characterised as the most stressful period of undergraduate medical education [1-3]. The first clinical year has been described as a period where medical students go through intense emotional experiences [4] and students have described entering the clinical arena as though they were being "thrown in at the deep end" [5]. Boshuizen [6] highlighted that the "shock of practice", a crisis experienced by many medical students on first entering the clinical workplace, is marked by a temporary decrease in their ability to properly use biomedical knowledge in clinical reasoning. The ability to use theoretical knowledge to solve clinical problems is claimed to be enhanced by ProblemBased Learning (PBL) [7]. It has been suggested that the transition from theory to practice is less problematic for students in a PBL curriculum. However, both Van de Wiel et al. [8] and Prince et al. [9] discovered that, despite the use of PBL, students from a PBL-based medical school experienced difficulties that were similar to those reported by students from more traditional curricula. Early patient contacts are advocated as a way to improve students' preparedness for clerkships and hence overcome the "shock of practice" [9-12]. As yet there is not much evidence of the effects of these contacts. An opportunity to examine such evidence was presented by the introduction of preclinical patient contacts in the Maastricht PBL curriculum. We explored the following research question: how do students who have had * Correspondence: A.Diemers@sk.unimaas. nl 2 Skills lab, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands Full list of author information is available at the end of the article BioMed Central © 2010 Godefrooij et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Godefrooij et al. BMC Medical Education 2010, 10:28 http://www.biomedcentral. com/1472-6920/10/28 Page 2 of 9 preclinical patient contacts perceive the transition from preclinical to clinical training and, more specifically, how do they value these early patient contacts as preparation for learning in clinical practice?