A conceptual framework explaining 'professional preparedness' among fresh health professional graduates - a Critical Interpretive Synthesis of literature

Evidence from low- and middle-income countries like India and Nepal suggests that concerns exist regarding the quality of health professional graduates trained in a predominantly private-for-profit education sector (McPake et al. 2015). Professional preparedness is a concept that has been used in literature to indicate the readiness and self-efficacy of fresh graduates to independently practice after training. Due to the considerable variation in literature concerning the conceptualization of preparedness and the lack of clarity in the pathways through which the factors influencing preparedness operate, a systematic review was conducted to achieve the following objectives. • To identify the underlying domains which constitute professional preparedness among health professional graduates • To identify the factors influencing preparedness • To derive a conceptual framework explaining the pathways between them. Original articles published between January 1st 2012 and March 1st 2016 were searched in GoogleScholar, Pubmed and ScienceDirect following the PRISMA guidelines. Since one of our objectives was to develop a framework, a critical interpretive synthesis methodology, which is more conceptual in process, was chosen over a conventional systematic review. Based on the commonalities of attributes which constituted preparedness, eleven themes were identified from 44 papers, which were further reduced into six broad domains through iteration. Three types of factors (individual, institutional, global) belonging to two domains (training school, workplace) were found to influence preparedness. The conceptual framework which emerged brings out the inextricable link between the process of ‘becoming prepared’ and its social context (Theory of situated learning by Lave & Wenger, 1990). Key words: education, public health work force, research/knowledge translation, equity/inequity Key Messages: 1. The construct of professional preparedness has been conceptualized in literature under six broad domains - competence, communication & interpersonal skills, professionalism & ethical judgement, clinical entrepreneurship, social & community orientation and coping. 2. Three sets of factors (individual, institutional and global) operate in two domains (school and workplace) to influence preparedness among graduates. 3. The interlinking pathways which emerged out of the critical interpretive synthesis reflect the inextricable link between the process of 'becoming prepared' and its 'social context'.

Malu Mohan