Additional file 4: Table S3. Characteristics of Included Studies Country of Origin Aims of Study [study design] Context Findings Interpretation of Findings Setting / degree details Design Participants Shacklady (2009)[20] UK To quantify the effect of maturity on medical students’ transitions into the clinical environment and identify how experiences of transition might be improved [matched cohort] PBL-based, 5-year undergraduate program with 3 phases, with minimal clinical exposure in phase 1 Cross-sectional survey Survey focused on preparedness and consisted of 7 items (5 open-ended items, 2 Likert scale items) 2 consecutive student cohorts in Year 3 (Phase 2): Cohort: Mature aged students N=29 Gender: 15M, 14F Av Phase 1 performancea: 59.6 (range = 56-64) Comparison: aged students N=58 Mature aged students reported a Good transition (OR=6.1 p=0.002) Drew on previous years in medical school (OR=2.7 p=0.04 Drew on wide life experiences (OR=3.9 p=0.01) Factors which were Mature aged students reported greater preparedness and a smoother transition into the clinical environment, than non-mature aged students. The transition into the clinical environment was supported by Teacher support
Gender: 30M, 28F Av Phase 1 performancea: 53.3 (range = 49-58) RR: 42% perceived to influence perceived transition included: familiarity with the clinical environment, relevance of clinical teaching, support during transition, preparatory experiences (work experience, learning and teaching knowledge, skills, early experience) Prior workplace experience Clinically relevant knowledge Confidence in skills Wenrich (2010)[23] USA To determine teacher and learner expectations of clinical-skills training in preparation for clerkships [cross-sectional, Four-year graduate program; two years preclinical training followed by two years clinical clerkships. training underpinned by Cross sectional survey, which focused on the level of preparedness with respect to basic and advanced clinical skills and basic science knowledge 1 student cohort, 3 months after commencing the clinical N=115 (62%) Clerkship faculty N=56 (58%) Preclinical faculty and students had higher expectations than clerkship faculty in all basic skills except for communication and teamwork (p<0.05) Agreement is required between preclinical and clerkship faculty regarding expectations of preparedness of students prior to
comparative] Guided Bestide Learning pedagogy (measured on a likert scale), when entering the clerkship Gender: 38M, 18F Pre-clinical faculty N=30 (61%) Gender: 15M, 15F : Students had higher expectations in advanced skills than preclinical and clerkship faculty (p<0.05) No significant difference in basic science knowledge expectations between the groups commencing the clerkship Improved communication between students and faculty required to convey expectations of preparedness for the clinical clerkship Prince (2005)[21] Netherlands To seek quantitative verification of the qualitative findings from the group’s previous focus group study[22] on students’ perceptions of the gap between PBL-based 6-year undergraduate program; four years theory-oriented preclinical training incorporating clinical skills training and two years clinical Cross-sectional mail-based survey consisting of 95 items (8 items on demographic characteristics, 77 items measured on a 5-point likert scale, Clerkship students N=71 (67%) Gender: 19M 52F Mean age (SD): 23.1 (1.52) years Student reported that the following impacted on their transition into the clinical clerkship; an increase in workload, variable patient contact, a change in More study time Earlier patient contact to facilitate knowledge acquisition Better introduction to
theory to practice [focus group] (including clinical skills training) and two years clinical clerkships; (range 5-38) Contact with real patients Knowledge Practical skills Learning preclinical [phase and some tutorials in the clinical phase Dornan and Bundy (2004)[27] UK To provide a rationale for integrating experience into early medical education (“early experience”) [grounded theory analysis of group interviews] Three medical schools in the UK semi-structured group interviews; staff and students attended separate sessions; grounded theory analysis0 Purposeful sampling of 33 students from various years and 31 staff representing various curriculum aspects The rationale for early experience would be to ease the transition; make students more confident to approach patients; motivate them; increase their awareness of themselves and others; contextualize their theoretical knowledge; teach intellectual skills; strengthen learning of behavioural and Without early clinical experiences, the curriculum was socially isolating and divorced from clinical practice
social sciences; teach them about the role of health professionals O’Brien (2007)[24] USA To explore the relationship between students’ and clerkship directors’ perceptions of students’ struggles with the transition to clerkship. [focus groups] Ten US Medical Schools – details on curricula not provided Data obtained from a large national study; responses gained from 16 interviews and 8 focus groups with clerkship directors and 11 focus groups with clerkship students 83 clerkship students and 65 clerkship directors Students reported difficulties understanding roles and responsibilities, adjusting to clinical cultures, performing clinical skills, learning the logistics of clinical settings, encountering frequent changes in staff, settings and content. Clerkship directors identified students struggle with roles and responsibilities, Curricula and teaching strategies should be focused on areas which are not congruent between students and clerkship directors
performing clinical skills, adjusting to clinical cultures, difficulties applying knowledge to clinical reasoning and engaging in learning Godefrooij (2010)[26] Netherlands To explore how students who have had preclinical patient contacts perceive the transition to clinical training and how they value these early patient contacts as preparation for learning in clinical practice [focus group with PBL-based 6--year undergraduate program; four years theory-oriented preclinical training with clinical skills training) and two years clinical clerkships; early contact with patients in Year 3 Focus group interviews of 1.5 hours in duration, 2 focus groups were conducted with each of the 3 groups (for theoretical saturation) Clerkship (Year 4) students who had completed 1 full week of their first rotation N=21 Gender: 7M, 14F Students reported increase in stress due to increased working hours and workload, uncertainty of what is expected of them and lack of knowledge