Residents’ and preceptors’ perceptions on newly introduced milestones—a qualitative study in general practice/family medicine in Finland

In the context of competency-based postgraduate education, professional progression is often tracked through milestones, particularly in North American settings. This study aimed to explore the perceptions of residents and preceptors regarding newly implemented milestones in self-assessment and formative assessment within Finland's 6-year national postgraduate education (PGE) program for family medicine/general practice. We conducted a qualitative study involving preceptors and residents participating in a nationwide 1-year pilot study that utilized a mobile application for milestone tracking. All five universities responsible for PGE recruited a total of 35 preceptors and 36 residents for the study, which began in April 2022. Participants for the focus group interviews were recruited via email from those study participants still involved in training or serving as preceptors between late 2022 and March 2023. Subsequently, six preceptors and six residents participated in semi-structured interviews, conducted in groups of three participants each. The interviews were conducted separately for preceptors and residents. We employed a constructionist approach and used inductive thematic analysis to examine the data from a sociocultural perspective. We identified six major themes reflecting perceptions from both groups: 1) Enhancing goal orientation, 2) Facilitation of supervisory meetings, 3) Milestones document as a tool, 4) Support in assessment, 5) Variability in the search for the zone of proximal development, and 6) Provocation of emotions. The major theme of ‘enhancing goal orientation’ including the subthemes, was perceived similarly across the groups. However, we found differing emphases in 14 out of 22 subthemes. The study provided insights into previously unexplored themes, including the emotional impact of milestones, the role of supervisory meetings, and variability in strategies for searching for the zone of proximal development. Other themes we identified, such as enhancing goal orientation, milestone documentation, and support in assessment, aligned with existing literature.