Achieving good medical practice: guidance for medical students

Domain 2: Safety and quality

Contribute to and comply with systems to protect patients

  1. Registered doctors must not only comply with rules designed to protect patients, but also seek to improve the quality of the services they give to patients - both at an individual and at a systems level.
  2. As a medical student, you'll learn about quality improvement and quality assurance, and will have the opportunity to take part in audits and reviews. You'll also be in clinical settings during your studies and you must tell your supervisor when things go wrong and when these problems affect, or could affect, patient care.
  3. During your medical training, you may witness or be involved in something going wrong with a patient's care, and you may be asked to contribute to an internal inquiry. Although your medical school will normally be told about significant events, you should contact senior staff (for example, your year director or personal tutor) at an early stage, so they can arrange support for you. This will protect patients and allow the clinical team you are working with to respond appropriately.
  4. You must contribute honestly and openly to the process. Openness and honesty are key to being a good medical student and a safe and trustworthy doctor. You may hear this referred to as your professional duty of candour.

The GMC and the Nursing and Midwifery Council have produced joint guidance for nurses and doctors, Openness and honesty when things go wrong: the professional duty of candour.

Respond to risks to safety

  1. Patient safety is the responsibility of the whole team, which could include clinical and non-clinical members. This is why registered doctors must take action to raise concerns and support others to raise concerns about patient safety.
  2. This applies to everyone working in a healthcare setting - including medical students on clinical placements. Patient safety does not just relate to the clinical treatment patients get - it also includes raising concerns when a patient's dignity or comfort is compromised.
  3. You must:
    • raise any concerns you have about patient safety, dignity or comfort promptly
    • follow your medical school’s policy on raising concerns, wherever possible.

The GMC has produced guidance on Raising and acting on concerns about patient safety and a decision-making tool that will help registered doctors know what to do if they have a concern about patient safety.

How to raise a patient safety concern

  1. We recognise that raising concerns about patient care can be difficult. As a medical student, you may not feel comfortable raising issues with supervisors who may be responsible for making assessments of your performance on the placement. You may also feel uncomfortable raising concerns with senior clinicians. This is why you should, wherever possible, follow your medical school's formal policy on raising concerns, which will help you understand how to deal with difficult issues like these.
  2. In exceptional circumstances, you may not feel comfortable following the medical school's policy (for example, because the person causing the concern is the person you have to raise it with), but you must still find another way to raise your concern. For example, you can talk to a member of staff with whom you have an ongoing relationship, such as your personal tutor, who can support you. If the concern arises while you are on a placement, you may also find it helpful to refer to the placement provider's raising concerns policy.
  3. It can be difficult for organisations to deal with anonymous concerns, because it's more difficult to investigate the situation if they don't know who made the complaint. Therefore, you should avoid raising concerns anonymously wherever possible. Remember that, although your medical school will know who raised the concern, they won't necessarily need to name you as the source of concern when they investigate.

What if my concern is about my friends or peers?

It can be difficult to raise concerns about fellow students, who may be people you work with on projects or placements or your friends. But as a student choosing to join a regulated profession, it is your duty to put patients first and this includes patients you see on placements and those treated by your fellow students in the future.

You might be concerned about the behaviour of a fellow student, for example if they:

  • are rude to a patient
  • do not contribute to group work you've been assigned
  • post inappropriate content on social media (see the Social media dos and don'ts box)
  • are intoxicated when attending a placement, lecture or seminar.

It can be even harder to raise concerns about a peer's health, but you must bring this to the attention of your medical school if you are worried about their safety or wellbeing. You should never attempt to treat a fellow student's health condition - when you raise your concerns it's important to remember that this will enable your medical school to give them help and support.

  1. If you're not sure whether you should raise a concern formally, you should ask your medical school or an experienced healthcare professional for advice. GMC guidance to doctors on raising concerns acknowledges issues like this, including, for example, if the person causing concern is part of the problem or the doctor doesn't have confidence that the concern will be addressed adequately based on previous experiences. You may therefore find this guidance helpful.

What should I do if I have a concern about a member of staff at my medical school or on a clinical placement?

  1. It's just as important to raise concerns you have about the staff you work with. For example, a doctor, nurse or other healthcare professional who is or may be:
    • acting outside his or her competence
    • failing to see concerns about their health or not following advice on these concerns.
  2. You may also have concerns about the lecturers and staff at your medical school. And while they may not be an immediate risk to patients, your medical school will still want to know if you are concerned about someone's health or wellbeing. They can then take steps to enable the individual to get the support they need. You must always raise concerns in a confidential, non-judgemental way.

See the Steps to raise a concern section of the GMC's guidance Raising and acting on concerns about patient safety.

Raising concerns - a legal or a moral duty?

Medical students are not registered with the GMC and are not employees of their placement providers. This means that neither the GMC nor placement providers can legally require students to raise concerns. However, students do have a formal relationship with their medical school, which will expect them to raise concerns.

Medical students also have a moral responsibility to raise concerns about patient safety, dignity and comfort. Professionalism is not about doing the minimum - it is about doing what is necessary to protect patients.

Protect patients and colleagues from any risk posed by your health

  1. Registered doctors must protect patients from any risk posed by their health. To do this, they must ask for help from a suitable colleague and follow their advice about any changes to their practice the colleague considers necessary.
  2. You'll have significant contact with patients while on clinical placements. Any health issues you have may affect them, as well as your fellow students and teachers.
  3. If you know or suspect that you have a condition that could be passed on to colleagues or patients, you must follow your medical school's guidance about this.
  4. 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.
  5. You should be aware that some conditions that are usually minor - such as the common cold - may have a disproportionate impact on some patients, for example those with compromised immune systems. You need to bear this in mind when you decide whether to go to a placement if you are unwell.
  6. You must comply with the occupational health policies and procedures of your medical school or university (for example, immunisation against common, serious communicable diseases).
  7. You must engage with the occupational health referral process if your health has deteriorated, or if there are concerns that your health may have an impact on your ability to study.
  8. You don't need to perform exposure prone procedures (EPPs) to achieve the outcomes of undergraduate medical education. Students with blood-borne viruses can study medicine, but they may not be able to perform EPPs and may have restrictions on their clinical placements. They must also complete the recommended health screening before they carry out any EPPs and must limit their medical practice when they graduate.

Getting independent medical advice

  1. Doctors should, wherever possible, avoid treating themselves or providing medical care to anyone with whom they have a close personal relationship. They must seek independent medical advice on issues relating to their own health.
  2. As a medical student, you also need to seek independent and objective advice from a GP or other appropriately qualified healthcare professional and not rely on what you have learnt as a medical student or the views of other students, medically qualified family members or friends. It is important that you have access to independent advice and you should register with a GP who is local to your medical school.

Your health - dos and don'ts

Do

  • tell your medical school if you have a health condition or you experience significant changes to a stable health condition
  • get appropriate support - all medical schools have support systems in place to help you, so take advantage of these
  • register with a GP local to your medical school
  • seek independent advice if you have a health condition or think your health or personal circumstances may be affecting your studies or training
  • make sure you follow any treatment plan you are given, and don't make changes to your treatment without consulting your treating physician.

Don't

  • hide it - your medical school will want to help you
  • diagnose or treat yourself
  • seek treatment from friends, family or those close to you.

Informing your medical school

  1. Doctors must declare any health conditions which might affect their fitness to practise to the GMC so that it can take any necessary action to protect patients and help the doctor get the support they need.
  2. As a medical student, you must tell your medical school about any serious health problems, or any aspect of your health or personal circumstances that could affect your training (especially your placements) or your relationship with colleagues. This is so that your medical school can support you, and it can only do this if it knows that you have a problem. Telling your medical school shows you have insight into the impact your condition may have on patients, your fellow students and yourself. This is a crucial factor that medical schools consider in relation to health and fitness to practise.
  3. Supporting medical students with mental health conditions is guidance for medical students and medical schools on dealing with mental health conditions. Welcomed and valued provides advice for medical schools and postgraduate educators on how to support disabled learners and those with long term health conditions.