Student doctors taking responsibility

New guidelines require all undergraduate medical students to undertake at least one period of assistantship where they assume most of the responsibilities of a first-year graduate doctor (FY1 doctor in the UK) under supervision.

To investigate the feasibility of these assistantships.

All UK schools were sent a questionnaire addressing the supervision required and the main barriers around implementation.

Competencies that students already engage in as part of existing clinical placements and a number of 'tacit' competencies (e.g. practice and promote infection control) were regarded by most as suitable. Activities that present a clear clinical risk (e.g. prescribing and writing clinical correspondence) were regarded by most as unsuitable or requiring continuous supervision. Some lower risk but hard to measure activities (e.g. responding in practice to audit) were also regarded as unsuitable by some. A competency was usually considered inappropriate for one of three reasons: (1) current clinical governance and patient safety protocols appeared to bar students undertaking the competency; (2) a competency was not considered to be part of the current FY1 doctors' role; or (3) brief assistantships were considered unlikely to create sufficient opportunity for performing the competency.

The article presents a number of practical issues in relation to assigning responsibility to student doctors. Respondents indicate that successful assistantships will only be possible if the UK National Health Service trusts review their attitude to balancing short- and long-term risks: assistantships need to be long enough to create genuine responsibility opportunities, and will require investment in supervision beyond the current capacity.