Head To Head

Should undergraduate medical students be regulated? Yes

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c1677 (Published 05 May 2010) Cite this as: BMJ 2010;340:c1677
  1. Jane Dacre, director of medical education,
  2. Peter Raven, fitness to practise lead
  1. 1UCL Medical School, London
  1. Correspondence to: J Dacre jdacre{at}medsch.ucl.ac.uk

    Jane Dacre and Peter Raven are convinced that regulation will prevent potentially dangerous medical students from becoming dangerous doctors, but Edward Davies (doi:10.1136/bmj.c1806) thinks it an absurd over-reaction

    The General Medical Council regulates the medical profession in the United Kingdom. As a component of this responsibility, it aspires to instil in our medical students a clear sense of their professional duty. It does this by writing guidance for all medical schools and by checking that its guidance is followed when it visits each school as part of its quality assurance process.1 This certainly helps but, in our view, is not enough.

    All UK medical schools now have fitness to practise procedures based on those for registered doctors2 and try to use them to encourage a strong sense of professional commitment and to deal with those students who stray. However, schools’ interpretation of the guidance varies. University College London recently held a series of informal meetings between the welfare deans of the five London medical schools to compare their approach to fitness to practise issues. These meetings showed striking differences in the way similar student problems were dealt with between the schools. There were variations in both referral thresholds and the outcomes of cases.

    The GMC recognises that there is a problem with consistencey and is working with medical schools to improve this through regular workshops. Again, in our view that will not be enough because the variations we found in London have persisted despite representatives from different schools sitting on fitness to practise panels. Central registration is the only way to achieve consistency and fairness of approach.


    Students’ understanding of their professional status and the importance attached to fitness to practise would be enhanced by registration with the GMC. This would support the medical school’s efforts to promote professional values and responsibilities during the course and make students more aware of the rules they will need to follow as doctors. Although the GMC has been successful in increasing medical students’ understanding of its role, there is a common misconception among students that they are learning a code of behaviour that comes into force only after qualification.

    Despite the best efforts of the schools, students continue to be unfamiliar with what constitutes a fitness to practise problem, and rumours take hold. An example—possibly apocryphal but nevertheless revealing—of this is a student at one medical school who was concerned that having an untidy bedroom in his hall of residence may result in a referral to a fitness to practise panel. There are also, at the other extreme, those who think that taking recreational drugs during evenings and weekends shouldn’t interfere with their medical school career.

    Early intervention

    Janet Smith, after looking at professional self regulation in the Shipman inquiry,3 suggested that student registration should be considered in the UK (although as this was not part of her inquiry, it was not the subject of a recommendation). Other healthcare professions do not register students, but it has been introduced for solicitors.4 The main concern is to prevent potentially dangerous medical students from becoming dangerous doctors. Recent research—albeit with small numbers—has shown that a substantial number of doctors whose conduct has been investigated by the regulators had some evidence of performance or behaviour problems in medical school.5 6

    At the moment, it is difficult to track students with problems in the UK because of a lack of longitudinal data. A GMC register that kept details from undergraduate students through training and into career posts would be a valuable resource that could provide evidence to enhance the trust the public has in doctors. It would also be possible to use the pooled information to determine the types of problem that may, if unresolved, result in a referral for fitness to practise in the future. This would help inform the approach to the teaching and learning of professionalism in undergraduate and postgraduate medical education.

    Finally, central registration and the concomitant closer involvement of the GMC with fitness to practise issues in medical schools would remove the annual round of uncertainty for students who have been the subject of fitness to practise inquiries. Currently, we do not know if the GMC will accept the medical school’s investigations and outcomes or will wish to hold its own investigation and hearing. Since the GMC does not look at the medical school fitness to practise paperwork until the time of provisional registration, some students are left wondering if they will be able to start their foundation year jobs.

    There may well be some practical considerations, such as cost and the time to develop and administer a student register, but these are a small price to pay to better protect the public and maintain the status and trust of the profession.


    Cite this as: BMJ 2010;340:c1677


    • Competing interests: JD is a member of the GMC council.

    • Provenance and peer review: Commissioned; not externally peer reviewed.


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