“Assistant physician light?” – Feedback from graduates on the practical year

Background: As the final and longest practical phase of undergraduate medical study in Germany, the final year is essential for the acquisition and development of core medical competencies. However, studies show that the educational conditions are often not optimal. The aim of this study was to learn more about the educational conditions connected with the final year and to find out how it can be improved. To do this, written comments from graduate evaluation surveys were analyzed. Methods: Using the data from the survey of Freiburg medical students in the graduating classes of 2015/16 and 2016/17, we investigated which potential improvements were identified by students who had completed the final year and which aspects these students felt they especially benefited from in terms of beginning their medical careers. The written responses by the Freiburg graduating classes of 2015/16 (n=88; response rate: 28%) and 2016/17 (n=112; response rate: 36%) to the questions about beneficial aspects of the final year and potential improvements were qualitatively analyzed for content. As a comparison condition, the written comments of medical students graduating in the same years from the other medical schools in Baden-Württemberg were analyzed. Results: The written responses of the Freiburg graduates to these two questions could be classified according to five main categories. Comments were most frequently assigned either to the category “(more) autonomous work, like an assistant physician” or “(increased) mentoring of the final-year students as learners”. In hindsight, the Freiburg medical graduates felt that they had already benefited in terms of beginning their careers from working independently under supervision during the final year, but they also saw room for improvement and wished that they had been perceived more strongly as learners and encouraged as such. The analysis of the written comments made by students in the same graduating classes at other medical schools in Baden-Württemberg showed corroborating results. Conclusion: The results of this study show how the educational conditions of final year can be optimized. For instance, more opportunities should be created for final-year students to work independently and care for patients, and the course offerings should be expanded and adjusted, if needed, to match the needs of the students. Furthermore, those teaching final year students should be better trained and released from other duties so that they can focus on teaching.