A study on the Dilemmas faced by Chinese clinical medicine interns preparing for postgraduate entrance examinations: a grounded theory approach

Introduction Clinical internship is a critical stage for cultivating clinical competence among medical undergraduates. However, Chinese clinical medicine interns (CMI) often face intense conflicts between completing internships and preparing for the postgraduate entrance examination (PEE), which severely affects the quality of clinical internship and professional development.Methods Adopting a grounded theory approach, this study conducted in‑depth interviews with CMI who had experienced an internship and PEE preparation. Data were analyzed using open coding, axial coding, and selective coding to explore the dilemmas and corresponding solutions.Results Three levels of dilemmas were identified: (1) Student‑level dilemmas: limited learning outcomes from internships, pressure for postgraduate advancement, and aspiration‑reality gaps. (2) Teaching‑level dilemmas: low sense of teaching accomplishment and low teaching efficacy. (3) Institutional‑level dilemmas: weak regulation enforcement and misalignment of institutional orientation.Conclusion To alleviate these conflicts, this study proposes optimizing the internship model, strengthening teaching incentives, redesigning the clinical skill evaluation system, and tightening regulation enforcement. These strategies are expected to foster a supportive clinical learning environment and strengthen the development of competent medical professionals.