Doctors Need More Structured Training in Clinical Risk-Taking, Says Chief Medical Officer

—

Medical practice involves making life-or-death decisions every day. A GP must decide whether to admit a patient to hospital or manage them at home. A surgeon must weigh the benefits of a major operation against the risks of serious side effects. A consultant must determine which patients receive treatment and in what order. These decisions are made under uncertainty, where outcomes cannot be guaranteed and mistakes can have profound consequences.

Yet according to a paper published in the British Medical Journal and backed by England’s Chief Medical Officer Christopher Whitty alongside leaders of the country’s medical royal colleges, the UK has no systematic approach to teaching doctors how to make these decisions responsibly. The issue is what medical leaders call “risk holding” – the professional responsibility for making and owning clinical decisions when the outcome is uncertain.

Risk holding is fundamental to medical practice. It means accepting that even with perfect skill and judgment, things will not always turn out well, and being able to explain this honestly to patients. It also means understanding how patients perceive risk differently and supporting them with impartial evidence to make informed choices about their own care.

Unlike medical knowledge and technical skills, which are carefully structured throughout a doctor’s training, the way doctors learn to hold risk is chaotic and varies widely by specialty and even by individual hospital. Some doctors are gradually introduced to higher-stakes decision-making over years. Others face a sudden jump in responsibility on their first day in a new role.

The paper, signed by representatives of the Academy of Medical Royal Colleges, the Royal College of Surgeons, the Royal College of Physicians, the Royal College of General Practitioners, and the General Medical Council, describes this as “a patchy approach to risk holding and decision making across career paths in different parts of the medical system”.

Over the past 30 years, the level at which risk is held in medicine has shifted significantly. Higher-risk clinical decisions have progressively moved to later stages of medical training. However, this shift has not been planned systematically or made explicit to trainees, their supervisors, or the organisations where they work.

The consequence is stark: a newly qualified foundation doctor, specialty trainee, GP, or consultant may suddenly be expected to make decisions involving substantially greater risk than the day before, without any clear preparation or acknowledgement of this transition. For some doctors, this happens multiple times throughout their career as they move between different specialties or roles.

“This is arguably worse now than it was previously,” the authors note, pointing out that the medical profession has become less systematic in its approach to risk holding even as it has strengthened training in medical knowledge.

The paper calls for a fundamental change in how the medical system approaches risk holding. Rather than allowing it to develop haphazardly, medical leaders want:

A structured framework that makes explicit the level of risk-holding responsibility expected at each stage of a doctor’s training and career. This would mirror the clarity that already exists around technical knowledge and clinical skills.

Recognition that different medical disciplines and institutions currently handle risk holding in vastly different ways, and that this inconsistency needs addressing through coordinated national guidance.

Formal training and support for doctors as they move into roles with higher-stakes decision-making, rather than assuming they will adapt on the job.

Clear communication with patients about uncertainty and risk, helping them to understand that even the best medical care cannot eliminate all adverse outcomes.

The importance of systematic risk holding extends beyond simply making better clinical decisions. When doctors are thrust suddenly into situations where they must make higher-risk decisions without preparation or support, it can contribute to burnout, anxiety, and errors. Conversely, doctors who understand and have been trained in how to hold risk are better equipped to make sound judgments and to support their patients through uncertainty.

The paper reflects broader concerns about medical culture in the NHS. Over recent decades, the system has become increasingly risk-averse in some areas – for instance, defensive medicine and over-investigation – whilst paradoxically becoming less systematic about ensuring doctors are properly prepared for the genuine risks they must navigate.

Medical leaders argue that a more mature, systematic approach to risk holding would actually improve patient outcomes by helping doctors make better-calibrated decisions and by reducing the anxiety and defensive practices that sometimes characterise medicine today.

The authors emphasise that this is not a call for doctors to take reckless risks. Rather, it is a call for the medical system to be as intentional and structured about teaching doctors how to hold and communicate risk as it is about teaching them anatomy or pharmacology.

—

Key Takeaways

• Medical leaders in England are calling for the NHS to adopt a more structured approach to teaching doctors how to make clinical decisions under uncertainty, a concept known as “risk holding”.
• Currently, the level of responsibility a doctor is expected to carry varies widely by specialty and institution, with no systematic framework guiding the transition to higher-stakes decision-making.
• The paper, published in the British Medical Journal and endorsed by the Chief Medical Officer and medical royal colleges, argues that better preparation for clinical risk-holding could improve patient outcomes and reduce doctor burnout.

What This Means for Kent Residents

For patients across Kent and Medway, this call for more structured risk-holding in medical training has direct implications for the quality and safety of NHS care. The NHS Kent and Medway Integrated Care Board oversees health services across the region, working with hospital trusts including Maidstone and Tunbridge Wells NHS Trust, East Kent Hospitals University NHS Foundation Trust, and Dartford and Gravesham NHS Trust. If medical leaders’ recommendations are adopted, doctors working in these organisations – from GPs in community practices to consultants in acute hospitals – would receive clearer guidance and support when making high-stakes clinical decisions. This could improve consistency of care and help ensure that patients are given honest, evidence-based information about risks and benefits. Patients with concerns about clinical decision-making or who wish to understand more about their treatment options should speak with their GP or the relevant NHS service providing their care.