The doctors discussed whether they learned the required basic science knowledge base when they graduated and how much was relevant to how they practised 6 years after graduation. Perhaps, unsurprisingly there were mixed views on this and some of the views were very much specialty dependent. For example, some of those who became surgeons wanted more anatomy teaching, but the graduates who became GPs or psychiatrists wanted less anatomy teaching.
As a whole they did feel they graduated with a good science knowledge base and despite stating that they covered a lot of subjects in the pre-clinical part of the course which gave a good background knowledge there were complaints that they had learned too much irrelevant knowledge in those areas. For many, the first two years of the course were "dry" and "uninspiring" with biochemistry in particular being cited.
"I did feel with the biochemistry that we did too much and that was laboured more than it should have been"
"some of the lectures were very good, excellent, but some were rubbish...I remember sitting in some being thoroughly confused..."
"The lectures served me well, I didn't need to know it all but it gave me a good grounding"
The majority also felt that although they had forgotten a lot of what they had learned it was useful to have that some of that background when revising for postgraduate Royal College exams. For many of the interviewees, though knowing the science for postgraduate exams was more useful than knowing it for diagnosing patients.
"..it was logical and although a lot of it didn't apply to being a doctor you got the bits that did apply and could build on that, certainly when revising for postgraduate exams."
The interviewees were split about when they tied their science understanding together to understand disease processes. None of the interviewees managed to grasp this in the pre-clinical course, but then they were split almost 3 ways whether it came together for them during the early part of the clinical course, final exams or when working in the first postgraduate year.
History and examination skills
The interviewees felt that they had received a good grounding in taking history and examination skills and many of them still referred back to the tips they picked up as undergraduates when they examined patients working as doctors.
"It is drilled into you like nothing else"
"I got it from an early time, the first medical attachment I did. It was repeated and repeated. I presented to the registrar and consultant until it stuck. It was good."
They felt that the first general medical and surgical placements and the long final year placements in medicine and surgery were useful for gaining these skills. These attachments were also seen as most beneficial for learning about differential diagnoses - which all the graduates felt they had a good grounding in. Some, though, did feel intimidated by learning the skills with consultants on the wards straight after the pre clinical course.
"I found it a bit overwhelming doing learning it on the wards in my first attachments."
Despite this, all interviewees did feel that they were very competent in these areas when they graduated.
The vast majority of graduates felt they were competent communicators despite not having specific communication skills classes.
"I think I do have good communication skills, but I don't think I got them from medical school, I think I got them from my parents."
They felt they had managed to acquire the necessary communication skills simply by observing other doctors on clinical placements as undergraduates and didn't feel they needed tuition.
"you can just pick up your skills by observing senior doctors, what was good...what was bad and pick the style you would like in the future."
Only a small number of interviewees felt tuition would have been beneficial and mostly these were GPs. Some of the interviewees linked communication skills solely with being able to take a competent history rather than, breaking bad news or conversations with patients' families for example, which perhaps illustrated a lack of perception about communication skills.
Apart from the 5 interviewees who had taken intercalated degrees none of the graduates indicated that they had received any experience in learning about research skills.
"no, it just wasn't like that, I don't think we thought about things like that really."
" I didn't get an understanding of audit or of research.. there was very little of that which is a disadvantage now because in postgraduate medicine it is something that is seen as very important now."
They did feel that students who undertook a PBL education would have these skills.
"that is one of the things I have been impressed with the undergraduate courses now - they can research and they have their heads around understanding publications much sooner."
Practical skills/preparedness for role of junior doctor
Although it was 6 years since these doctors graduated they were asked about how well prepared they had been to work as first year medical graduates and what their tuition in gaining the practical skills associated with the role were like. The consensus was that they hadn't been well prepared in this area.
"I didn't feel well prepared at all, I felt like a scared rabbit for the first 6 months."
"I think the biggest downfall of the traditional course is that it doesn't prepare you for the first day at work"
"when I got lumped on the ward I didn't have a clue what to do....where to start.. whether to examine them, whether to take bloods or observations.. I didn't know how to fill in an x ray form.. prescribe paracetemol...it was a horrible few weeks.."
There were low expectations of how well an undergraduate curriculum could prepare graduates for work, anyway.
"I don't think anything can prepare you... but you learn on the job, pick it up and everyone is in the same boat.."
Many interviewees said that they spent their final year learning what they needed to know for their exams rather than what they needed to know to begin postgraduate training.
Strengths and weaknesses of the course
The interviewees did feel that the structure of the course was good and useful with the pre clinical/clinical divide and there was a good amount of clinical exposure. They believed that the course was "logical" and that they found it reassuring to be told what they needed to know through lectures, which clinical attachments they had to go on and there was some good bedside teaching.
"In essence we were spoon fed and everything we needed to know and it was perfect for me."
However, the fact there were two distinct pre clinical and clinical sections of the course was also seen as weakness as well. Many respondents cited the grounding in the basic sciences as a strength of the course but they felt they had learned too much irrelevant knowledge and many of the lectures were seen as boring.
"It was thorough and we covered a lot of ground but this was also a weakness as it was too thorough!"
The overwhelming weakness according to interviewees was lack of preparation to work as a first year postgraduate and, to a lesser degree, lack of exposure to research skills. The graduates were almost split down the middle over whether the amount of General Practice was enough or whether it should have been increased despite approximately a third of the doctors saying they had little idea about the relationship between primary and secondary care. The GPs in the study, though felt there were far too few community placements. However, despite the lack of preparation for their first job after graduation and knowledge "overload" they had enjoyed their course and the vast majority were glad they studied under the traditional curriculum rather than a reformed curriculum.