Easing the transition from student to doctor: how can medical schools help prepare their graduates for starting work?

Background: In 2000/1, a survey found that 42% of newly qualified UK doctors felt their medical training had not prepared them well for starting work.
Aim: To determine factors associated with preparedness.
Methods: A questionnaire to all 5143 newly qualified doctors in May 2005.
Results: The response rate was 2062/4784 = 43.1%. 15% of respondents felt poorly prepared by medical school for starting work. There were no associations between gender or graduate entry status and preparedness. The personality traits of conscientiousness (r=0.14; p < 0.001) and extraversion (r=0.15; p < 0.001) were associated with high preparedness. Neuroticism was associated with low preparedness (r= -0.16; p < 0.001).Respondents who had done shadowing attachments were more likely to feel prepared (58.6% vs 48.5% felt prepared; 2=4.0; p=0.05), as were graduates of problem based learning courses (61.3% vs 56.1%; 2=5.0; p=0.03). Preparedness correlated with agreement with the statements 'My teaching was relevant to real life as a doctor' (rho=0.36; p < 0.001), and 'As a house officer I found it easy to get help when I needed it' (rho=0.29; p < 0.001).
Conclusions: Improvements in the preparedness of UK medical school graduates may be due to increased relevance of undergraduate teaching to life as a junior doctor and increased support in the workplace.