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Dr Tucker (February 2002 JRSM1) suggests that medical schools have lost enthusiasm for competency as an aim in itself, describing the value of his experience as a ‘shadow’ house officer when a final year student at St George's in the 1970s. Competency has not been forgotten by the present generation of clinical tutors at St George's. As a final year student I am currently partaking in my shadows as Dr Tucker once did—assisting an already qualified house officer in completion of forms, running errands, taking blood, learning other practical procedures and interacting with many members of the multidisciplinary team. During this time I have had ample opportunity to gain experience of the eight core clinical skills identified by Goodfellow and Claydon in their initial study2. The medical school has always made clear that, while it may facilitate my clinical learning, it cannot provide the same experiences and exposure for each student; I am ultimately responsible for my own learning, and have been well directed to this aim. St George's provides written learning objectives and offers access to a clinical skills laboratory, to supplement teaching by senior clinicians. We also record our experience in logbooks. Whilst I cannot claim total confidence in all clinical skills, the grounding has been good; and the ‘Introduction to the PRHO year’ lecture course held by St George's shortly after finals is said to be informative and useful.
Although satisfied by my training so far, two developments are cause for concern. The first is the introduction of shift-systems for junior doctors, preventing continuity in education with patients throughout their training; and the second is the negative influence of medicolegal issues, limiting the activities of students. These factors might prevent my generation from gaining all the experience that our seniors enjoyed at the same level.