Domain 3: Colleagues culture and safety

47. Doctors must treat colleagues with kindness, courtesy and respect, and develop and maintain effective teamworking and interpersonal relationships by:
• listening to colleagues
• communicating clearly, politely and considerately
• recognising and showing respect for colleagues' skills and contributions
• working collaboratively with colleagues and be willing to lead or follow as the circumstances require.

Doctors must be compassionate towards colleagues who have problems with their performance or health, but must put patient safety first at all times.

48. As a medical student, you must:
• treat your colleagues with kindness, compassion, courtesy and respect. This includes your fellow students, clinical and non-clinical teachers, those responsible for the administration of your course, other healthcare students, the clinicians and other staff you work with on clinical placements. You'll also learn with students from other health professions, which is important to help you develop a better understanding of the roles that different professions play in a multidisciplinary healthcare team
• work collaboratively with your teachers, trainers, administrative or support staff and fellow students.
49. When on clinical placements, you must be aware of and contribute effectively to the work of any healthcare team you are part of at all times, including in your non-clinical training.

50. Doctors must help to create a culture that is respectful, fair, supportive, and compassionate by role modelling behaviours consistent with these values.
51. As a medical student, you must:
• show respect for, and sensitivity towards, others’ life experience, cultures and beliefs
• be aware of how your behaviour, and that of others, may influence others within and outside the team.
52. You should be aware of the risk of bias, and consider how your own life experience, culture and beliefs influence your interactions with others, and may impact on your decisions and actions.

56. Every doctor must make sure that all colleagues they are overseeing have appropriate supervision. They must be accurate, fair and objective when writing references, and when appraising or assessing the performance of colleagues, including locums and students. They should be willing to offer professional support to colleagues, including students, for example through mentoring, coaching, teaching or training. They must complete these activities fairly.
57. As a medical student, you may be expected to mentor medical students and other learners in the multi-professional team or be asked to give feedback about them. If you are asked to do this, you must do so in an honest, constructive, open and fair way.
58. You'll be asked to give feedback on the quality of your placements and teaching. You must give this feedback when asked, as it will help your medical school to improve the overall quality of the education they provide. You must be fair, constructive and professional in your feedback and make comments based on your own experience. You should try to highlight areas of good practice as well as identifying areas where improvements could be made. Good conversations, fairer feedback is a GMC qualitative research study into the perceived impact and value of feedback for doctors in training.

59. Continuity of care is important for all patients, but especially those who may struggle to navigate their healthcare journey or advocate for themselves. Continuity is particularly important when care is shared between teams, between different members of the same team, or when patients are transferred between care providers.
60. To contribute to continuity of care, registered doctors must:
• promptly share all relevant information about patients with others involved in their care, within and across teams as required
• share information with patients about the progress of their care, who is responsible for which aspect of their care, and the name of the lead clinician or team with overall responsibility for their care
• be confident that information necessary for ongoing care has been shared before they go off duty, delegate care, or refer the patient to another health or social care provider
• check, where practical, that a named clinician or team has taken over responsibility when their role in a patient’s care has ended.
61. As you progress through your medical course, it is likely you'll be expected to look after patients, under supervision. When you are transferring the care of a patient, you must make sure you transfer care to an appropriate person and that you share relevant information with them. If you have any concerns about this process, you should ask a senior colleague for help.

62. If a task is delegated to a doctor by a colleague but they are not confident they have the necessary knowledge, skills or training to carry it out safely, they must prioritise patient safety and seek help, even if they’ve already agreed to carry out the task independently. More detailed guidance can be found in Delegation and referral.
63. There are some circumstances where you should not be carrying out a task:
• if it is unfamiliar to you
• if you do not believe you are competent to carry it out safely
• if you feel that you do not have the appropriate supervision or support to carry out the task
• if it has not been signed off by a supervisor.
64. Under these circumstances you must not carry out the task and should notify your supervisor or another healthcare professional, and notify your medical school as soon as possible.

64. Doctors must make sure that formal records of their work (including patient records) are clear, accurate, contemporaneous and legible.
65. Doctors should take a proportionate approach to the level of detail, but patients’ records should usually include:
• relevant clinical findings
• drugs, investigations or treatment proposed, provided or prescribed (ie what medication a patient is taking)
• the information shared with patients
• concerns or preferences expressed by the patient that might be relevant to their ongoing care, and whether these were addressed
• information about any reasonable adjustments and communication support preferences
• decisions made, actions agreed (including decisions to take no action) and when/whether decisions should be reviewed)
• who is creating the record and when.
66. This helps to ensure effective team working, safe handover and continuity of care. Therefore, the information must make sure that anyone reading those notes can understand them and rely on the fact that the information is correct. This includes patients and their relatives or carers.
67. As a medical student, you must make sure that the notes you write are clear, accurate and legible, even when made as part of the learning process, as this will help you develop the skills you'll need as a doctor.
68. You should make sure all the documentation you submit to your medical school is written in a professional way. This includes the findings of activities, such as audit or research you carry out as part of your studies. See Maintaining patient confidentiality for information about sharing identifiable information.
69. You must keep records that contain personal information about patients, colleagues or others securely, and in line with any data protection law requirements and our guidance on Confidentiality: good practice in handling patient information.

70. To help keep patients safe, doctors must:
• contribute to confidential inquiries
• contribute to adverse event recognition
• report adverse incidents involving medical devices (including software, diagnostic tests, and digital tools) that put the safety of a patient or another person at risk, or have the potential to do so
• contribute to incident reviews and/or investigations
• report suspected adverse drug reactions
• respond to requests from organisations monitoring public health.

This also applies to you as a medical student.

71. Doctors must act promptly if they think that patient safety or dignity is, or may be, seriously compromised. This includes acting if a patient is not receiving basic care to meet their needs, raising concerns if patients are at risk, or if they have concerns that a colleague may not be fit to practise.
72. 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.
73. 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.
74. As a medical student, 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.

81. Registered doctors should try to take care of their own health and wellbeing, recognising if they may not be fit for work. They should seek independent professional advice about their fitness for work, rather than relying on their own assessment. They must ask for help from a suitable colleague and follow their advice about any changes to their practice the colleague considers necessary, and must not rely on their own assessment of the risk to patients.
82. You'll have significant contact with patients while on clinical placements. Any health conditions you have may affect them, as well as your fellow students and teachers.
83. You should think about the impact your health might have on your ability to study or sit an assessment. Just as doctors in practice need to be able to determine whether they are well enough to care for their patients, so as a medical student you would be expected to determine if you are well enough to fully engage with the course including assessments, raise this with your medical school and seek independent medical advice if appropriate. Your medical school will support you to develop this awareness.
84. 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.
85. 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.
86. 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.
87. You must comply with the occupational health policies and procedures of your medical school or higher education institution (for example, immunisation against common, serious communicable diseases).
88. 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.
89. 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. EPPs are those where there is a risk that injury to the worker may result in exposure of the patient's open tissues to the blood of the worker. These procedures include those where the worker's gloved hands may be in contact with sharp instruments, needle tips or sharp tissues (spicules of bone or teeth) inside a patient's open body cavity, wound or confined anatomical space where the hands or fingertips may not be completely visible at all times.