Table 1. Overview of the challenges and adaptations identified by the participants

IV. DISCUSSION

A. Theme One: Disruptive Novel Elements

Firstly, participants described their experiences in adapting to a new pedagogy, from Conventional Didactic Learning (CDL) to Team-Based Learning (TBL). While numerous studies confirm TBL’s superior effectiveness and engagement over CDL, participants in this study faced hurdles in adjusting their learning methods. 

Participants discovered that a lot of the learning had to be self-directed, with little to no guidance from the school. This left them uncertain about expectations and the ‘proper’ way to prepare for the TBLs. This feeling is similar to other studies performed in Western societies (Malau-Aduli et al., 2020).  

“I also didn’t know how to prepare because, the lessons are completely new. It was quite overwhelming.”

Male #1

Participants also expressed that the sheer volume of content was quite overwhelming, marking a significant leap from their experience in secondary education.  

Secondly, participants discussed how the increased number of social activities influenced their transition experience. Some found it tough to balance their academic commitments and social life, a challenge exacerbated by the lack of structured timetables and the influx of social events. 

Naturally, participants felt some apprehension upon entering medical school, aware that each year it attracts the nation’s most intelligent. However, they experienced a sense of solidarity when they realised that their peers were not markedly smarter or more skilled than they were. It is natural for individuals to unite and support one another during such challenging times, which is mirrored in studies analysing the transition from pre-clinical to clinical years of training. 

B. Theme Two: Perceptions and Coping Strategies

First-year medical students often bring preconceptions shaped by prior life experiences into university (Kang et al., 2021) and this influences both their self-perception and their transition experience. Participants with family members who are doctors, seemed better mentally prepared for the rigours of medical education and career while first-in-family doctors were more surprised by the intensity of the workload. 

To navigate these changes, participants began to seek avenues for support and guidance, and found that they were readily able to do so within both the school and the broader medical community. While trust among healthcare workers is a cornerstone of efficient interprofessional collaboration and teamwork there is limited literature on how this can be nurtured. 

“If I approach my seniors they are really nice about it, even those who are 3 years into being a doctor… it’s cool.”

 Female #1 

C. Theme Three: Personal Development and Outcomes

Despite being in the early stages of their medical journey, participants already feel driven to excel and manage this significant change in their lives. They exhibit a clear endeavour to cultivate resilience, which mirrors the typical profile of students medical school tends to attract: those fuelled by a deep sense of purpose in the profession, and who are thus willing to invest the necessary effort to succeed. 

Transitional periods within the medical education continuum invariably come with heightened stress levels as students experience constant evolutions of their professional roles and identities. Considering that stress can hinder learning, educators are advised to better educate and prepare students for these shifts, thereby facilitating a smoother transition. Even if students do not raise their concerns to the teaching faculty, it might stem from placing trust in the educational system, even within suboptimal learning environments. This can lead to cognitive dissonance, which students might resolve through rationalisation. Recognising that the transition into medical school carries significant mental health implications for students is something educators must consider (Nyquist, 2011).

D. Strengths and Limitations

There is a noticeable lack of research focusing on the transition from pre-university to undergraduate medical education. This report begins to bridge this gap. Additionally, by incorporating the distinct cultural context of Singapore, it offers an Asian perspective in the field of medical education that has been predominantly influenced by Western viewpoints.  

The sample size for this study is limited, and the perspectives gathered may not comprehensively represent the broader Year 1 undergraduate medical school population. Further studies may look into gathering data from other local medical schools in Singapore or Southeast Asia or explore clinical educator’s perspectives on balancing altering the curriculum to ease the transition period with meeting the demands of the universities in producing competent doctors.  

V. CONCLUSION

For most, studying medicine is a cherished dream. Although the transition presents many challenges, it also offers enriching and positive experiences. Students have their own motivations and coping strategies to navigate this phase, but no matter how adeptly they seem to handle the transition, there remains an ever-present role for educators to improve this process. 

Notes on Contributors

Prabanjini Rajkumar is a fourth year medical student at the Lee Kong Chian School of Medicine. She carried out the review of literature, conduction of interviews, analysis and coding of transcripts and the writing of the manuscript.

Dr. Lucy Wilding is a Senior Lecturer in Medical Education and serves as the Assistant Dean for Years 1 and 2 at the Lee Kong Chian School of Medicine. Dr. Wilding conceived the topic and nature of this study. She has provided invaluable expertise and guidance in shaping its direction.  

Ethical Approval

The study was approved and IRB number for this paper is IRB-2023-348, with the Review Board being NTU (Nanyang Technological University) Institutional Review Board.

Acknowledgement

I would like to acknowledge the Year 1 Medical Students who graciously took part in this study without any incentives and would like to thank them for sharing their experiences with me.  

Funding

This is an unfunded study.  

Declaration of Interest

All authors have no potential conflicts of interest.  

References

Kang, Y. J., Hwang, J. S., Lin, Y., Lee, H. J., Han, S. Y., & Kim, D. H. (2021). Exploring the preconception of the first year of medical students on medicine before entering medical school. Korean Journal of Medical Education, 33(4), 369–379. https://doi.org/10.3946/kjme.2021.205

Malau-Aduli, B. S., Roche, P., Adu, M., Jones, K., Alele, F., & Drovandi, A. (2020). Perceptions and processes influencing the transition of medical students from pre-clinical to clinical training. BMC Medical Education, 20(1). https://doi.org/10.1186/s12909-020-02186-2

Nyquist, J. G. (2011). Educating physicians: A call for reform of medical school and residency. The Journal of Chiropractic Education, 25(2), 193–195.

Sá, J., Strand, P., Hawthorne, K., Da Silva, A., & Kitto, S. (2021). Transitions in medical education: Filling in the blanks. Educacion Medica, 22(6), 346-351. https://doi.org/10.1016/j.edumed.2021.07.001

Westerman, M., Teunissen, P. W., van der Vleuten, C. P., Scherpbier, A. J., Siegert, C. E., van der Lee, N., & Scheele, F. (2010). Understanding the transition from resident to attending physician: A transdisciplinary, qualitative study. Academic Medicine, 85(12), 1914–1919. https://doi.org/10.1097/ACM.0b013e3181fa2913

*Prabanjini Rajkumar
50 Nanyang Ave
Singapore 639798
82330803
Email: m200068@e.ntu.edu.sg