Students whose behaviour causes concern: The GMC's view

doi:10.1136/bmj.a2876

Published 29 December 2008, doi:10.1136/bmj.a2876
Cite this as: BMJ 2008;337:a2876

Analysis

Ethical Debate

Students whose behaviour causes concern: The GMC’s view

Joan Trowell, member

¹ General Medical Council, London NW1 3JN

jtrowell{at}gmc-uk.org

What should you do when you see a fellow student behaving inappropriately?After a group of students wrote to the BMJ about their experienceduring an elective (doi:10.1136/bmj.a2874), we sought the opinionsof an ethicist (doi:10.1136/bmj.a2882), a dean (doi:10.1136/bmj.a2884),a GMC representative, and a lecturer from an African university(doi:10.1136/bmj.a2875)

These authors have shown a good understanding of the ethicalprofessional behaviour expected of both medical students anddoctors. It takes great personal resolve to confront a colleaguewhose behaviour is cavalier and who deliberately puts patientsat risk. These students, in difficult circumstances far fromhome, tackled the situation maturely and are right to seek mechanismsto communicate their concerns about the inappropriate behaviourof a fellow student.

Concerned students

Students and doctors have a professional duty to work withinthe limits of their professional competence, to know when thebest interests of the patient require them to step back, andto ask for help. Many fitness to practise cases heard by theGMC result from doctors who fail to show such insight.

The students rightly identified it as their duty to raise concernsabout a colleague when patients are at risk. The GMC expectsstudents and doctors to inform the appropriate person locallyof any concerns they have about a colleague’s conduct,performance, or health when this is putting patients at riskof harm.¹ These students properly escalated their concerns tothe senior doctor who was supervising them. Still concerned,they sought further advice. If they think that their concernsfor patient safety are being ignored, they should discuss thesituation with their medical school dean, who should contactthe other medical school. If they are still uncomfortable, thestudents may consider it necessary to contact the other medicalschool directly.

To provide documentary evidence, the students should have recordedtheir concerns, the student’s attitude, inappropriateactions, and procedures that they witnessed. I appreciate thatthey were abroad and it is easy to be wise after the event,but this is a learning point. A written record of all conversationswith the student, the local doctor who was their supervisor,and the medical school dean and any written complaints are valuablein establishing what occurred. Ultimately, it is the responsibilityof the unprofessional student’s medical school to investigatethe accusations about its student and determine if there isa case to answer.

Unprofessional student

The GMC emphasises that medical students "have certain privilegesand responsibilities different from those of other students.Because of this, different standards of behaviour are expectedof them."² Clearly, the student described by the authors haslittle respect for patients, colleagues, and the locality wherehe was working. His desire to further his skills at the patients’expense contravenes the first duty of a doctor in Good MedicalPractice to make the care of your patients your first concern.¹

The GMC does not register students and has no jurisdiction overthem, but it does have a duty to consider the fitness to practiseof all applicants at the point of registration. Even if a medicalschool decides to graduate a student, it does not guaranteeprovisional registration. Students must complete a declarationto confirm that they are fit to practise.

Local supervisor and medical schools

The authors’ position was made harder by inadequate supervisionduring this student’s placement. Medical schools are responsiblefor ensuring that their students are supervised appropriately,whether in the UK or abroad. The errant student’s supervisoralso acted inappropriately in completing his assessment beforethe end of the placement. Reports from clinical supervisorsinform the medical school’s decisions, allowing the deanto confirm at graduation that a student is fit to practise asa doctor.³

Finally, medical schools have a responsibility to ensure thereare systems in place to support students. During the GMC’scurrent consultation on fitness to practise of medical studentsand its review of Tomorrow’s Doctors 2008 we have receivedfeedback that medical students are concerned there are few channelsfor raising concerns about students, supervisors, or lecturersand worry that taking action may open them up to victimisation.The GMC therefore aims to work with medical schools to strengthenthese mechanisms.

Cite this as: BMJ 2009;338:a2876

Competing interests: None declared.

References

General Medical Council. Good medical practice. London: GMC, 2006.
General Medical Council, Medical Schools Council. Medical students: professional behaviour and fitness to practise. 2007. www.gmc-uk.org/education/undergraduate/undergraduate_policy/professional_behaviour.asp
General Medical Council. Tomorrow’s doctors.London: GMC, 2003.