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Role of the junior doctor

Report of the BMA Junior Doctors Committee Working Party
June 2008

Professor Sir John Tooke challenged the medical profession to define the role of the doctor. We considered this with particular regard to junior doctors, starting from the premise that medical school education is unique and equips junior doctors with a diverse and comprehensive range of knowledge, skills and attitudes that cannot be replaced. The training and working environment of UK Medicine has changed hugely over the last decade, with the advent of “Modernising Medical Careers”, the implementation of the European Working Time Directive, and the changing roles of other healthcare professionals. All of these have impacted on the role of the junior doctor.

A professional, a trainee and a deliverer of healthcare
We believe our first and foremost role is as a professional, with our service and training roles hinging on our professional standards. Further, we believe that the roles of a junior doctor as a professional, as a trainee, and in delivering healthcare service cannot be separated. Properly supervised service is essential to training. There have been suggestions that doctors in training should be supernumerary; this may mean that the service can be delivered without the trainee, but we do not believe it means the trainee does not deliver service, nor that learning would occur without this.

The impact of new curricula and assessments
Junior doctors now demonstrate competence at different levels to a greater degree than ever demanded previously. Learning as an apprentice within a “firm” has been supplemented with demonstrating competence via validated workplace-based assessments. Recording learning in a portfolio and being assessed is increasingly a role of the junior doctor.

The impact of changes to working patterns
Junior doctor hours have reduced and shifts have largely replaced on-call working over the last decade, due to the New Deal and the European Working Time Directive (EWTD). This has made providing continuity of care a particular challenge, and juniors have had to develop particular skills in communication, handover and multiprofessional team-working.

The impact of the changing roles of other members of staff
New and extended healthcare professional roles have been developed to manage some of the workload of junior doctors as the EWTD is implemented, as well as to take on tasks which are not considered educationally valuable. There is some evidence that training opportunities are being reduced, however, and that other healthcare professionals do not perform as well as doctors on traditionally medical tasks, as well as that doctors are more cost effective. Additionally, doctors of all grades may be expected to perform duties beyond their usual area of responsibility in an emergency, as they have a range and depth of knowledge and skills that make them unique amongst healthcare professionals.

The wider role of the junior doctor
The junior doctor has a role to play in all aspects of the profession including setting standards, training and education of other juniors and students, regulation and workforce planning, as well as direct patient care. The need for training in medical management was another of Tooke’s recommendations, and we hope that this will be developed as a future role of the junior doctor.

Download a pdf of the full report using the link on the right