Learning with patients remains at the heart of medical student training. From outpatient clinics to emergency departments and general practice, 'learning by doing' in real clinical settings provides rich and meaningful educational experiences.
Since the days of Osler, learning in the clinical environment, commonly referred to as 'work-based learning', has remained integral to nurturing the next generation of doctors. More than just observing patient care, there is now a greater emphasis to actively involve medical students in the care of patients - experience-based learning (ExBL)2.
Contributing to patient care can create transformative learning moments for medical students, whether that is taking a history, recording vital signs or taking a venous blood sample. Such 'hands-on' experiences help students develop clinical competence and their professional identity as a future doctor2.
As medical students scaffold their learning through active involvement in patient care, they gain a vital understanding of what it feels like to be a doctor. Often, this learning involves being given slightly more responsibility than expected.
However, it is during these important learning moments that clinical supervisors play a critical role in providing support and oversight to ensure both student development and safe patient care.
Clinical supervisors are central to balancing the dual responsibility of supporting medical students' learning while ensuring high standards of patient care.
The role of clinical supervisors
Clinical supervisors are central to balancing the dual responsibility of supporting medical students' learning while ensuring high standards of patient care. With an increasing focus on ExBL in clinical settings, the need for accountable clinical supervision has never been greater.
This is particularly important in general practice, where medical students are increasingly gaining clinical experience. GP tutors must take every measure to uphold accountability in both their clinical and educational practice.
This becomes especially relevant when student actions potentially risk compromising patient care - such as taking an incomplete history that goes unreviewed, relying solely on a student's suboptimal clinical examination findings, or not clearly communicating to a patient that they are speaking with a medical student rather than a qualified doctor.
How to support GP tutors
To support GP tutors in this role, we offer practical tips to help ensure they maintain accountability while creating the best possible opportunities for medical students to learn and provide safe and effective patient care.
From a GP tutor perspective
- Emphasise professional introductions: During the student's induction to the practice, reiterate to students the importance of introducing themselves correctly and consistently to patients, family, carers and staff.
- Obtaining patient consent: Always ask patients if they are comfortable with a medical student's involvement in their consultation and explain clearly what the student might do (for example, take a history, perform an examination). Patients must never feel rushed or pressured into agreeing, and they should also be made aware that they can change their mind, and that this won't affect the care they receive.
- Managing patient expectations: Briefly explain the student's stage of training to help patients understand the level of studies and what they might expect.
- Provide clear oversight: Whether you are physically present in the room or nearby, always make it clear to the patient that you are ultimately overseeing their care.
- Use learning moments wisely: Where appropriate, ask students to present their findings in front of patients. This encourages professional communication skills and places another check that an accurate assessment has been made by the medical student.
- Trust your clinical instincts: If a student's findings or conclusions seem incomplete or incorrect, double-check with the patient directly -particularly in higher-risk scenarios (for example, chest pain suggestive of cardiac causes rather than a chest wall aetiology). Such moments can be valuable learning opportunities without compromising patient care.
From a medical student perspective
- Work within your level of competence: Always acknowledge your limits. Seek help when necessary and never undertake tasks you are not trained or authorised to perform.
- Clearly identify yourself to patients: Even if your tutor introduces you, re-confirm with patients, family and carers that you are a medical student. This applies during in-person and telephone consultations. Consent is a continuous process, and patients must be given opportunities to change their minds at any stage without pressure.
- Use clear professional identifiers: As scrubs are now commonly worn in general practice, it can be difficult for patients to distinguish roles. Wearing a medical student lanyard and visible ID card helps patients recognise your role.
- Correct misunderstandings promptly: If a patient refers to you as 'doctor' ("Hello doctor, it's nice to see you today"), politely clarify your status: "Can I just double-check that you know I'm a medical student working with the GP today? Is it still okay for me to continue with you?"
From a GP practice perspective
- Ensure team-wide awareness: All practice staff, including receptionists, should know which students are present, along with their names and year of study. Receptionists are often the first point of patient contact and may help with scheduling or managing patient, family and carer expectations.
- Communicate openly with patients: Inform patients that your practice hosts medical students. This can be achieved through website notices, waiting room posters and appointment reminders.
- Marking appointment slots: When scheduling appointments, flag consultations involving medical students to act as a reminder for both staff and patients on the day.
From a medical school perspective
- Promoting patient consent and transparency: Guide students to always seek explicit consent from patients before any interaction. Students must introduce themselves clearly as medical students, not doctors, and explain their role during consultations.
- Supporting and equipping GP tutors: Provide GP tutors with clear guidance on their role in supporting students, emphasising the principles of accountable supervision. This can be delivered through tutor handbooks,
induction workshops, and ongoing faculty development activities.
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Gerry Gormley
Gerry Gormley is a general practitioner and professor of simulation at Queen's University Belfast (QUB). In his academic role, he leads the Clinical Skills Education Centre (CSEC) for medical students at QUB.
While his research focuses on how simulation can enable transformation in individuals, teams, and organisations, he has had a long-standing interest in left-right confusion in medical students. Following repeated observations of students encountering challenges with laterality decisions in teaching practice, this led him to research and publish widely on right-left discrimination, providing insights into how best to minimise errors from this common human phenomena.
See more by Gerry Gormley