Working on the ward

This would be in line with GMC guidance.

Teresa would need to identify herself as a medical student and be correctly supervised by the nurse under the overall direction of the doctor. It is also important that Teresa has an appropriate level of experience in performing the procedure.

This would be in line with GMC guidance.

Teresa would need to have the appropriate level of experience in performing this particular procedure. Teresa should also be supervised by a registered healthcare practitioner.

This may be in line with GMC guidance.

Para 7 of Achieving good medical practice says that students should only treat patients or give medical advice when under the supervision of a registered healthcare practitioner. It does not bar students from performing invasive procedures. However, it may be that Teresa lacks appropriate experience in performing a blood test or is incorrectly supervised. If this were the case, she would be correct in declining to perform the procedure.

Teresa explained to the patient that she is a medical student in her final year and that the nurse would supervise the procedure.

However, the patient was uncomfortable with Teresa performing the blood test due to her lack of experience, and Teresa decided to wait until another healthcare professional was available.

This is not in line with GMC guidance.

Medical students should accept that they may not be able to accurately assess their own health, and that their own health problems may put patients and colleagues at risk. Para 33 of Achieving good medical practice says that some conditions that are usually minor - such as the common cold - may have a disproportionate impact on some patients, for example those with compromised immune systems. Students need to bear this in mind when they decide whether to go to a placement if they are unwell.

This is not in line with GMC guidance.

Para 38 of Achieving good medical practice says that medical students should seek independent and objective advice from a GP or other appropriately qualified healthcare professional and not rely on what they have learnt as a medical student or the views of other students, medically qualified family members or friends.

This may be in line with GMC guidance.

However, only in exceptional circumstances should doctors involved in teaching the student also be involved in providing a medical assessment or healthcare (Good medical practice, para 16 g).

This is in line with GMC guidance.

Medical students should be registered with a GP to ensure they have access to independent and objective medical advice (AGMP para 38).

Teresa left a message for one of the doctors on the ward asking to meet up to receive a medical assessment. However, the doctor in question responded saying that he really shouldn't be providing a medical assessment as he is also teaching her on the placement.

Teresa decided to go and see her local GP for advice instead and was subsequently advised to take a few days off to fully recover.

This is in line with GMC guidance.

In Outcomes for graduates, there are two outcomes (paras 2t and 3c) which specifically mention developing skills to reflect effectively whilst at medical school, and learning to reflect as a coping strategy to help maintain and improve personal well-being.

A reflective note should be anonymised as much as possible. If it relates to a patient Teresa has seen or any other specific individual, she must take steps to anonymise the details. This doesn’t just mean not naming the patient; other things can be put together to identify an individual, like:

• age
• gender
• job title
• ethnicity
• ward/GP practice you saw them at
• medical condition.

In practice, reflective notes need very little clinical detail, just the context. The learning is on the reflection – what you did, how did you feel and what might you do differently next time.

This is not in line with GMC guidance.

Any reflective note needs to be anonymised. Information is anonymised if it does not itself identify any individual, and if it is unlikely to allow any individual to be identified through its combination with other information.

This is in line with GMC guidance.

Reflection is personal, and there is no set way in which to reflect. A medical student will need to experiment to find what works best for them to demonstrate evidence of reflection. Thinking about ways they learn, and how they process and retain information most effectively, can be helpful.

However, sometimes the medical school will require students to submit a piece of written reflection to show that they have met a specific outcome, so it would be a good idea to practise writing a reflective note.

Reflection is an essential activity that doctors use every day in their practice – doctors in training are required to reflect as part of their Annual Review of Competence Progression and it is a core requirement for revalidation.

Teresa decided to write down her reflections about her experiences on the hospital ward. She first checked the guidance for students on being a reflective practitioner, to make sure her reflections were appropriately anonymised. Teresa wanted to practise doing this as she knew that she would need to record her reflections later in her career as a doctor, and so needed to learn how to do it effectively.

Teresa showed her reflections to her personal tutor, and they had a very productive discussion about her experiences, what she had learnt and what she would do next time. The tutor gave Teresa constructive feedback on her writing style, suggesting techniques for how she could structure future reflective notes.