A fictional story illustrating the steps that medical students can take in raising a concern.
A fourth year medical student was nearing the end of his first week at a clinical placement in the north of England. He had been placed on the gynaecology ward of a large district general hospital. He noticed a number of incidents on the unit where patients were not receiving basic care and had to decide how to act.
On his second day, as he was leaving the ward to get lunch, he witnessed that Mrs Smith, who had been transferred from A&E with an ectopic pregnancy almost two days before, had not touched her food or drink. He stopped to talk to her and found that she had not eaten since she came in. She did not feel like eating when she first arrived and was asleep when lunch was delivered so missed that.
The next day he mentioned this to one of the junior doctors and was told that patients often miss meals but that, as they were generally not in the ward for long, they did not worry too much.
The situation made the medical student very uncomfortable. He therefore raised it with his personal tutor, who he happened to be meeting the next day. The tutor suggested that the student speak to the nursing staff and pointed him to the relevant GMC guidance.
The student was concerned to make sure that future patients were checked on their food and fluid intake. He was aware that in other wards this was recorded on patient's charts. He therefore thought he should mention the issue to a consultant as well.
The issue was acted upon by the consultant who raised it at the next multidisciplinary team meeting and flagged it to nurses and doctors on the ward.
The personal tutor also decided to follow up the issue when he met the medical director a few months later and was pleased to hear that checks had been put in place.
Students are uniquely placed to drive improvements to the culture within the NHS. Their personal values and commitment to their patients have not been worn down by workload or habituation. They can be the eyes and ears of the NHS due to their unique role moving around a variety of healthcare settings.
Personal tutors are an excellent pastoral resource. They are people who can provide support and advice as well as people in whom students can confide within a confidential setting. Moreover, if students raise concerns as a group, the process can seem less daunting.
The student in this vignette identified a problem and was able to raise it for the benefit of future patients. It is important that students are supported in raising concerns and that they know with whom to raise them and have an avenue for validating them.
Doctors of the future should be able to approach reporting issues of misconduct safe in the knowledge that they will not be victimised for speaking out. Providing a safe environment for staff, colleagues and patients can only help create a better health service for the people of the UK.
If the student in this vignette had wanted the issue to be taken forward confidentially, the personal tutor should have been able to do this through the sub-dean or another channel.