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What should students do if a patient treats them in a derogatory or aggressive manner?

Medical schools and the NHS organisations where the schools send their students for clinical placements should have policies and student and staff support mechanisms in place, to deal with any incidents where patients (or others) are abusive or aggressive to a student during their clinical placement.

What do the GMC standards say?

In Promoting excellence, we set out our expectations from education and training providers in terms of managing the learning environment and supporting their learners. We would highlight in particular:

  • S1.1: The learning environment is safe for patients and supportive for learners and educators. The culture is caring, compassionate and provides a good standard of care and experience for patients, carers and families.
    • R1.2: Organisations must investigate and take appropriate action locally to make sure concerns are properly dealt with. Concerns affecting the safety of patients or learners must be addressed immediately and effectively.
    • R1.13: Organisations must make sure learners have an induction in preparation for each placement that clearly sets out:
      • c) how to gain support from senior colleagues
      • d) the clinical or medical guidelines and workplace policies they must follow.
  • S2.3: The educational governance system makes sure that education and training is fair and is based on principles of equality and diversity.
    • R2.19: Organisations must have systems to make sure that education and training comply with all relevant legislation.
  • S3.1: Learners receive educational and pastoral support to be able to demonstrate what is expected in Good medical practice and to achieve the learning outcomes required by their curriculum.
    • R3.2: Learners must have access to resources to support their health and wellbeing, and to educational and pastoral support, including:
      • a) confidential counselling services.
    • R3.3: Learners must not be subjected to, or subject others to, behaviour that undermines their professional confidence, performance or self-esteem.

Responsibilities of education providers

When sending medical students to clinical placements, we would expect the school and the host organisation to take steps to ensure that the students are aware of relevant policies and processes that apply within the host organisation, including how students on placement can report any incidents that occur during their time there.

We can’t advise on the extent to which a medical student on placement has the same legal rights as an employee to be protected from discrimination, bullying or harassment. However it should be clear the requirements we set, that medical schools and other education and training providers have responsibilities to provide appropriate protection and support for students.

Responsibilities of the student

In terms of what we would expect a student to do, if faced with a challenging or abusive patient, we would refer to the professional standards in Good medical practice and relevant sections of our new student fitness to practise guidance, Achieving good medical practice. See in particular:

  • Para 32: As a medical student, both during study and on a placement, you’re likely to experience situations that will have an emotional impact on you. At times, you may experience stress and anxiety. This is completely normal and your medical school will support you with safe ways to share and reflect on difficult experiences. But if you are concerned about your levels of anxiety, you should seek help from your general practitioner (GP) and other appropriate sources (for example, helplines) to address any issues at an early stage. This may include making adjustments to your training or practice, if necessary.
  • Para 54: All registered doctors must establish and maintain partnerships with patients. This means being polite and considerate and treating patients as individuals. It also means respecting their dignity and privacy and treating patients fairly and with respect, whatever their life choices and beliefs.
  • Para 55: As a medical student, you’ll learn how to develop a partnership with patients. Therefore you must:
    • be polite and considerate at all times
    • listen and respond to patients’ views and concerns
    • respect patients’ dignity, confidentiality and privacy
    • treat patients fairly and with respect, no matter what your own thoughts are about their life choices or beliefs
    • be clear with patients about the role you’ll take in their care.

Summary

We would stress that, while students have a responsibility to treat patients politely and with respect, it is clearly distressing and unacceptable for medical students to be subject to any abuse. It is essential that any kind of derogatory or aggressive behaviour is reported to both the medical school and the organisation providing the student placement, so that they can tackle it in line with their responsibilities and the requirements of our standards. This is also essential so they can support the student who has been subject to abuse.