The Clinician's Perspective: Train for the Conversation, Not the Keyboard (Why Ambient Scribes Belong in Junior Doctor Training)

This article is part of our series, The Clinician’s Perspective, where we explore the intersection of AI and healthcare through the eyes of our team – former clinicians who understand the realities of patient care firsthand.

TL;DR: We should train junior doctors to master the art of the clinical conversation, not data entry. Ambient Voice Technology, used with good governance and clinical supervision, can amplify the uniquely human skills that matter most: empathy, curiosity, and diagnostic reasoning.

The (polite) controversy

GP trainers are discouraging trainee doctors from using ambient scribes, insisting they “learn documentation the hard way”. I disagree. Doctors are not data-entry monkeys; our core work is to elicit, interpret, and act upon a patient’s story. The skill we must amplify during training is history‑taking as an art, not documentation competency.

History‑taking is a craft

A great history is never just a checklist. It’s the ability to:

• Draw out what matters, and filter out what doesn’t
• Spot subtle cues: eye movements, hesitation, body language
• Allow patients to feel heard, yet maintain momentum
• Build a narrative that naturally flows into differential diagnosis and next steps

These are the muscles trainees must build through practice. Yet, the burden of documentation during the consultation often acts as a barrier, pulling attention away from the patient and hindering the very skills clinicians are trying to cultivate.

The documentation trap

Documentation is vital for safety, continuity, and medico‑legal clarity. But over the last decade, it has ballooned with doctors now spending up to 40% of their time of admin tasks. Notes have grown defensive and transactional; the administrative tail wags the clinical dog. When trainees spend large chunks of their day crafting prose for the record, we crowd out the higher‑order skills that determine care quality and career satisfaction.

Technology evolves and so should training

We’ve moved from pen-and-paper to keyboards to voice-driven tools. Ambient scribes are just the latest step: they listen, draft the note, and free the clinician to focus on the conversation. The right training question isn’t “should trainees use scribes?” but “how can they use scribes" to accelerate their learning and improve their clinical judgment.

Counterarguments - and why they fall short

1. “Scribes will de-skill trainees.”

Only if we let them. We should assess the underlying competencies directly: history-taking, clinical reasoning, communication, and safe delegation. A trainee who can take a crisp, complete history and then review and sign off a high‑quality note is more prepared than one who types efficiently but interviews poorly.

2. “Trainees must learn to document.”

Yes - at the level of clinical responsibility. Trainees must learn to use the tools at their disposal safely: understand note structure and medico‑legal essentials, and know when/how to correct, augment, or reject a drafted note. Using an ambient scribe is a skill, just like touch‑typing, and it should be accounted for in the curriculum. Scribing competence should be assessed as a core capability for all trainee doctors. The objective is accurate, adequate, timely documentation with clear ownership, not manual data entry.

3. “Trainees will blindly trust AI notes and stop thinking.”

Not if training and workflow are designed correctly. The clinician remains the author and is accountable for the final record. The scribe produces a draft; trainees must review, edit, and remain ultimately responsible for the output. The tools are there to support judgement, not replace it, for example, by highlighting what has changed, showing timestamps, or allowing supervisor spot-checks. If a trainee signs a note without reading it, that signals a training issue that needs correction, not a reason to discard a scribe tool.

4. We need “human” scribes to support senior physicians

High-pressure trauma call scenarios, maybe, but there is no longer any place for the F1 doctor traipsing around after a consultant in a sleepy DGH. The educational value lies in authoring your own notes after a clerking, understanding the story, committing to an assessment, and documenting the plan. Purely scribing for someone else is service provision, not education. A sensible policy: consultants use the mix that maximises clinic quality (ambient and, where appropriate, human support); trainees focus on eliciting the history and owning the final note.

5. AI scribes are "not safe" for junior doctors

Safety comes from governance, not the input modality. This is a paradigm shift, but not the first. Clinicians already rely on digital guidelines, calculators, and references (e.g., BNF) to increase safety and efficiency. Apply the same principles here: explicit consent and audit trails; secured data handling; clear attribution that the draft is AI-generated; mandatory clinician review; and targeted quality audits. With these guardrails, AI scribes can be safer than rushed manual note-taking, reducing omissions and freeing attention for the patient.

6. “Patients won’t accept it.”

When explained clearly, most patients value the doctor’s undivided attention. Consent, opt‑out, and transparency are non‑negotiable. Trainees can and should practice the script: “With your permission, an AI assistant will capture our conversation so I can focus fully on you. I’ll review everything before it goes into your record.” In my experience, this is much more welcomed than a junior doctor with their head buried in a clipboard!

What trainees gain when we get this right

• Deeper interviewing skill - with their heads up and hands free, trainees can pick up the nuance of the conversation
• Sharper clinical reasoning. More cognitive bandwidth to structure differential diagnoses and next steps
• Better patient rapport. Sustained eye contact and active listening
• Efficient training. More time for feedback, study, and sleep, the foundations of learning and safety

The bigger picture

The GMC’s standards and global competency frameworks centre on patient‑centred care, communication, and professionalism. If we want to future‑proof the NHS and our trainees’ careers, we must double down on these human skills and use technology to remove the clerical sludge. Let’s train doctors for the art of the conversation, and let the tools handle the paperwork.

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About Dr. Ian Robertson

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‍Dr. Ian Robertson is a trained NHS surgeon with over a decade of experience in secondary care. He has worked at leading UK hospitals, including Charing Cross and St George’s, specialising in urology and robotic surgery. Ian also holds an MBA from London Business School, where he focused on healthcare strategy and was awarded the Healthcare Scholarship for leadership in medical innovation.

Before joining Tandem, Ian led national improvement programmes and advised major NHS trusts on clinical operations and service redesign. Drawing on his deep understanding of hospital workflows and system challenges, he now leads Tandem’s commercial efforts to bring AI scribe technology into secondary care, working closely with clinicians and NHS leaders to improve frontline efficiency, reduce burnout, and protect time for patient care.

If you’d like to explore how AI scribes can support hospitals, feel free to connect with Ian on Linkedin.

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