Abstract
This study sought to explore the teaching experiences of medical interns in their first year of practice in the New Zealand health care setting. It explored the broader context that influences and shapes interns as doctors and teachers. This included their reflections on positive and negative clinical teaching experiences as medical students, their experiences of transition to practice, and the teaching and learning culture they worked within. This background context was an essential part of their story to preface experiences of being an intern and a teacher, teaching as part of professional life, and what they had learned about teaching in their first postgraduate year.
Exploring the teaching experiences of interns and the influences that shape interns as doctors and teachers connects two formative periods for new graduate doctors: the context of transition to practice from medical student to doctor, and intern as teacher, highlighting an aspect of professional practice not yet understood in our new graduate medical workforce in New Zealand. Furthermore, in medical education literature, studies have predominantly positioned junior doctors as a single group and not distinguished first year interns as a distinct subset of the junior doctor workforce. This is problematic because the context of the different subsets of junior doctors, their titles, and their stage of training vary considerably internationally, so they are not readily applicable or transferable to other contexts. Focusing on new graduate doctors as a distinct subset of the junior doctor workforce avoids any confusion regarding the stage of professional development and progresses our understanding of new graduate doctors as teachers: their conceptions of teaching, what influences these conceptions, how they enact teaching, and how they experience the relationship between teaching and clinical work.
An exploratory sequential mixed methods research design was employed. The qualitative phase comprised semi-structured interviews with seventeen new graduate doctors employed in hospital settings at the beginning and end of their first postgraduate year. A survey questionnaire based on the qualitative themes was utilised in the second phase of the research to test if the data could be generalised to the wider population of new graduate doctors in the following cohort year.
System requirements, role schema, and self-concept were found to be important influences in the formative period of transition to practice. Learning about the system requirements were derived exclusively from enacting their new role which contributed to a steep learning curve. There is an important role for the clinical team to ensure interns are made to feel welcome, to play a significant part of their orientation to the clinical environment, and to clearly communicate their expectations of the intern role.
Three circles of influence conveyed the teaching and learning culture in the workplace: the clinical team (the microsystem), the department and service (the mesosystem) and the hospital and wider organisation (the macrosystem). Although all layers of the organisation were conceived as necessary, interns experienced the clinical team as the most significant influence on the teaching and learning culture.
The perceived quality of interns’ past clinical learning experiences (good or poor) informed their conceptions of teaching and the attributes of good and poor teachers. Although knowledge, skill, and a doctor’s interest in teaching and learning were perceived as important, personal character traits were highlighted as most important.
Interns undertook various teaching activities, predominantly in the form of individual or small group scenarios. Teaching activities primarily involved trainee interns and focused on aspects of patient care that aligned closely with the intern's role and responsibilities. Interns perceived that there was a significant relationship between teaching and clinical work. They want to teach, enjoy teaching, and believe it is their professional obligation. The first year of teaching experiences was formative, highlighting beliefs, behaviours, and conditions for teaching. They emphasised how they could support a positive teaching and learning environment and demonstrate the characteristics they believed to be necessary for a successful teacher-student relationship.
Interns conceive teaching as part of professional life. Although professional obligation is a strong theme and interns learn more about teaching as they enact their role as doctors and teachers, the absence of formal support for teaching growth and development is evident. The risk is that teaching, therefore, becomes something that doctors do as part of their role, leaving it up to the individual about what, how, and when they teach, with only subjective data to determine whether their teaching is ‘good enough’. For teaching to be more than what a doctor does as part of their role, teaching skills need to be developed early and incrementally, as interns see them as necessary for the teaching roles they have throughout their medical careers. Vital to accompanying this development is reflection and feedback mechanisms and normalising talking about teaching as part of what doctors do in order to progress teaching growth and development beyond ‘teaching the way you were taught’.