Medical student Ethics England Northern Ireland Wales

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11. As a medical student, am I always on duty?

Medical students have at times expressed concern that their behaviour is subject to greater scrutiny and constraint than other students. Doubts have also arisen about what constitutes unprofessional behaviour.

In this card we briefly outline what professionalism involves and give some examples of behaviour for which students have been criticised.

 

Does how I behave out of work really matter? 

Being a student is about more than learning a subject. For many students university is also a time for personal experimentation and discovery. For younger students it can involve a first experience of freedom from parental constraints. Social life can be hectic and demanding, at times coming into tension with crammed academic schedules.

Medical professionalism signifies a set of values, behaviours, and relationships that underpins the trust the public has in doctors  

Doctors in society: Medical professionalism in a changing world. Royal College of Physicians 2005

A medical degree however is a preparation for a responsible and at times challenging profession and the General Medical Council makes it clear that along with the privileges of professional life come attendant responsibilities and that they extend to medical students.

Among these responsibilities is the general requirement to avoid acting in ways that bring the profession into disrepute, thereby undermining the trust that patients have in their doctors. This requirement extends at times beyond the professional sphere to include some aspects of your personal and private life.

 

What the GMC says

“Students must be aware that their behaviour outside the clinical environment, including in their personal lives, may have an impact on their fitness to practise. Their behaviour at all times must justify the trust the public places in the medical profession.”

General Medical Council. Medical students: professional values and fitness to practice. 

 

What is professionalism and why is it required?

Medical education involves more than the acquisition of technical knowledge and skills, vital though these are. Effective doctors also internalise a set of values that underpin their medical practice. This is sometimes described as the process of developing appropriate medical virtues. A virtue can be understood as a morally-oriented disposition or set of dispositions. The moral emphasis here is less on what a doctor or medical student does, but what kind of character traits they express.

Virtues often seen as central to medical practice include the following:

  • Trustworthiness
  • Benevolence
  • Intellectual honesty
  • Courage
  • Compassion
  • Truthfulness

It is clear from this list how important these are to the trust that patients have in doctors. Because they are character traits rather than individual actions, if you behave in your private or personal life in ways that seriously compromise you, trust in the profession can be undermined and questions about your suitability for a medical career can be raised.

 

What sorts of behaviour should you be concerned about?

In its guidance 'Medical Students: professional values and fitness to practice' the GMC provides an indicative list of the kinds of behaviour that have given rise to concern. Although these include serious or persistent breaches of the standards of professional practice laid out in Good Medical Practice, they also include, but are not limited to, the following:

  • Criminal convictions or cautions – including theft, fraud, possession of illegal substances, physical violence or abuse
  • Drug or alcohol abuse – including drunk driving and alcohol consumption that affects clinical practice
  • Aggressive, violent or threatening behaviour – including bullying
  • Persistently inappropriate attitudes or behaviour – including lack of commitment, non-attendance, poor communication and failure to follow educational advice
  • Cheating or plagiarising
  • Dishonesty or fraud – including falsifying research, financial fraud and misrepresentation of qualifications or in CVs
  • Unprofessional behaviour – including breaches of confidentiality, failure to respect professional boundaries, persistent rudeness to patients, colleagues or others
  • Health and insight – including failure to seek appropriate medical support or to follow medical advice

You should therefore familiarise yourself both with the GMC’s guidance for medical students, and with its core guidance Good Medical Practice.

 

Students and medical professionalism – grey areas

The factors listed above constitute clear breaches of the kinds of behaviour expected of you. At times however, the situation can be less clear-cut.

In 2009 for example, a group of doctors and nurses were suspended for taking part in “The Lying Down Game”, an internet craze where participants took pictures of themselves lying face down in unusual places and uploaded them onto Facebook. The group were reported to hospital management after pictures of them lying on resuscitation trolleys, ward floors and the ambulance helipad were spotted on the site. The pictures broke hospital regulations and breached NHS and Trust codes of conduct. The medical director for the trust stated that the group faced disciplinary action because they expected high standards of behaviour from their staff.

Although it is not clear that this behaviour would be directly in breach of GMC guidance it raised questions about the professionalism of the participants, particularly as it was taking place on hospital grounds. Although disclosing confidential information about patients without consent is both illegal and in breach of GMC guidance, doctors have also been criticised for making comments in publicly accessible new media in which they disparage patients and colleagues even though they cannot be identified.

There are no hard and fast rules here. We advise however that you should take a cautious approach to any behaviour that may be thought to undermine trust in the medical profession. When posting material on publicly available new media sites you should also consider whether you would be happy for future patients to see it. If in doubt, you should discuss the matter with tutors or senior colleagues.

 

Good reads

 

Next card: Students and social media