BACKGROUND New doctors are expected to assess and manage acutely deteriorating patients from their first days in the hospital. However, current evidence suggests that medical graduates are not prepared for this. We aimed to explore junior doctors' first experiences with unwell patients and how they developed preparedness over time. METHODS We conducted seven semi-structured interviews with doctors in their first postgraduate year. The interview transcripts underwent inductive thematic analysis using consensual qualitative research approaches. Themes identified were categorised into early experiences of unpreparedness, first experiences of genuine preparedness, and making sense of how they became prepared. Reflection on how participants progressed between the two was facilitated through a sorting and ranking exercise. RESULTS Most participants initially felt unprepared when responding to acutely unwell patients. They described feeling overwhelmed, apprehensive and challenged. Two main challenges involved knowing when to escalate, and feeling expected to perform beyond their level of competency. A lack of acute care exposure at medical school was a common thread. All participants felt prepared to respond to unwell patients three to six months after starting work. Hands-on experience, reflection, simulation and multidisciplinary team-working were consistently ranked as the most useful learning experiences. CONCLUSION Starting work as a doctor is a challenging time and preparedness to manage an acutely deteriorating patient is a common area of concern. As preparedness in acute care ranks poorly compared to other outcomes, we see this as an important area for improvement. Our findings suggest that undergraduates may lack sufficient opportunities for scaffolded decision making in acute care, and that increasing the intensity of clinical shadowing may improve preparedness and should inform future educational interventions.

中文翻译：

---

定性分析初级医生准备急诊的过程。

背景技术新医生被期望从住院的第一天起就评估和治疗严重恶化的患者。但是，目前的证据表明，医学毕业生对此并不准备。我们旨在探讨初级医生对身体不适患者的初次经验，以及他们如何随着时间的推移做好准备。方法我们在研究生的第一年对医生进行了七次半结构化访谈。访谈笔录采用自愿定性研究方法进行归纳主题分析。所确定的主题可分为早期的未准备经验，真正的准备的初体验以及对它们准备方式的理解。通过排序和排名练习，可以方便地反思参与者在两者之间的进步。结果大多数参与者最初对严重不适的患者做出反应时都没有做好准备。他们描述了不知所措，忧虑和挑战的感觉。两个主要挑战涉及知道何时升级，以及期望超越其能力水平的表现。医学院缺少急救措施是常见的问题。所有参与者都准备在开始工作三到六个月后对身体不适的患者做出反应。亲身实践，反思，模拟和多学科团队合作一直被认为是最有用的学习经验。结论作为医生开始工作是一个充满挑战的时间，准备好应对严重恶化的患者是一个普遍关注的领域。与其他结局相比，急救的准备工作排名较差，我们认为这是需要改进的重要领域。我们的发现表明，大学生可能缺乏足够的机会进行急诊护理中的脚手架决策，并且增加临床阴影的强度可能会改善准备，并应为将来的教育干预提供依据。