Concern exists that the transition from student to doctor is abrupt and stressful, and that new graduates lack both clinical skills and confidence. This paper explores the effect of a preparation programme on the confidence and skills of new graduates commencing their first clinical post. Fifty-three participants in two English hospitals undertook a two-week induction combining life support, emergency and clinical skills training with administrative induction and shadowing the outgoing house officer. Questionnaires and focus groups at the beginning, end, and one month following the programme explored participants' perceptions. Respondents were initially anxious about starting work, concerned mainly about clinical skills; taking responsibility; being alone; non-technical skills; and local geography and procedures. Confidence increased following the programme, and the programme's contents directly mitigated some fears. Shadowing was most highly valued, though experiences varied; acute emergency training was also valued, but clinical skills revision was more variably received. Having commenced work, these perceptions remained. Confidence increased further, but clinical practice still represented a steep learning curve. This programme to support the transition from medical student to practising doctor was useful and effective, but could be improved. Increasing responsibility during shadowing could effect an even smoother transition.