Working within the limits of your competence

Starting work as a junior doctor can raise some anxieties for many and it is inevitable for new doctors to feel out of their depth at times. While undertaking new tasks is a necessary part of your professional development, it is important that this is done in a structured and supported manner. The priority is always patient safety.

It can be particularly difficult to speak up when a senior colleague asks you to perform a procedure or do something where you feel out of your depth. However, the overriding principle is laid out in the GMC’s Good medical practice (paragraph 14):

14. You must recognise and work within the limits of your competence.

Therefore, if you feel like you’re being asked to do something that is outside your level of expertise or experience, you should explain this rather than attempt to undertake the task.

How to say no

How to say no can be as important as actually saying it. It might feel awkward to decline a request from a senior, especially if they seem dismissive of your valid concerns. You may feel embarrassed admitting you do not feel competent to undertake the task they are requesting. Instead of refusing the request, consider the following:

• Explain that you are willing, but you do not have the requisite experience to agree to the request. This can frame the refusal in a collaborative way.
• Follow up with confirmation that you are keen to learn and therefore would like to assist or observe so you can perform what is requested of you in future.

It is worth bearing in mind that the landscape current medicine is practised in is very different from how it was even a decade ago. There have been significant shifts in the medico-legal and regulatory aspects of medicine and an increasing emphasis on patient safety.

The old adage of see one, do one, teach one (SODOTO) is sometimes used to reference the fact that previous generations of junior doctors just ‘got on with it’ even if they had minimal training. The principle of observing a procedure before attempting it under appropriate supervision is not necessarily problematic, but it can push juniors to complete procedures they do not feel safe to do – which is problematic. If your concerns are met with a SODOTO type response, remember that just because something was common practice in the past, does not mean that it’s acceptable now.

Addressing gaps in your knowledge

Another point to consider when you are unable to do something as a junior doctor is whether this is something that you should be able to do. We all learn differently and at different rates. However, if all your peers are able to carry out a task, it’s possible the request was not unreasonable. If this is the case, you still should not perform the task if you feel unsafe to do so. Instead, it would make addressing this gap in your knowledge a priority learning need.

Don’t forget to accept help and teaching from other health professionals where appropriate. It does not have to be another doctor that teaches and supervises you. Many nurses and other allied health professionals will be able to perform the tasks you need to become competent at and are often happy to help you learn.

If you keep getting asked to work beyond your capabilities

If you are consistently asked to act beyond your competence to the point it becomes a patient safety issue, it would be appropriate to discuss this with your clinical or educational supervisor in the first instance. If this discussion does not lead to a resolution of your concerns, then contact your foundation programme director for further advice.