Achieving independence: a decision-making framework for doctors in training.

Postgraduate medical training presents many instances in which a junior doctor must decide whether it is appropriate to proceed without the advice, supervision or practical assistance of a senior. These decisions, vital to the development of any doctor, are commonly made in the context of providing medical treatment to acutely unwell patients or undertaking practical procedures. The major factors requiring reflection before making the decision to proceed or request help may be separated into patient-centred and physician-centred categories: the patient's right to choose who treats them, the patient's safety, the physician's assessment of their own competence and the physician's personal comfort. The relevance of each of these factors is explored in the context of two scenarios. In this way a simple framework to assist junior doctors in considering the risks and benefits of their intended actions is presented.