Young surgeons’ challenges at the start of their clinical residency: a semi-qualitative study
Authors: Stefanescu Maria-Christina , Sterz Jasmina , Hoefer Sebastian Herbert , Ruesseler Miriam 
Published: June 2018

Introduction

According to German regulations on licensing to practice medicine, the aim of undergraduate medical training is to produce a scientifically and practically trained physician who is able to work independently. More precisely, medical training has to impart the required knowledge and skills in diagnostics, therapy, health promotion, prevention, and rehabilitation. From the young residents’ point of view, this aim is not achieved, and they do not feel prepared to be a doctor. However, the literature on this subject relies mostly on data based on surveys, and there is a lack of deep analysis of the specific details of the topic. The aim of this study was to analyze in depth how junior doctors in their first and second years felt about their preparation for clinical practice as a doctor from their undergraduate training, as well as which teaching formats and factors influence their preparedness.

Methods

This semi-qualitative study is based on recorded interviews conducted using a structured interview manual. This serves to limit the subject matter of the interview and to target the topics. The study participants were 35 residents of general and visceral surgery, trauma surgery, and urology in their first and second years of medical specialty training. The number of participants was defined by the concept of saturation of the content. Basic data regarding age and the location and length of study were collected using a questionnaire. The audio recordings were transcribed word by word and analyzed with structured qualitative content analysis techniques.

Results

Only 43% (n=15) of the 35 participating residents stated they were sufficiently prepared to be a doctor from undergraduate medical training, and 22.9% stated that they were not prepared for their work as a resident (8/35). However, 34.3% of the residents stated that undergraduate medical training did prepare them for some of the parts they were expected to master in daily clinical practice, but not other parts. Most of the participants described their first weeks as doctors as particularly stressful and exhausting. As major hurdles during their daily clinical work, participants described knowledge gaps regarding organizational and administrative pathways (71%), deficits in linking knowledge to clinical reasoning (71%), decision making (54%), and therapy planning (51%). Most participants stated that the practical placements during the semester, the clinical clerkships, and the last year internship were most effective as preparation for clinical residency. To be better prepared for clinical practice, participants suggested providing a clearer structure and that the course subjects bear better relations to each other. Nearly all participants proposed increasing patient encounters directly from the beginning of medical training as a longitudinal approach.

Discussion

Even though we were able to demonstrate an increase in residents’ preparedness, 57% of the study participants still felt unprepared for their job to some extent. One might argue that starting a new profession will always result in a feeling of being unprepared to some extent. However, this unpreparedness can increase the risk for patients’ well being due to medical errors, which actually represents the third leading cause of death in the US after malignant tumors and cardiovascular diseases. Structured on-the-job adjustment, structured qualification training, and guided professional training are becoming increasingly important for future doctors as selection criteria for career choice and choice of employer. Thus, the surgical disciplines that are struggling with new young residents have to improve their concepts.