Differences between medical school and PGY1 learning outcomes: An explanation for new graduates not being “work ready”?

Background: Widespread concerns about new medical graduates’ ‘work readiness’ may reflect, in part, differences in mandatory learning outcomes for medical students and new medical graduates.
Purpose: To examine differences between required medical student and PGY1 (first year resident) training program outcomes, and the nature and magnitude of these differences.
Method: Comparison, systematic identification and thematic analysis of differences between the graduate outcomes in the Australian Medical Council Standards for the Assessment and Accreditation of Primary Medical Programs and those in the New Zealand Curriculum Framework for Prevocational Training.
Results: The relationship between these outcome statements were categorized as: essentially similar; continuity; partial discontinuity; and complete discontinuity of learning trajectory. Areas requiring substantial new learning may reflect medical schools’ focus on individual student performance, and on learning and assessments based on single episodes of often uncomplicated illness. This contrasted with a post-graduate focus on integrated health care delivery by teams and management of complex illnesses over the whole patient care journey.
Conclusions: Characterizing these marked differences between pre-graduate and postgraduate standards, within a trajectory of learning, explains some of the difficulties in students’ preparation for work readiness. These could inform learning interventions to support new graduates’ professional development to ensure patient safety. Development and revision of accreditation standards should include formal review against the expectations of the preceding and succeeding phases of learning.

研究背景：社会各界对医学应届毕业生职业就绪能力（work readiness）的广泛担忧，在一定程度上或可归因于医学生与医学应届毕业生的强制性学习成果要求存在差异。
研究目的：探讨医学生必修培养目标与第一年住院医师（Postgraduate Year 1, PGY1）培训项目成果要求之间的差异，并分析此类差异的性质与程度。
研究方法：采用对比研究法，系统识别并开展主题分析，对比《澳大利亚医学委员会（Australian Medical Council）初级医学项目评估与认证标准》中的毕业生培养成果要求，与《新西兰职前培训课程框架（New Zealand Curriculum Framework for Prevocational Training）》中的相关要求之间的差异。
研究结果：两类成果表述的关联可被归类为学习路径基本一致、持续衔接、部分脱节、完全脱节四类。需大量新增学习内容的领域，往往反映出医学院校的培养重点聚焦于学生个体表现，以及基于单次、通常为轻症病例的学习与考核模式；而毕业后阶段的培养则侧重团队协作开展整合式医疗服务，以及贯穿全患者照护流程的复杂疾病管理能力。
研究结论：明确学习路径中本科医学教育与毕业后住院医师培训标准间的显著差异，可部分解释医学生在职业就绪能力准备过程中面临的诸多困难。此类发现可为支持应届毕业生职业发展的学习干预措施提供参考，以保障患者安全。认证标准的制定与修订工作，应纳入针对前后衔接学习阶段预期要求的正式审查环节。