The transition out of medical school – a qualitative study of descriptions of borderline trainee interns

OBJECTIVE: To describe the characteristics of borderline performance in final year medical students (trainee interns), as judged by their supervisors. DESIGN: Qualitative study based on in-depth interviews followed by validation descriptions of borderline trainee interns identified prospectively over 12 months. SETTING: Christchurch School of Medicine, University of Otago, New Zealand. PARTICIPANTS: Fourteen supervisors of trainee interns chosen because of their experience and/or close contact with trainee interns. MAIN OUTCOME MEASURES: Analysis of supervisors' narratives to identify key themes. RESULTS: Borderline trainee intern performance occurs within a transition period from clinical student to doctor and is characterised by difficulty taking on a professional role. This difficulty may be manifest by not getting involved with the health care team, poor time management and occasionally by interpersonal difficulties or not recognising limits. Taking on a professional role requires ability in the clinical task, including diagnostic ability, which is built on a foundation of basic knowledge and clinical skills. These can be influenced by personal factors such as rigidity, motivation and shyness. Personal illness can affect performance at any stage. CONCLUSIONS: The difficulties faced by borderline trainee interns fit a model of transition from competence as a student to performance as an intern. A sensitive marker of such difficulties is poor time management or not getting involved with the patient care team. Such difficulties may reflect more specific problems such as professional socialization, setting priorities, hypothesis generation, assigning probabilities to identified problems, integrating competing issues, recognising limits and learning when to call for assistance.