The do’s, don’t and don’t knows of supporting transition to more independent practice

Strong

A large and consistent body of evidence

Moderate

Solid empiric evidence from one or more papers plus the consensus of the authors

Tentative

Limited empirical evidence plus the consensus of the authors

Do’s

Embed learning in practice and provide authentic and meaningful learning opportunities

Strong

Don’ts

Avoid rather than manage risk

Moderate

Don’t knows

What is the best balance between prescriptive programs tailored to individuals and ‘one size fits all’ competency-based or target-based training programs?

–

Transitions to independent practice: independence and responsibility

Do’s

Provide meaningful pre-transition preparation courses linked to local inductions

Moderate

Encourage progressive independence by offering a sliding scale of decreasing supervision alongside demonstrating increasing trust (both globally and for specific tasks)

Moderate

Apply the concepts of graduated responsibility to non-clinical as well as clinical domains of training, such as leadership and responsibility

Moderate

Make postgraduate trainees aware of the psychological impact of actual responsibility (including the process of their own identity formation) once they move up a level of training or into consultancy

Moderate

Don’ts

Treat transition as a moment in time

Strong

Don’t knows

What is the best way to ensure ongoing continuing professional development as a consultant or general practitioner?

–

Can we move understanding of the outcomes and impact of transition beyond perceptions?

What is best practice in helping doctors-in-difficulty or training-departments-in-difficulty? In optimizing transitions, what should be the role of regulatory bodies and employers?

Transitions to independent practice: mentoring & coaching support

Do’s

Establish a mentorship program with local champions

Moderate

Seek to aid the development of resilience and independence

Moderate

Don’t knows

How do we develop common understanding around what is optimal in mentoring and coaching for multidimensional medical roles?

–

Transitions to independent practice: patient perspectives

Don’t knows

How can patient feedback encourage effective transitions to independent practice and contribute to risk management?

–

What is the best way to manage the tension between creating opportunities for progressive clinical independence as a learning mechanism and managing patient safety?

 1. Medline database search using the search string <[Transition OR trajectory] AND Medical Education [limit] review articles. Identified 81 articles which were screened for relevance and those selected were then reference screened for additional original work to add to the records generated from personal experience of the literature. A total of 44 papers remained eligible from these searches after full-text screening

 2. Medline search using the search string <[Transition OR trajectory] AND [Professional Autonomy [exp MeSH] OR independen* OR Professional Competence [MeSH] OR Clinical Competence [MeSH] OR [EPA or Entrusted professional activity] OR Mentors [MeSH] OR coach* OR supervis* OR social support OR pastoral care OR Prepar* OR stage OR progress* OR [CCT or completion of certificate in training] OR board certificat* OR Workplace learning OR practice-based learning OR Clinical reasoning OR decision making OR Rehears* OR Resilience, Psychological [MeSH]]. This was limited to specific journals as the initial search was not sensitive enough. Selected journals were Medical Education, Academic Medicine, Medical Teacher, Advances in Health Sciences and Education, BMC Medical Education, Teaching and Learning in Medicine, Perspectives on Medical Education and BMJ. 262 articles were identified through this wider search string. Following the removal of duplicates on combining references from this search string with our existing records and addition of citation checks the total for screening was 387 papers

 3. Of the papers screened, 210 were excluded at title or abstract screening and a further 107 at full text screening. All authors contributed to screening, with at least two authors screening each record at each stage

Reasons for rejection were:

– Not relevant to medical transitions—evident from title/abstract screening (n = 210)

– Research questions or methods of data collection did not include career/seniority transitions (n = 97).

Examples of articles excluded on this basis included those:

– Focused on specialty selection/assessment rather than student/trainee/consultant transitions testing methods of assessment or teaching specific tasks/skills separate to transitions in clinical practice

– About organizational or institutional transition to new structures, or technological innovations for clinical practice

– Historical articles on introduction of problem-based learning in undergraduate settings

– Transition of international graduates into Western healthcare employment

– Hierarchies and transitions in non-clinical careers

– Only about preparation rather than the actual transition

– Local and specialty specific surveys if findings not more widely relevant or potentially transferable

– Curriculum design and evaluation that is not actually about transition to independent practice

– Impact of transitions in demographic make-up of medical graduates

Review articles (these were reference screened for inclusion of original papers as described above) (n = 10)