INFLUENCIA DE LAS TIC EN LA COGNICIÓN HUMANA
3. O BJETIVOS E H IPÓTESIS DE LA I NVESTIGACIÓN
Having set out the strengths and limitations of our rapid review, we now present the key findings within each research question with the association recommendations for future research in Table 6 (below).
TABLE 6:SUMMARY OF KEY FINDINGS AND ASSOCIATED RECOMMENDATIONS FOR FUTURE RESEARCH
Key findings within each RQ Key recommendations for further research based on findings RQ1: How has preparedness for practice been researched?
The concept of preparedness is typically glossed over and/or conflated with other terms in the literature (e.g. readiness). Preparedness is mostly conceptualised as
something possessed by the individual and his/her knowledge and skills rather than having a contextual dimension.
Most studies conceptualise preparedness as preparedness for the short-term transition period between Y5/F1 rather preparedness over the longer-term. Studies typically explore preparedness
through self-report questionnaires that consider preparedness as a generalized and acontextual notion.
When qualitative interviews with trainees or trainers are utilized preparedness is analysed acontextually with little
consideration of the factors that impact on (self)reports of preparedness.
Few studies triangulate data using multiple participant groups or multiple methods.
Future research should adopt a more rigourous approach to developing a body of research that considers the issue of methodological consistency to enable the small-scale research efforts prevalent in medical education to be combined to provide transferable knowledge of the issues around preparedness for practice in terms of how this is conceptualised and measured. Attention to the issues around self-reported data should be a priority.
Further research is needed to explore multiple stakeholders’ understandings of what preparedness is and how it might be researched in order to understand the complexity of individual patient encounters that might shed light onto the broader question of how we might best support medical graduates to treat patients safely and appropriately.
Only one single study used patients as participants.
Questionnaires in the research identified have no general uniformity in terms of the methods adopted to record and analyse responses and therefore act as more like ‘stand alone’ studies rather than adding to a consistent body of knowledge.
Further research should attempt to understand longer-term preparedness issues.
Further research should attempt to understand the complex interplay between individual, relational, technological, and cultural issues in terms of preparedness.
Further research should include multiple methods and multiple participant groups (e.g. trainees, medical and non-medical trainers, patients etc.).
RQ2: How effective are final year undergraduate to FY1 transitional interventions? Three key transition interventions are
outlined in the literature: Y5
assistantships and shadowing and F1 induction.
Although authors cited in the review consider assistantships to be valuable there is currently no evidence about their effectiveness.
Research evidence shows that shadowing is typically effective, although there are variable findings as to the most
efficacious method.
Research evidence shows that induction can be effective, although there is variation in induction programmes offered (e.g. hospital/ward etc.) and can sometimes be conflated with induction.
Further research is needed to explore what is currently covered in the
different transitional interventions and what should be covered (in terms of learning outcomes, teaching and
learning methods, assessment, duration etc.).
In particular, multi-site and longitudinal research examining the different
models of assistantship and the effectiveness of these models is an urgent requirement given that medical schools are now adopting this method as standard at the end of their curricula. Further research exploring
stakeholders’ views and experiences of the three different transitional
interventions is needed using multi-site, longitudinal studies with appropriate methodological considerations. RQ3: How prepared are graduates for specific tasks/skills/knowledge?
Preparedness for 11/32 TD09 and an additional 11 practical procedures are cited across a range of studies included in this review.
There is wide variation of preparedness reported across studies of practical procedures with the exception of venepuncture (prepared) and suturing, central venous line insertion, and chest drain insertion (unprepared).
Most of the data on practical procedures comes from studies with data collected pre-TD09.
Most of the data suggesting graduates are
Further research should measure preparedness for
tasks/skills/knowledge in a consistent way to enable meta-analyses to be conducted and comparisons to be made across studies.
Further research on preparedness for specific tasks/skills and knowledge should include all those cited in TD09 and particularly address current gaps in the literature such as students’
preparedness for planning discharge. Further research on preparedness for
prepared comprise a limited range of studies using generalized acontextual self- report methods, whereas most of the data suggesting graduates are unprepared come from a broader range of studies using a greater variation of research methods. Research suggests that trainees are
reasonably well-prepared for history- taking and performing full physical examinations but are mostly unprepared for prescribing safely and legally, clinical reasoning and making diagnoses and the early management of emergency patients.
should include both trainee and trainer perspectives.
RQ4: How prepared are medical graduates for interactional/interpersonal aspects of practice? Few studies have explored students’
preparedness for
interactional/interpersonal aspects of care.
Some evidence suggests that students are prepared for team-working, and
communication with colleagues and patients.
Evidence tends to suggest that students are ill-prepared for communicating in multidisciplinary teams.
Further research on preparedness for interactional/interpersonal aspects of practice is required that employs multiple stakeholders’ perspectives (e.g. trainees, trainers, patients) and includes observational research. Further research should prioritise
trainees’ communication within multi- professional teams and particularly within the context of handover. Further research should also tackle
current gaps in the literature such as graduates’ preparedness for dealing with end of life care (including breaking bad news), dealing with difficult or violent people (TD09 outcome 15e) and preparedness to deal with patient concerns and complaints in a positive way.
RQ5: How prepared are medical graduates for cultural, systemic and technological aspects of practice?
Few studies have explored students’ preparedness for cultural, systemic and technological aspects of practice.
Some evidence suggests that students are unprepared for dealing with error and safety incidents and lack understanding of how the clinical environment works.
Further research on preparedness for cultural, systemic and technological aspects of practice is required that employs multiple stakeholders’ perspectives (e.g. trainees, trainers) and includes observational research. Further research should prioritise
trainees’ dealing with error and safety incidents and understanding the clinical environment.
Further research should also tackle current gaps in the literature such as students’ understanding of
organisational decision-making and the purpose and practice of appraisal.
RQ6: How personally prepared are medical graduates for practice? Few studies have explored students’
personal preparedness for practice. Some evidence suggests that students are
prepared to identify their own limitations. Other evidence suggests that students are
unprepared for time management. Contradictory evidence exists in terms of
students’ preparedness for identifying their own learning needs, reflective practice and ethical and legal aspects of practice.
Further research on personal
preparedness is required that focuses specifically on trainee perceptions. Further research should tackle
current gaps in the literature such as students’ managing health including stress and dealing with problems in the performance, conduct and health of colleagues.
RQ7: Do personal demographic factors contribute to the variance in preparedness? Few studies have explored the
relationships between students’ personal demographics and their perceptions of preparedness for practice.
Some research evidence demonstrates relationships between ethnicity; with white students feeling more prepared. Evidence typically suggests that gender
does not predict perceptions of preparedness.
Some evidence suggests that personality ‘traits’ are related to perceptions of preparedness (e.g. conscientiousness) and unpreparedness (e.g. neuroticism).
Further research is needed to explore the relationships between personal demographic factors and students’ perceptions of preparedness for practice.
Researchers would be wise to explore the interplay between personal and situational demographic factors with perceptions of preparedness (see RQ8 below).
RQ8: Do situational demographic factors contribute to the variance in preparedness? Evidence suggests that graduates from
more recent cohorts, graduate-entry students, students on problem-based learning courses, UK-educated trainees and those with an intercalated degree feel better prepared.
Further multi-school studies need to be conducted to explore differences in preparedness by school and perhaps more importantly, to explore why any differences exist.
Further research on preparedness needs to take into account trainees’ postgraduate training experiences at the time of self-report as these experiences may influence their retrospective feelings of preparedness.