From AT to BT – research shows what works
The transition from medical student to licensed physician is a crucial phase in medical education. A research project at the University of Gothenburg has examined the medical internship (allmäntjänstgöring, AT) as part of this process. Three publications provide new and important knowledge about this transition.
As the medical internship (AT) is now gradually being phased out and replaced by “bastjänstgöring” (BT), it is important to ask: What are we leaving behind – and what do we need to preserve? That is the starting point for the research project led by Matilda Liljedahl and Yvonne Carlsson at Sahlgrenska Academy.
"We have not tried to evaluate the internship program, but to understand what has been perceived to work. It is about learning, support, and structures – and what it means when one is growing into their first professional role," says Matilda Liljedahl, Associate Professor of Health Professions Education at the University of Gothenburg and resident physician in oncology at Sahlgrenska University Hospital.
The studies are based on interviews with internship doctors and program directors across Sweden. The researchers describe the studies as important contributions to the understanding of the intenship as a learning environment – a field that has previously been sparsely explored in a Swedish context.
A system that works
The findings are clear: the medical internship in Sweden functions as a safe transitional phase where doctors have both the time and space to learn the profession.
"Internationally, this phase is often described as extremely stressful. But our interviewees spoke of strong structure and present support. They did not feel burned out or overwhelmed – quite the opposite," says Yvonne Carlsson, doctoral student at the University of Gothenburg. This is not to say that the AT program cannot be challenging or that individual doctors may not experience work-related health issues during their internship.
An important factor for success is that medical interns (AT-läkare) are seen as individuals who are there to develop as doctors – and not just as labor. There seems to be a built-in expectation of learning and a clear mandate within the intership structure for supervision and support.
Space for learning
Perhaps the most central concept to emerge from the research is the "space" that the internship program creates – for reflection, learning, and development.
"This is a phase where you are allowed to be new. You are allowed to ask questions, to develop at your own pace, and to work in an environment that is consciously designed for learning. It is a space we must protect," says Matilda Liljedahl.
The intership program directors in the study also emphasized the importance of not wasting this space – something that needs to be considered in the implementation of BT.
Pedagogy in focus
The studies clearly place themselves within an educational research tradition, focusing on how professional identity is formed and how learning is organized. In a time when the educational system is changing, there is a risk that important structures may fall through the cracks.
"We must not throw the baby out with the bathwater, as the saying goes. Our studies show that the internship has served as a way to gradually grow into the role of a doctor, with a safe framework. This does not mean that the new bastjänstgöring cannot work – but we need to retain what has been valuable so far," says Yvonne Carlsson.
The researchers believe it is important to continue monitoring the transition between the educational systems and the changed conditions that the introductory program entails.
Here you can read the three scientific articles resulting from the project:
Yvonne Carlsson, Anna Nilsdotter, Stefan Bergman and Matilda Liljedahl. Junior doctors' experiences of the medical internship: a qualitative study. International Journal of Medical Education, 2022; 13:66-73. DOI: 10.5116/ijme.6229.d795
Yvonne Carlsson, Stefan Bergman, Anna Nilsdotter and Matilda Liljedahl. The medical internship as a meaningful transition: A phenomenographic study. Medical Education, 2023;57:1230–1238.
DOI: 10.1111/medu.15146
Yvonne Carlsson, Filip Olow, Stefan Bergman, Anna Nilsdotter and Matilda Liljedahl. Learning to work and working to learn: a phenomenographic perspective on the transition from student to doctor.
Advances in Health Sciences Education (2025). DOI: 10.1007/s10459-025-10424-9
The transition from AT to BT is part of a national reform aimed at creating a more unified and structured path to specialist training (ST), harmonizing with the rest of Europe, and serving as an introduction to Swedish healthcare.
The new six-year medical education leads directly to medical licensure without the requirement for AT. BT is an introductory service that is the first part of ST. BT is shorter than AT, with a standard duration of 12 months compared to AT's 18 months. During BT, placements are made in emergency care, primary care, and psychiatry, with a key component being the observation of competence progression, which is evaluated through regular assessments. Doctors who begin ST after July 2021, without having completed Swedish AT, must all undergo BT.
The first cohort from the new medical education program will graduate in June 2027 and will then be eligible to apply for BT as an initial part of their ST.
At Sahlgrenska University Hospital, three forms of basic service (BT) are currently offered: independent BT (12 months of clinical service), research BT (12 months of clinical service where doctors conducting active research at Sahlgrenska University Hospital or the University of Gothenburg are offered 6 months of paid research time as part of BT), and BT integrated into specialist training (ST).
For those ST doctors who complete their BT integrated, the BT subgoals should be met within the first two years. At Sahlgrenska University Hospital, there is a BT office within the Education Unit for Research and Education (FoUUI), which handles overarching BT issues and supports the entire SU with BT-related questions.