Research conducted in New Zealand found that a small proportion of the medical students surveyed – around 5% – are practicing invasive clinical procedures on themselves and the majority of such procedures were unsupervised.
The aim of the study was to investigate different ways medical students learn invasive clinical procedures and was conducted via a survey of 284 students at the Otago Medical School who responded to the invitation to participate. The study, published in the New Zealand Medical Journal in October 2016, found medical students are also practicing on their peers, both at home and while at medical school.
The invasive clinical procedures are reported to be inserting cannulas, taking blood, and performing injections. Suturing and inserting nasogastric tubes have also been cited.
The motivation given for medical students conducting such procedures is a desire to become proficient and prevent avoidable patient harm. However, self-practice may actually increase the potential for harm through the use of incorrect disposal of medical equipment and not getting expert feedback on technique.
Development of proficient procedural skills is essential to the training of new doctors and historically this was done in clinical settings. Stricter privacy and patient consent guidelines has led to reduced access to human patients for medical students.
Today’s medical students typically train on simulation equipment but even the most advanced simulation models cannot replicate the intricacies of an unwell human patient and skills gained in simulation suites may not equate to proficiency when undertaking invasive clinical procedures in a clinical setting.
While it is fairly common for students to practice non-invasive medical procedures on others, such as taking blood pressure, practising unsupervised surgical procedures is potentially dangerous.
Medical students conducting clinical procedures on themselves is not novel to those working in medical education, but questions have been raised about the ethics and safety of medical students practising in this way.
While practising on oneself and on one’s peers may not necessarily be considered unprofessional or unethical, it should raise concerns that medical students feel the need to do so and medical educators should be looking at ways to help students feel better prepared for clinical settings.
The study states that more than one in five of the medical students, reported being unsupervised when performing a clinical procedure on a patient for the first time.
Better supervision and immediate feedback, along with increased access to simulation facilities and clearer guidelines in the support and management on the safe practice of students may help to reduce the incidence of medical students performing invasive clinical procedures on themselves.