Open Access Highly Accessed Research article

Perceptions of UK medical graduates’ preparedness for practice: A multi-centre qualitative study reflecting the importance of learning on the job

Jan C Illing1*, Gill M Morrow1, Charlotte R Rothwell nee Kergon1, Bryan C Burford1, Beate K Baldauf2, Carol L Davies3, Ed B Peile3, John A Spencer4, Neil Johnson3, Maggie Allen3 and Jill Morrison5

Author Affiliations

1 Centre for Medical Education Research, Durham University, Burdon House, Leazes Road, Durham DH1 1TA, UK

2 Warwick Institute for Employment Research, The University of Warwick, Coventry CV4 7AL, UK

3 Institute of Clinical Education, Warwick Medical School, The University of Warwick, Coventry CV4 7AL, UK

4 School of Medical Sciences Education Development, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK

5 College of Medical, Veterinary and Life Sciences, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK

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BMC Medical Education 2013, 13:34  doi:10.1186/1472-6920-13-34

Published: 28 February 2013



There is evidence that graduates of different medical schools vary in their preparedness for their first post. In 2003 Goldacre et al. reported that over 40% of UK medical graduates did not feel prepared and found large differences between graduates of different schools. A follow-up survey showed that levels of preparedness had increased yet there was still wide variation. This study aimed to examine whether medical graduates from three diverse UK medical schools were prepared for practice.


This was a qualitative study using a constructivist grounded theory approach. Prospective and cross-sectional data were collected from the three medical schools.

A sample of 60 medical graduates (20 from each school) was targeted. They were interviewed three times: at the end of medical school (n = 65) and after four (n = 55) and 12 months (n = 46) as a Year 1 Foundation Programme doctor. Triangulated data were collected from clinicians via interviews across the three sites (n = 92). In addition three focus groups were conducted with senior clinicians who assess learning portfolios. The focus was on identifying areas of preparedness for practice and any areas of lack of preparedness.


Although selected for being diverse, we did not find substantial differences between the schools. The same themes were identified at each site. Junior doctors felt prepared in terms of communication skills, clinical and practical skills and team working. They felt less prepared for areas of practice that are based on experiential learning in clinical practice: ward work, being on call, management of acute clinical situations, prescribing, clinical prioritisation and time management and dealing with paperwork.


Our data highlighted the importance of students learning on the job, having a role in the team in supervised practice to enable them to learn about the duties and responsibilities of a new doctor in advance of starting work.