LAUSR

This spring, a “list of practical procedures” in which junior doctors in the UK should be competent is published by the GMC. However, barriers to achieving competency are not addressed despite junior doctors’ lack of confidence in performing such skills (Monrouxe et al. 2017). This is particularly true for complex skills such as suturing and nasogastric (NG) tube insertion but also where basic skills are concerned, for example, urinary catheterization and IV drug administration. We suggest such unpreparedness, in part, stems from lack of incentive and supervised practice in medical school. This conclusion is supported by interviews conducted with students attending 10 UK medical schools which highlighted significant variability in training requirements and opportunities and exposed an antagonistic culture towards practice within hospitals. However, venipuncture and cannulation are typically practiced at least 3–5 times (7 of 10), many schools only require suturing and catheterization practice once or twice (5 of 10). Equally, many schools require no NG tube insertion practice at all (5 of 10). Other essential skills such as ABGs and IV drug/fluid administration are practiced to variable degrees. The range of practice opportunities also varies: whilst all medical schools offer simulation training, only some provide specialist clinical skills tutors for supervision (8 of 10). A major barrier students’ encounter on wards is the lack of opportunities to practice on patients. Increased reliance on physician assistants means procedures are performed by staff in preference to students. Suturing and NG tube insertion, typically confined to surgery and gastrointestinal wards, respectively, are permitted only at the discretion of the senior staff. Students also describe a need to be ‘pushy’ in seeking opportunities for practice and feel uncomfortable disturbing staff to request supervision. This ethos results in a cycle where students’ lack of confidence is recognized by patients who are then reluctant to offer themselves for procedures. Our poll highlights a need for consistent standards of supervised practice of practical procedures across medical schools. Minimum requirements, especially for suturing, NG tube insertion and catheterization, would incentivize students to become competent. Furthermore, routine supervision by clinical skills tutors would allow for feedback and technique refinement. Underpinning these recommendations is an overarching culture more amenable to student practice – ultimately resulting in improved proficiency of junior doctors.