Clinical competence and growth
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Competence means that a doctor or medical student must act within their abilities to ensure they provide a good standard of care to patients.
It is essential to ensure the competence of the doctors and medical students on the clinical team, otherwise patient treatment may be compromised.
Competence depends on:
- Each doctor and medical student working within their level of training and experience.
- Making clear to patients when a medical student is involved in their care.
- Following ethical and professional principles for doctors and medical students.
To demonstrate competence in a clinical setting, a medical student must
- Understand and not exceed their skills, abilities and training.
- Take the initiative to seek help and guidance whenever needed.
- Clarify their skills and experience to clinical supervisors.
- Take steps as needed to let patients, relatives and clinicians know that they are medical students, not doctors.
- Act promptly when proper supervision is not provided in a clinical setting.
- Ensure they do not perform procedures on patients unless they have the necessary skills, training and experience to treat patients safely.
- Ask for help from a suitable colleague when they are unsure they have the capability to treat patients safely.
Scenarios may challenge you to spot specific issues related to competence. Look for the ethical concerns about skills and experience along with the potential risk to patients.
A doctor or medical student may find themselves tasked to perform a procedure which they are not confident in performing, or are not yet qualified to do.
It is the doctor or medical student’s responsibility to recognise the limits of their competence, as clinical settings can often be busy. Other staff members might ask them to do things without the full knowledge of their capabilities.
As always, patient safety must be prioritised.
Doctors and medical students must be honest and transparent about what they can and can’t do safely.
You’ll find plenty of guidance for doctors on the topic of competence in the Achieving Good Medical Practice booklet:
- Work within your competence – Recognise the limits of your knowledge and skills and seek help when a situation exceeds your expertise.
- Keep knowledge up to date – Engage in continuing professional development to maintain and improve clinical skills and medical knowledge.
- Follow regulations and guidance – Adhere to professional, ethical and legal standards, ensuring patient care is safe and evidence-based.
- Seek training and feedback – Actively participate in training, audits and peer reviews, using feedback to improve performance.
- Delegate appropriately – Only assign tasks to others when confident in their competence, and provide appropriate supervision to ensure patient safety.
The Achieving Good Medical Practice booklet contains the following guidance for students on the issue of competence:
- Know your limits – Never attempt tasks beyond your training or ability without supervision.
- Be honest about your skills – Clearly explain your level of competence to supervisors so you are not asked to do anything you are not trained for.
- Commit to lifelong learning – Engage fully in teaching, training and reflection, ensuring your skills and knowledge remain up to date.
- Follow laws and guidelines – Learn and apply medical laws, regulations and ethical standards, including those set by your medical school and clinical placements.
Some scenarios have key issues related to competence.
A doctor or medical student may find themselves tasked to perform a procedure which they do not feel confident in performing, or are not yet qualified to do so.
It is the doctor or medical student’s responsibility to recognise the limits of their competence, as clinical settings can often be busy and other staff members might ask them to do things without the full knowledge of their capabilities.
As always, patient safety must be prioritised.
Doctors and medical students must be honest and transparent about what they can and can’t do safely.
Walkthrough question
Appropriateness - Competence
Let’s work through a regular Appropriateness set with a key issue related to competence.
Dealing with emergencies means that doctors and medical students should respond quickly and effectively to medical incidents, whether in clinical settings or in the broader community, while following professional and ethical responsibilities.
Doctors are expected to respond to emergencies if it is safe to help and they are competent to deal with the problem. They should also consider available care options for the person in distress, though a doctor may need to act urgently in public spaces when patient safety or dignity is at risk.
In a non-clinical emergency, a medical student should first check their own safety and that they are competent and able to help the person directly, or if it is better to find suitable assistance for the person who needs help.
Medical students must develop confidence in handling real-world incidents.
Medical training often lacks focus on emergencies outside clinical settings. But they may be able to help within their level of competence and ability.
Doctors must mentor students in real-life emergency management.
Public trust in doctors depends on their ability to handle urgent situations.
Poor preparedness can delay critical interventions and harm patient outcomes.
Practical emergency training, including realistic scenarios in the curriculum and hands-on practice in clinical placements, improves response times and decision making.
A culture of readiness in medical training and practice strengthens patient safety and professional integrity.
You’ll find guidance for doctors on the topic of dealing with emergencies in the Achieving Good Medical Practice booklet:
- Respond promptly – Act quickly in an emergency while prioritising patient and personal safety, assessing risks before intervening.
- Work within your competence – Provide care to the best of your ability but seek help if a situation exceeds your skills or experience.
- Communicate clearly – Give concise instructions, collaborate effectively and ensure vital information is shared accurately.
- Follow protocols – Adhere to emergency guidelines and involve senior colleagues or emergency teams when needed.
- Reflect and learn – Review emergency situations to improve future responses, identifying strengths and areas for development.
The Achieving Good Medical Practice booklet states that, whenever dealing with emergencies, as a student you must:
- Assess your own competence – Only provide help in an emergency if it is safe to do so and you feel competent to assist; otherwise, seek help immediately.
- Prioritise patient safety – If you encounter an emergency, focus on alerting qualified professionals and following instructions from supervisors or emergency responders.
- Recognise when to step back – Understand that, as a student, your role is to observe, support and learn, but not to act beyond your training or ability in high-risk situations.
Some scenarios feature doctors or medical students in non-clinical settings who are faced with sudden emergencies and must decide whether or not to intervene.
These emergencies can take place almost anywhere and at any time, such as:
- on a longhaul flight, with the decider en route to an exotic holiday.
- while the decider walks home alone late at night after a party.
- in a restaurant where a fellow diner suddenly falls ill.
Such scenarios emphasise:
- The need for doctors and medical students to intervene when the emergency is serious.
- The importance of identifying themselves and their level of competence clearly.
Walkthrough question
Importance - Dealing with emergencies
Let’s look at an Importance set that features a decider having to deal with a sudden emergency.
Teaching and mentoring is a professional and ethical obligation of all doctors and medical students. It means you must be ready and willing to share knowledge, skills and experience so you can help to develop competent, ethical and confident future doctors.
The GMC requires doctors to contribute to teaching and mentoring. There is a similar expectation for medical students to help mentor other students where possible. This ensures that medical education is a continuous process, with everyone engaged in teaching and mentoring along with lifelong learning.
A culture of teaching and learning benefits the entire medical community and improves patient care.
Medical students who participate in teaching and mentoring appropriate to their role and experience will strengthen clinical skills and confidence.
Medical students must also be open to mentoring from qualified senior colleagues. Mentoring provides essential guidance on career development and wellbeing.
Strong mentoring relationships improve learning and professional growth while also boosting career satisfaction.
You’ll find expectations related to tutoring or mentoring for doctors outlined in the Achieving Good Medical Practice booklet:
- Commitment to education – Doctors should actively engage in teaching, training, mentoring and coaching colleagues to ensure continuous professional development and the improvement of patient care.
- Creating a supportive environment – A positive and respectful learning environment should be fostered, where colleagues and trainees feel comfortable asking questions, discussing errors and raising concerns without fear of judgement.
- Providing constructive feedback – Doctors must offer fair, honest and constructive feedback when mentoring or assessing others, ensuring it facilitates growth and learning rather than discouragement.
- Ensuring safe supervision – Doctors should only delegate tasks to trainees or colleagues when confident in their competence, providing appropriate supervision to ensure patient safety.
According to Achieving Good Medical Practice, students involved in tutoring or mentoring activities, must:
- Provide fair feedback – If asked to mentor or assess peers, give honest, constructive and professional feedback to support their learning.
- Respect boundaries – Recognise your role as a student, avoid acting beyond your competence and refer peers to supervisors when needed.
- Engage in peer learning – Contribute to a supportive learning environment by collaborating with colleagues and sharing knowledge responsibly.
Some scenarios have key issues related to teaching and mentoring.
All doctors and medical students have a duty to pass on knowledge, skills and experiences to help others learn.
They must take this responsibility seriously and approach the role of teacher, trainer or mentor in a professional and engaged manner.
Trying to avoid this responsibility or pass it onto somebody else is inappropriate.
Complaining about this duty is also inappropriate, but conversely, so is taking on too much responsibility in this area voluntarily if it starts to impact patient care or a practitioner’s health.
Students may be asked to mentor other, younger students at their university, or to visit their old schools in order to share their experiences at university so far.
Junior doctors may be asked to teach, train or mentor students.
Consultants may be asked to teach, train or mentor junior doctors.
No matter the teacher or mentor’s level of seniority, they must treat those they are supporting with respect, and help to nurture a collaborative environment that is compassionate and one where everyone is treated equally.
Walkthrough question
Importance - Teaching and mentoring
Let’s look at an Importance set featuring a problem related to teaching and mentoring.