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Table 3 Early experiences of unpreparedness

From: A qualitative analysis of junior doctors’ journeys to preparedness in acute care

CategoriesThemesNumber of codes (number of respondents)Example quotes
EmotionsOverwhelmed10 (5)“Overwhelmed by the fact that there is a deteriorating patient and you are the main doctor.” (Respondent D)
Out of my depth8 (3)“In F1, so I was apprehensive and then felt worried during the on-calls and also kind of out of my depth in dealing with the things that I was presented with.” (Respondent E)
Challenged6 (4)“It was really hard, and it was really horrible for like, being a doctor for four days and then something like that to happen.” (Respondent B)
Apprehensive5 (3)“Whereas it’s like now go and fend for yourself type thing. I think I was quite apprehensive, apprehensive probably, and unsettled by it as an experience.” (Respondent C)
Unsettled6 (3)“I think in the first few on-calls I found them really upsetting like how unprepared I had felt for them.” (Respondent E)
Minor themes:
 Disassociation Adrenaline rush
“Well I think sometimes you are so busy that you don’t kind of process how you are feeling.” (Respondent C)
Main challenges they facedWhen to escalate9 (4)“I think probably most importantly is knowing when to escalate... I think but there’s a balance between okay, I can do the A to E and I can get all the data that I can think of and at what point does my management stop and there is nothing else that I am comfortable administering on my own? [At] what point do I need senior support?” (Respondent D)
Expectation to perform beyond level of competency11 (4)“So, you were kind of forced to grow faster in your role and to be treated more or less like a heavily supervised SHO.” (Respondent C)
No improvement following initial management3 (3)“I had never been in an experience to say, to see a patient go steadily downhill slowly over the course of the day and have outreach and ITU involved in his care. That’s, it’s usually just you know the unwell patient, acutely unwell patient, manage them, they get better.” (Respondent F)
Minor themes: Unsure on pace of management Difficulty managing families in an emergency“That was probably when it was quite emotional, his family were obviously distraught, they had very little faith in us…” (Respondent G)
Making sense of why they were unpreparedLack of exposure at medical school8 (5)“So, that was the first time I saw something that was quite outside of what I had been used to seeing before I came into F1.” (Respondent F)
Unaware of diagnostic possibilities7 (6)“I just didn’t know at that time what the possibilities were for what was causing that.” (Respondent E)
Managing failure of senior support4 (2)“I eventually got through to the med reg, who was downstairs; it was quite a busy night for clerking... So, eventually, after a little while, he came up, reviewed the patient.” (Respondent G)
Little experience of prioritisation4 (3)“So, it was quite a straightforward septic patient, complicated by the fact that I got two further bleeps; one about a potential MI and one about a potential re-bleed.” (Respondent D)
Preparedness is dependent on clinical scenario11 (5)“I felt more prepared for things like sepsis or a drop in blood pressure... But the things I was called about like on the stroke ward like drop in GCS I felt really unprepared for because I just didn’t know at that time what the possibilities were for what was causing that, what I needed to do and how urgently.” (Respondent E)
Comfortable with ABCDE assessment9 (3)“I suppose, actually kind of being grounded and thinking “well, I do know what to do, it’s just an A to E assessment, let’s start with that and let’s see where that takes us”.” (Respondent D)
Minor themes:  Difficulty translating theory into practise More difficult making decisions in complex cases“…and knowing what kind of, how fast things need to happen, how much I needed to do, what I should do and what I should do if the person I was escalating to didn’t want to come were the challenging things.” (Respondent E)