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What are GMC's views on students using cognitive-enhancing drugs for examination preparation and how is this reflected in the guidance?

Our view is that it is firstly an issue of safety for medical students. There are medical dangers in drugs that are not prescribed via the appropriate channels, and not following the advice of a qualified medical professional. Accessing the drugs by ordering them online also means the student has circumvented the appropriate clinical governance, safe prescription and monitoring of medications consistent with safe medical practice.

Why is this concerning?

Even if drugs were prescribed by a qualified medical professional, it is highly unlikely that the prescribing intent (or licensed indication) would be for ‘cognitive enhancement’ ahead of examinations, so the student would still be exposing themselves to health risks by abusing prescription-only medications.

Secondly, the behaviour itself, of a medical student being prepared to illicitly source drugs to enhance their performance is extremely concerning. It raises questions about an individual’s insight, judgment, appetite for risk-taking and quality of personal decision-making in this dangerous area of practice. This is a dangerous precedent for someone who will in due course, potentially be required to make prescribing decisions for patients under their care (see paragraph 16 of our prescribing guidance for what is expected of a registered doctor). It also raises concerns about the individual’s probity, which is one of the fundamental values we expect of all doctors.

Thirdly, this potentially harmful behaviour on behalf of the student could show a lack of insight into their own health and well-being, which is also a student fitness to practise concern.

How is this addressed in the guidance?

In terms of how this is covered in the new student fitness to practise guidance, the piece addressed to medical students (Achieving good medical practice) outlines key areas of professionalism concern, which might result in student fitness to practise procedures. We should stress that this is not an exhaustive list, but it includes ‘Abusing prescription medication’, ‘Dealing, possessing, supplying or misusing drugs, even if there are no legal proceedings – this may include legal highs’, ‘Possessing, dealing or supplying illegal drugs’ and a few examples under ‘health concerns and insight or management of these concerns’. Moreover, Achieving good medical practice:

  • highlights that part of professionalism is learning healthy ways to cope with stress and anxiety (taking the challenge of professional excellence)
  • tells students they must comply fully with the regulations and other systems or structures provided by their medical school or university (paragraph 4)
  • advises students on dealing with stress and anxiety (paragraph 32)
  • tells students they should avoid treating themselves or people close to them, and seek independent medical advice (paragraphs 37-38), as well as get support from their medical school (paragraphs 39-41)
  • discusses the importance of acting with honesty and integrity (paragraph 72-73).

Summary

In conclusion, we believe medical students’ taking ‘cognitive-enhancing’ drugs shows poor personal judgement, is potentially harmful, shows a concerning disregard for their own safety and well-being, as well as setting a worrying precedent for behaviour that we would not expect from future doctors.

We hope the new student fitness to practise guidance will clarify expectations and provide support for students and medical school staff in identifying and dealing with any such concerns.