Perception of readiness of future doctors for professional activities and determination of key factors affecting readiness to work Poltava State Medical University (Poltava, Ukraine)

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Perception of readiness of future doctors for professional activities and determination of key factors affecting readiness to work Poltava State Medical University (Poltava, Ukraine)

Kuzmenko N. V.,Ivanytska T. A., Poda O. A., Nesina I. M., Tanianska S. M.

The transition from theory to practice is usually associated with stress and uncertainty for a graduate of a higher education institution. In medical education, this problem appears most acutely due to rather stressful and responsible working conditions that a "newly trained" specialist finds himself in. A multifactorial influence on the process of transition of young doctors to independent practice has been proven, which is confirmed by many foreign studies. It is important to note that the most influential factors are personal characteristics, readiness to perform tasks and contextual factors. The development and improvement of essential practical skills in the work of a future doctor begins from the moment of admission to a higher medical educational institution and is regulated by educational programs that medical student masters during the entire study period. However, the acquisition of specific competencies, unfortunately, does not depend on the acquirer's intellectual abilities or the teacher's professional skill, while self-discipline, self-awareness, stress resistance and the ability to learn independently acquire great importance, which is difficult to evaluate and modify. Educational programs mastered by a medical student in obtaining higher education are designed to promote positive learning outcomes and a smooth transition from theoretical or paraclini- cal training to the clinical environment. In addition, the purpose of educational institutions is to take into account the needs of the industry before graduates begin to perform professional duties, as well as to track their professional fate.

In the conducted research, we tried to determine the readiness for professional activity among Poltava State Medical University students. The survey results made it possible to identify gaps in the acquisition of critical skills that are extremely necessary for the future work of medical students and interns, as well as the level of competence development and awareness of readiness to perform professional tasks. higher education applicant

Key words: higher education applicant, higher medical education, medical practice, readiness for work, factors.

Introduction

The main goal of medical education is to train highly qualified specialists in health care by providing quality educational services. The priority task of a scientific- pedagogical employee of a higher medical educational institution is the formation and development of future doctors' clinical thinking and practical skills, enhancing the ability to learn throughout life, and ensuring that students of higher education obtain an appropriate degree in their chosen specialities. In training medical students, it is essential to be aware of vertical and interdisciplinary integration in medical education and the importance of the problems of the transition period from theory to practice in developing the qualification competencies of future doctors [1, 2]. Recently, most educational medical institutions have revised their curricula and built them into vertically integrated ones. Vertically integrated curricula include such significant changes as the provision of prior clinical experience, a longer duration of training, promotion of increased levels of responsibility, and, finally, an easier transition to postgraduate education and practical activities at the workplace [3].

The transition to practical activity is defined in the literature as "a complex ongoing process of psychological, social and educational adaptation over time due to changes in the context, interpersonal relations and identity" [4]. For a medical university graduate, the transition to practice is the beginning of the independent performance of professional duties at the workplace with awareness of a high level of responsibility regarding decision-making regarding the patient's health and life. In addition, the clinical environment is inherently different from the academic environment, and there is a conflicting reality between what is taught in medical school and what happens in the real world. It applies both to the application of theoretical knowledge and professional attitudes and interprofessional cooperation. Newly trained doctors can identify essential gaps between what they have learned in practice and how things work in the real world, leading to feelings of confusion and difficulty in constructing a professional identity. The entire adaptation period of a young doctor to clinical conditions is combined with stress and anxiety, which can affect the quality of providing medical care to the population, as well as provoke early professional burnout [5, 6].

Medical students' readiness for future practice has traditionally been the research focus in this area. This problem is relevant in many countries, regardless of geographical latitudes or the economic well-being of states. For example, despite significant investment in medical education in the UK, published reports report that only 70% of newly qualified doctors felt well prepared for their new role [7]. In addition, as the healthcare needs of modern society change, so does the goal of clinical practice readiness. New requirements for changes in the organization of medical practice, new structures for the provision of medical care and approaches to medical education create different expectations and opportunities for modern medical graduates compared to previous generations. Most of the studies devoted to readiness for practice in the medical education framework are focused on the study of clinical competence [8] or the professional identity of young specialists [9].

Three main factors are believed to influence the process of transition to practice: personal characteristics, readiness to perform tasks, and contextual factors. Personal and professional characteristics of a specialist in- elude the ability to act professionally (honestly and decently), effective teamwork, modelling interprofessional relationships, communication with colleagues, the ability to introspect and lifelong learning, stress management, coping with uncertainty, etc. These competencies are quite difficult to modify; however, family and group mates' support and mentoring from teachers or senior colleagues can positively influence the process of adaptation to a change in the environment [10]. The interdisciplinary approach to learning, on which the training programs are built, includes modelling, team building, and the development of communication skills among team members and contributes to improving interprofessional cooperation in the future [11].

Clinical effectiveness is characterized by the ability to perform tasks related to professional duties and is directly proportional to the quality of education. At the same time, the teaching skill and professionalism of the teacher, who, in addition to performing control measures, must inspire, motivate, and support in case of failure, are of great importance. Thorough assimilation of theoretical knowledge and practical skills at the training stage affects the competence of a young doctor and confidence in making critical professional decisions because confidence is a fundamental achievement for solving tasks in the transition period [12].

The influence of contextual factors, such as the organizational or corporate culture of the institution where the specialist works, has been increasingly considered in Ukraine in recent years. Global changes did not bypass the domestic market of medical services when the sale of products and the provision of services became much more complicated than production, and the emergence of new management practices began to outpace theory [13]. Implementation of comfortable learning conditions in the system of medical education and performance of professional duties in a medical organization is the effective strategic management of the enterprise, aimed at improving the results of the work of each specialist and the entire team, increasing its competitiveness, and profitability in the long term. A newly arrived employee needs to demonstrate his belonging to the team and its values to clearly understand his place and role in the work of the organization or structural unit [14].

The aim of the study

Determining the readiness level of higher medical education students for future professional activities and key factors that influence this process.

Object and research methods

The research used a sequential, explanatory approach based on collecting and analysing quantitative data. The questionnaire developed by us included 51 questions divided into seven sections. Each survey assessed medical students' perceptions of their clinical training experience, focusing on six skill clusters: core skills; advanced counselling skills; personal and professional skills; patient-centred capabilities; clinical and systems thinking skills. In addition, demographic questions were used: age, place of residence (city or countryside), and presence of family members with medical education or health workers.

The survey lasted for three academic years: the spring semester of 2020/2021, 2021-2022 and the autumn semester of 2022-2023. In total, 322 students of higher medical education of the Poltava State Medical University were involved in the study.

In order to encourage survey participants to provide candid and detailed data, emphasis was placed on respondents' honesty, anonymity and confidentiality.

The results were evaluated on a 5-point Likert scale, where the respondent's judgment regarding the degree of mastery of a particular skill was assessed from 1 (not expressed) to 5 (extremely expressed) points.

Research results and their discussion

Out of the total number of interviewed students of higher medical education (n=322) - 37% were students in the 4th year, 52.8% in - the 6th year, and 10.2% were intern doctors.

The distribution of respondents by speciality was as follows:

- applicants of educational and professional program 222 Medicine before diploma higher education 80.1%, post-diploma - 2.5% of respondents;

- applicants of educational and professional program 228 Pediatrics - 4.1% of medical students and 4.3% of interns;

- applicants in the 4th year of the Faculty of Dentistry (educational and professional program 221 Dentistry) - 9%.

The age of the research participants was primarily up to 25 years (67.6% of respondents), and 12.4% of respondents were aged 25 to 30. The overwhelming majority of applicants were city residents (79.2%), and the rest - were from rural areas. 59.9% of respondents were the first in their family to study at a medical university and/or had family members with experience in healthcare.

Evaluation of the results according to the Likert scale

The evaluation of the answers to the questions of Cluster 1: "Patient-oriented abilities" showed that the majority of respondents understand the concept of the "Patient-oriented model of providing medical care" (67.7% of the respondents) and the principles of the influence of practice focused on patient satisfaction (75.1 %) and "Providing proper assistance to people of different cultural and social groups of the population" (74.8%). 73.6% of respondents can recognize the social and emotional factors of the disease, study the needs of patients (74.8%), and understand the importance of relationships between primary and specialized medical care (83.6%). Instead, the skill of "Making managerial (organizational) decisions" is developed only in 61% of the applicants surveyed. The most likely reason for this is the lack of teamwork experience and the low development of leadership qualities. In our opinion, this was influenced by the limitation of teamwork experience due to the introduction of long-term quarantine measures in Ukraine and the transition to a mixed form of education.

Responses to Cluster 2: "Advanced counselling skills" indicated that 269 study participants (83.6%) understood health literacy and its impact on informed consent; well versed in the skills "Education of patients (health promotion and health care)" and "Effective and sensitive communication with patients and relatives" (91.1% and 87.8% of respondents, respectively). Only 199 (61.8%) applicants feel comfortable in the consultant role. According to the authors, this may be due to a feeling of insecurity when working with patients, and hesitation in making important decisions, which is also explained by the limitation of the practical component of training, the direct practice of practical skills at the patient's bedside.

The analysis of the obtained assessment results of "Basic skills" (Cluster 3) revealed sufficient preparation of the students for taking anamnesis (78.9%) and examining patients (75.5%). Also, 75.2% of respondents demonstrated a high level of mastery of the skill "Understanding the scope of my practice and when to contact me." Lower indicators of skill acquisition were related to the selection of relevant studies and interpretation of the obtained results, as well as the establishment and justification of a clinical diagnosis (67.7% and 60.9% of respondents, respectively). And 162 applicants (50.3%) did not master the skill of safe prescription medicines.

As for "Personal and professional abilities" (Cluster

4) , only 57.1% of respondents feel ready to take on the role of a teacher, and 64% can cope with limited resources in clinical seffings. The term "Health Technology Assessment" is understood by 206 students (63.9%). 66.8% of respondents can deal with uncertainty, and 25.8% do not know how to cope with stress. Most participants highly appreciate their ability to work in a team (85.2%), consider themselves self-critical of their professional activities (91.2%), and 87.8% are ready to learn independently throughout their lives.

The assessment of mastery of clinical skills (Cluster

5) demonstrated sufficiently high preparation of the acquirers to use the sources of evidence-based medicine in patient care (78.9%) and the ability to maintain the appropriate quality of treatment (80.1%). However, the participants felt the least prepared to provide primary medical care to patients with emergency conditions (56.5%), and 26.3% of the respondents did not properly master the skill of basic nutrition and its role in the prevention and treatment of diseases. Regarding acquiring systemic thinking skills (Cluster 6), most students consider themselves able to contribute to patient's safety and their safety in practical activities in direct contact with infectious patients (81.3% and 80.8%, respectively). 61.5% of survey participants know how to complete medical documentation and the corresponding medical card. The degree of mastery of time management and organizational decision-making skills was 72.6% and 76.7%, respectively. 66.1% of respondents understand the importance of "Reporting errors and incidents, their resolution" in their future practical activities. 70.6% of respondents could use informatics as a tool in medical practice, and almost two-thirds of participants were ready for an audit to improve patient care (69.2%).

The gaps mentioned above in the development of basic and clinical skills (such as the selection of relevant studies and interpretation of the obtained results, making and justifying a clinical diagnosis, prescribing drugs safely and providing primary medical care to patients with emergency conditions) could be interpreted as incompetence due to the global problem of ignorance of clinical disease treatment protocols, which is confirmed by the misunderstanding of the concept of "Clinical management, including "evidence-based medicine" among more than 30% of respondents. In addition, such indicators can be explained by future doctors' uncertainty regarding independent decision-making due to the awareness of a high level of responsibility for the patient's health and life. The above results are directly proportional to feelings of insecurity, coping with uncertainty and stress management because almost a third of the study participants had problems with stress resistance.

Conclusions

In general, the survey revealed strengths and weaknesses in preparing future doctors for practical activities. According to the survey results, medical students felt most prepared in patient-oriented abilities and advanced counselling skills. Also, education seekers demonstrated high personal and professional skills, with some exceptions. The rates of assimilation of clinical and system thinking skills were somewhat lower. One of the most critical obstacles on the way to the perfect acquisition of skills was the limitation of the practical component of training, the lack of the opportunity to directly practice practical skills at the patient's bedside under the supervision of a teacher due to the use of distance forms of education, which in general affected the level of confidence and readiness to perform professional duties of future doctors.

Prospects for further research.

The broader implementation of the used research method in higher medical education will not only expand the possibilities of assessing the quality of the student's education in general but also help in planning or changing educational programs to match the needs and expectations of graduates of medical universities with the requirements for specialists at the place of employment in the field of health care.

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