The effectiveness of the internship in meeting established learning objectives: A qualitative study

Objective: To identify and explore variations in intern (Postgraduate Year 1 doctors) exposure to clinical activities defined by an established early postgraduate curriculum within the contemporary health service environment.

Methods: A mixed methods study was undertaken in seven health services comprising (1) a questionnaire regarding interns’ exposure to a range of clinical activities within a two-year early post-graduate curriculum and (2) group interviews with intern supervisors and managers to explore barriers and facilitators of interns’ clinical exposure.

Results: One hundred and eleven interns completed the questionnaire and seventeen intern supervisors and managers participated in group interviews. Interns’ exposure to early postgraduate curriculum activities varied significantly, with participation in patient emergency management and procedures being undertaken less frequently than interns wished. These findings were consistent across different regional settings. Of three mandatory terms, exposure to curriculum activities was greater in medicine and emergency medicine than in surgery.

Conclusions: Junior doctors’ participation within the complex contemporary health service environment is constrained by barriers relating to clinical governance frameworks and health system performance, particularly in high-risk clinical activities. Solutions will require structural approaches to internship reform to ensure that placements provide the necessary safe clinical experiences required for intern training.