What should medical students do during a winter crisis?
Clinical students may feel the strain of winter pressures during placements, but be ready for opportunities to practise key skills and to help the team within your competence
During the winter of 2017-18 the NHS struggled to cope with the number of patients seeking care. Elective lists and outpatient clinics were cancelled, ambulances queued outside emergency departments, and the BMA said it was the worst winter on record. Doctors’ leaders raised concerns about decreased training opportunities for junior doctors, and in some areas medical schools asked clinical students to step in and help, prompting some to worry about exploitation and safety. Clinical students may wonder how their training might be affected and what they should and should not do during a crisis.
Winter pressures are acutely noticeable to a medical student on clinical placement, says Declan Murphy, a final year medical student at Norwich Medical School, but he is positive that the demand on services can bring opportunities for students to develop their clinical acumen. “The increased influx of patients provides an opportunity for students to practise procedural skills that are integral to the role of a foundation year doctor,” he says.
“Get stuck in”
Medical students should not stay out of the way during the winter pressures, says Vikky Morris, a consultant geriatrician at Taunton and Somerset NHS Foundation Trust. “Get stuck in,” she says, “there are plenty of opportunities to help.” Depending on their competence and what stage of their training they are at, Morris suggests students might be able to write notes, request blood tests, find charts on ward rounds, get blood taking equipment, and take blood.
Giles Bond-Smith, a consultant general surgeon at the Oxford Radcliffe NHS Trust, says students can make themselves extra useful by taking on administrative tasks such as chasing reports and finding out times of scans to help with patient flow. “Patient flow is the most important part of ensuring the hospital does not clog up,” he says.
“What can I do to help?”
Bond-Smith also says that help in theatre is always appreciated. “Ask early in the day if all theatres are fully staffed and could they do with an extra assistant,” he suggests. “There’s a big difference between a positive ‘what can I do to help’ and a more negative ‘does anything need doing’ question.”
Medical students are in a unique position because they can spend more time with patients, says Nik Kendrew, a general practitioner in Kent. “Time is such a precious commodity in healthcare, and you could make such a difference with that,” he says. For example, he suggests that students take a detailed social history and explore the patient’s ideas, concerns, and expectations. “A busy doctor might touch on [this] but might not complete the picture, whereas you’ve got the time to explore that properly,” he says.
As well as practising their history taking skills, Kendrew says that this is also an opportunity for students to work on presenting their findings in a slick and succinct way. “The doctor doesn’t have time to listen to you repeat verbatim what’s going on, and that will help with your development as a student,” he says.
Know your limits
Kendrew advises students that if there is anything they are not sure about they should ask. “They should not go beyond what they have been trained to do, and what they feel confident doing,” he says. Students should not make management decisions or promise any kind of test or treatment without running it past the doctor first. “If you start promising things or giving a firm diagnosis, which you may or may not be right about, that can make life more difficult for the doctor to unpick and sort out,” Kendrew added.
Kendrew says that there is a desire to help people at every level in medicine, but warns students that even if they are keen to assist they must recognise their limitations. “This is especially true when you are a student because it can be tempting to do more than is safe. Going beyond the limits of competence could cause harm to a patient, could lead to a complaint, and could also raise questions about the student’s professionalism and even concerns about their fitness to practise,” he says.
Guidance from the General Medical Council is clear that students must recognise the limits of their competence and ask for help when necessary. “You should only attempt practical procedures if you have been trained to do so, and only under supervision that is appropriate to your level of competence,” it says. The guidance goes on to say that you should make sure patients, carers, and colleagues are aware that you are a medical student and not a registered doctor. You should “clearly explain your level of competence to anyone who supervises you on a placement, so you are not asked to do anything you are not trained to do,” it says.
If you have concerns about patient safety, dignity, or comfort, the GMC says that you should raise these promptly, and follow your medical school’s policy on raising concerns wherever possible. “If you think you are not being properly supervised on a placement,” it says, “you should stop the work you are doing and raise your concerns with the placement provider and your medical school.”
Students should be prepared for teaching sessions and lectures to be cancelled because the doctors are too busy. “Last year we ended up with a lot of free time,” recalls Ryhan Hussain, a fourth year medical student at Newcastle University. “It’s up to you how you utilise this time but I’d suggest signing off competencies and starting to look over stuff for the exams,” he says.
Murphy adds that if teaching is cancelled or doctors are too busy to help, students should be proactive in finding educational opportunities for themselves. “Consider asking [staff] if there is anything that you could help with to reduce the burden of their workload,” he suggests.
Trusts and practices should aim to provide the teaching they have agreed with the medical school. Kendrew says that students who are not getting the teaching they are meant to should speak to their educational supervisor. “Ask them the best way forward if you’re not getting the teaching you are expecting,” he advises.
Overall, the winter pressures should be a positive experience for students, says Kendrew. “No matter what happens you can get something out of it,” he says. “It’s an opportunity to gain an understanding of how tough it is out there, because you’ll be in that position one day.”
Tips for students during a winter crisis
- Remember that the GMC’s rules of good medical practice always apply, regardless of how busy it is
- Recognise and act within the limits of your competence—it is your responsibility to ensure that you do not exceed your competence, even if you are asked to do so by healthcare professionals
- Ask for help if you are not confident in performing a task, even for procedures that you think you should know how to do
- Be proactive in approaching doctors and nurses and asking if you can assist them in their jobs
- If you write in a patient’s notes, make it clear that you’re a medical student and include your name and year of study
- Take time to talk to patients, and be honest with them if you don’t know the answer to their questions
- Speak to your educational supervisor if you have concerns about the impact on your training
- Raise any concerns about patient safety, dignity, or comfort in line with your medical school’s policy
- Contact your defence organisation for advice if any issues such as a complaint against you or concerns about your fitness to practise arise from your work on a placement
- Be positive—observing how staff working under pressure during the winter months is an invaluable experience for when you are qualified
- General Medical Council—Achieving good medical practice: guidance for medical students. www.gmc-uk.org/education/standards-guidance-and-curricula/guidance/achieving-good-medical-practice
- British Medical Association—When, why, and how to raise concerns. www.bma.org.uk/advice/employment/raising-concerns
- Understanding the winter pressures: Winter 2017/18: the worst winter ever for the NHS? www.nuffieldtrust.org.uk/news-item/winter-2017-18-the-worst-ever-for-the-nhs#the-worst-winter-ever
Competing interests: MD was employed as a medicolegal adviser by the Medical Protection Society until December 2018.
Provenance and peer review: Not commissioned; externally peer reviewed.
- BMA press release. May 2018 https://www.bma.org.uk/news/media-centre/press-releases/2018/may/bma-analysis-shows-patients-endured-the-worst-winter-on-record
- Rimmer A. Winter pressure is putting junior doctors training at risk, doctors warn. BMJ. 2018. https://www.bmj.com/content/360/bmj.k100
- Gregory J. Medical schools ask students to aid hospitals and GP practices in winter crisis. Pulse today 2018. http://www.pulsetoday.co.uk/news/commissioning/commissioning-topics/urgent-care/medical-schools-ask-students-to-aid-hospitals-and-gp-practices-in-winter-crisis/20035978.article
- The General Medical Council. Achieving good medical practice: guidance for medical students. 2016. https://www.gmc-uk.org/education/standards-guidance-and-curricula/guidance/achieving-good-medical-practice