Development of clinical reasoning during the transition from a medical graduate to a junior doctor: A qualitative study with novice medical graduates in Sr Lanka

The transition from graduates to doctors, puts additional demands on ones clinical reasoning ability. Despite the criticality of this period, literature exploring the longitudinal development of clinical reasoning during transition is limited. This longitudinal study was conducted to explore how junior doctors learn and develop clinical reasoning and develop a framework to condense the empirical findings and bridge the recognised gaps in the literature.
Summary of Work: The study employed a hermeneutic phenomenological methodology and was conducted on junior doctors during their first clinical placement (internship) over a period of 12 months. Semi-structured narrative interviews (n=18) to explore their experiences of learning clinical reasoning and post-consultation discussions based on recorded doctor-patient consultations (n=48) to explore their reasoning during consultations were conducted. All interviews were audio-recorded, transcribed verbatim and analysed to generate themes to explain the dataset as a whole. Summary of Results: Eight broad themes were formulated. The themes emphasised clinical reasoning as an evolving process, it changes during undergraduate training and along the internship and is influenced by drivers, facilitators, sources and challenges of learning clinical reasoning. During the transition, there is an abrupt transformation of the approach to clinical reasoning influenced by many factors, from a diseaseoriented to practice-oriented model. This produces a steep learning curve for junior doctors. However, some factors of this model can be culture specific particularly concerning the role of senior doctors and the junior doctors self-views which can vary between different cultural contexts.
Discussion and Conclusions: The transition from a medical graduate to a junior doctor is very challenging and stressful with a steep learning curve. The mismatch between the disease-oriented approach, which is learned as undergraduates and the practice-oriented approach demanded in practice is the main challenge. Understanding the complex factorial relationships in this model will therefore help re-orient and reform undergraduate clinical education and internship training to narrow the gap in clinical reasoning and ease the transition from graduation to the internship.
Take-home Messages: 1. The factors informing the development of the practice-oriented approach to reasoning are diverse, yet many are learnable. 2. Efforts need to be taken to ease the transition during undergraduate training and the internship.