Students whose behaviour causes concern: Role of universities

doi:10.1136/bmj.a2884

Published 29 December 2008, doi:10.1136/bmj.a2884
Cite this as: BMJ 2008;337:a2884

Analysis

Ethical debate

Students whose behaviour causes concern: Role of universities

Jon Cohen, dean

¹ Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PX

j.cohen{at}bsms.ac.uk

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, a GMC representative(doi:10.1136/bmj.a2876), and a lecturer from an African university(doi:10.1136/bmj.a2875)

The behaviour of the student described in this report is clearlyunacceptable and worrying. If this was one of our students Iwould want to know and I would take urgent steps to understandexactly what had been happening and then either provide helpthrough student support mechanisms or, if necessary, invokefitness to practise procedures. Equally, had the students facedwith this difficulty been from our school, I hope that we wouldhave mechanisms in place that would allow them to report theirconcerns and, just as importantly, that they understood whattheir professional responsibilities were in situations likethis.

Dealing with poor or unsafe performance in colleagues is anuncomfortable process. The situation described by these studentscould have equally taken place in UK medical practice, althoughthe distant setting and the fact that there was no one immediatelyobvious to whom they could report their concerns no doubt highlightedthe anxiety.

Although overseas electives are a popular part of the curriculumand a great opportunity to see a completely different healthcareenvironment, they pose headaches for medical schools. Theseinclude concerns for the health and welfare of the students,but schools also want to ensure that there is proper educationalsupervision, something that clearly was not quite right here.Key to this is detailed preparation by both the school and thestudent. At Brighton—and I’m sure it’s thesame elsewhere—a senior member of the faculty is responsiblefor the electives programme and can be contacted by email ortelephone by any student while they are away for any problemsthat cannot be sorted out locally. Ideally this would have beenthe route that the students in this case could have followed.

Professional behaviour

The students were concerned that it might be unprofessionalto contact the other medical school directly. They thought thatthey should have gone through a senior colleague or have had"objective evidence" of their concerns. As a dean I would hopethat students would feel able to report these concerns and thatI had in place the mechanisms that would allow them to feelsafe to do so. There is no single right answer to this, andindeed, I think it is important that a range of options areprovided. Like most schools, we have academic and clinical tutors,student support advisers, and senior colleagues with overallresponsibility for student welfare. Students differ in whomthey feel most comfortable speaking to, and we need to be surethat they know that they will be listened to carefully and respectfully.

The issue of what it means to be a professional and how thatapplies to medicine is topical. The Tooke report¹ drew attentionto this, and the Royal College of Physicians together with theKing’s Fund have recently published their report "UnderstandingDoctors: Harnessing Professionalism."²

Medical students are not qualified doctors, but one of the mostimportant things medical schools can do is to begin to instillthe principles of what being a professional means. Perhaps unintentionally,this has slipped off the educational radar in recent years,and it is reassuring to know that it is re-emerging as an importanttheme in the forthcoming revision of Tomorrow’s Doctors.³Ethical problems such as the one faced by these students providea clear illustration of why we need to think about this moreactively.

Cite this as: BMJ 2009;338:a2884

Competing interests: None declared.

References

Tooke J. Final report of the independent inquiry into modernising medical careers. 2007. www.mmcinquiry.org.uk/draft.htm.
Levenson R, Dewar S, Shepherd S. Understanding doctors: harnessing professionalism. King’s Fund, Royal College of Physicians, 2008. www.rcplondon.ac.uk/professional-Issues/Documents/Understanding-doctors(Kings-fund)-FINAL.pdf.
General Medical Council. Review of tomorrow’s doctors. , www.gmc-uk.org/news/articles/Review%20of%20Tomorrow.pdf.