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Being asked to perform a task beyond your level of training or competence is one of the most critical SJT themes. These scenarios test a fundamental professional principle: knowing the limits of your competence and acting within them.
The GMC's Good Medical Practice is explicit: doctors (and medical students) must recognise and work within the limits of their competence. This lesson works through detailed scenarios where this principle is tested.
You must never attempt a clinical task you are not trained, competent, and supervised to perform — regardless of who asks you.
This applies even when:
The SJT rewards candidates who set clear boundaries while offering constructive alternatives.
| Risk of exceeding your competence | Consequence |
|---|---|
| You may harm the patient | The task may be performed incorrectly, causing physical harm |
| You are personally liable | If you perform a task beyond your competence and something goes wrong, you bear responsibility |
| You undermine the supervision system | The system is designed to ensure appropriate oversight of trainees |
| You set a dangerous precedent | If you comply once, you may be asked again — and the pressure escalates |
| Patient trust is damaged | Patients consent to treatment from qualified professionals, not untrained students |
You are a medical student on a surgical placement. The FY1 is overwhelmed and asks you to insert a urinary catheter into a male patient. You have observed the procedure twice but have never performed it.
| Option | Rating | Reasoning |
|---|---|---|
| A: Attempt the catheterisation because you have watched it and feel you understand the steps | Very inappropriate | Observation is not competence. Male catheterisation carries real risks (urethral damage, false passage, infection). Performing it without training and supervision could harm the patient |
| B: Decline and explain: "I have only observed this twice and have not been signed off. I am not confident I could do it safely without supervision. Is there someone who could supervise me, or could another team member do it?" | Very appropriate | Clear, honest, and constructive. You explain your limitation, protect the patient, and offer alternatives |
| C: Agree but ask the FY1 to talk you through it over the phone | Very inappropriate | Phone guidance is not adequate supervision for a procedure you have never performed. If something goes wrong, you are on your own |
| D: Refuse and walk away without offering any alternative | Inappropriate | While refusing is correct, walking away without helping find a solution is unhelpful. The patient still needs the catheter |
Notice how option B works:
This is the gold standard for handling competence boundary situations.
You are a medical student shadowing an FY2 in A&E. The department is extremely busy. The FY2 asks you to clerk a new patient independently, make a provisional diagnosis, and order initial investigations. They say, "Just write it up and I will sign it later."
| Option | Rating | Reasoning |
|---|---|---|
| A: Clerk the patient as asked, make a diagnosis, and order investigations | Very inappropriate | Medical students cannot make independent clinical decisions, order investigations, or create management plans without supervision. Even if the FY2 signs later, the initial clinical decisions were unsupervised |
| B: Explain that you are happy to take a history and examine the patient, but you would need them or another doctor to review before any decisions are made | Very appropriate | You are contributing within your competence (history-taking and examination) while maintaining appropriate boundaries (not making clinical decisions unsupervised) |
| C: Refuse to help at all because you are "only a student" | Inappropriate | There are things you can do within your competence. Refusing entirely is unhelpful when you could contribute meaningfully within appropriate boundaries |
| D: Clerk the patient but escalate to the registrar instead of the FY2 | Inappropriate, but not awful | The escalation to the registrar is unnecessary at this stage. The FY2's request is well-intentioned; the issue is the scope, not the person |
Medical students can:
Medical students cannot:
The correct approach is to contribute what you can and ensure appropriate supervision for what you cannot.
You are an FY1 covering a ward overnight. A nurse calls to say a patient is in severe pain and asks you to prescribe a controlled drug (an opioid) that you are not familiar with. You have never prescribed this particular medication before and are unsure of the correct dose, route, and monitoring requirements.
| Option | Rating | Reasoning |
|---|---|---|
| A: Prescribe the medication based on a quick internet search | Very inappropriate | Prescribing unfamiliar controlled drugs based on internet searches is dangerous. Opioids require careful dosing, and errors can be fatal |
| B: Tell the nurse you are not familiar with this medication and ask them to contact the on-call pharmacist or a more senior doctor for advice | Very appropriate | Honest, safe, and constructive. You acknowledge your limitation and direct the nurse to someone who can help |
| C: Prescribe a different pain medication that you are familiar with | Inappropriate, but not awful | While pain management is important, prescribing a medication that may not be appropriate for the level of pain is not ideal. It is better to seek advice about the correct medication |
| D: Tell the nurse you cannot help and to wait until the morning team arrives | Inappropriate | The patient is in severe pain. You have a duty to act — even if acting means seeking help from someone more qualified rather than prescribing yourself |
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