Transition to clinical training: influence of pre-clinical knowledge and skills, and consequences for clinical performance

Elisabeth A. van Hell*, Jan B. M. Kuks, Johanna Schonrock-Adema, Mirjam T. van Lohuizen, Janke Cohen-Schotanus

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

59 Citations (Scopus)
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CONTEXT Many students experience a tough transition from pre-clinical to clinical training and previous studies suggest that this may constrict students' progress. However, clear empirical evidence of this is lacking. The aim of this study was to determine: whether the perceived difficulty of transition influences student performance during the first 2 weeks of clerkships; whether it influences students' overall performance in their first clerkship, and the degree to which the difficulty of transition is influenced by students' pre-clinical knowledge and skills levels.

METHODS Clerks (n = 83) from a university hospital and eight affiliated hospitals completed a questionnaire measuring the perceived difficulty of the transition period. Data collected included student scores on pre-clinical knowledge and skills, their performance during the second week of the first clerkship, and their overall performance in the first clerkship. Univariate and multivariate multiple regression analyses were used to analyse the data.

RESULTS The perceived difficulty of transition was neither predictive of student performance during the transition period (adjusted R(2) = 11.8%, P = NS), nor of their overall clerkship performance (adjusted R(2) = 8.6%, P = NS). Students' pre-clinical knowledge and skills played a minor role in the perceived difficulty of the transition period.

CONCLUSIONS The negative effect of the transition period on student progress suggested in the literature was not found in this study. A possible explanation for the limited influence of students' knowledge and skills on performance during the transition period is that the workload in this period causes a cognitive overload, interfering with students' abilities to apply their pre-clinical knowledge and skills.

Original languageEnglish
Pages (from-to)830-837
Number of pages8
JournalMedical Education
Issue number8
Publication statusPublished - Aug-2008


  • multicenter study [publication type]
  • clinical competence, standards
  • clinical medicine, education clinical clerkship
  • stress, psychological
  • humans
  • Netherlands
  • students, medical, psychology
  • attitude of health personnel
  • educational status


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