An interview with Terence Stephenson, chair of the General Medical Council
The General Medical Council is due to publish new guidance for medical students and medical schools in Spring 2016. The guidance will include an updated version of professional values for medical students and a document for medical schools on what to do if a student’s behaviour is a cause for concern. Matthew Billingsley met Terence Stephenson, the chair of the GMC, to find out more about what’s in the new guidance and the role of the regulator in the lives of medical students and doctors.
How would you define professionalism?
For students professionalism can seem an abstract and woolly topic. But professionalism is all of the things that we expect from a doctor which are over and above their technical skills—such as communication, leadership, and compassion.
The best way of describing it is to give a hypothetical example: someone could be the most technically gifted surgeon or the cleverest medical student, but if they have lied about their achievements on their CV or are rude to patients and their colleagues, then they are not acting professionally. Professionalism is just as important for doctors as being technically competent.
In early 2015 the GMC released the results of a survey on decision making by medical students. Did any of the results influence the new version of the professional values guidance?
We had 2500 responses and it was really helpful in flagging up some things that we didn’t expect. For example, it was interesting that some students thought that it was acceptable to sign another student into a lecture that they had not attended. Now, to me as a practising doctor, that’s not acceptable pure and simple—in fact it’s being dishonest. Clearly, some medical students see that as quite a trivial matter. But if you get in the habit of doing these things as a student, then as a doctor you may think similar things are acceptable. Honesty as a doctor is absolutely crucial.
Some other examples in the new guidance include raising concerns about inappropriate posts on social media, as well as how to be professional on placements, and being honest with patients if you do not know the answer to their question.
What feedback did you receive during the consultation phase of the new guidance?
Students said they wanted more information about what they should declare to us at the point of registration, when they graduate from medical school. About 7500 medical students graduate each year and 10 percent of them declare something—like a police caution or a mental health problem. Those 750 students did exactly the right thing. It’s important students tell us about these issues—because if they don’t, their medical school will. Then they’re facing a double problem—the original mistake plus the mistake of not declaring it. So I’m keen for medical students to play safe, err on the side of caution, and be honest with us.
The reason for declaring something is so we can make sure they can provide safe care to patients first and foremost but also so they can get the right support if they need any. The handover of information is a good thing and has only been in place for the past 10 years. It used to be that if your medical school had some information about you it wouldn’t get passed on when you qualified. This meant a newly qualified doctor’s supervisors would be in the dark. The best way we can support young doctors is to know about these things—not to be pejorative or to stigmatise them, but to help them.
The professional values guidance says “You must raise any concerns you have about patient safety, dignity, or comfort promptly.” Is this a legal obligation for medical students?
No, it’s not a legal obligation and because we don’t regulate medical students we can’t require them to raise concerns. But medical schools do. They expect their students, who are in an environment of privileged patient information, to act in the same way as doctors. If the student did not report something they saw, which they knew was wrong, that would be quite serious.
If a student does see something they know is wrong, in the first instance they should raise their concerns with their tutor or someone more senior. If their complaint is ignored, then they should come to us. We have a confidential hotline you can call, but you will need to include all of the details of what you saw—name, day, and place—in order for the matter to be properly followed up. It can be stressful to report things and we understand that you may well think twice before contacting us. But as doctors we must always put the patient first.
A Student BMJ survey found that 30% of medical students have experienced mental health problems while studying and a vast majority think that the support they have from medical schools is inadequate. Why do you think this is and what could medical schools do to better support students?
We recognise that medical students are different to other students and standard university procedures may not be appropriate for them, because of the confidence placed in the profession by the public.
What I learnt during my time as dean of a medical school, [University of Nottingham 2003-9] was that when a student’s behaviour comes to light and it’s a fitness to practice issue, the first thing to do is to check whether they have an underlying health problem. If this is the case then it can be appropriate to have an independent assessment done by a doctor who is not associated with the student or medical school.
Staff should be trained to see signs of health problems and be aware of misconduct issues. Often students with health conditions, particularly mental health conditions, can display unprofessional behaviour that is out of character, such as poor attendance or failure to engage with their studies.
I would divide the support in two ways. I don’t think that the GMC would suggest that medical schools should provide the care for students with mental health conditions—that’s why we have the NHS. They should go to their local GP. When the NHS is caring for your mental health problem, you can declare it to your medical school and they give you time out or extra support.
Our first bullet point in our guidance Supporting medical students with mental health conditions says “medical schools should create an environment where mental health is openly discussed to try to reduce the stigma around it.” I am firmly of the belief that no student should be stigmatised. The vast majority of the 30% of doctors experiencing mental health issues will graduate and go on to be successful, so supporting them through difficult times is important.
But at the end of the day, whether it is a mental health problem or a physical problem, there are minimum standards which students have to meet. It’s no good to have a kind of dilution where if you’ve been quite ill during your course you can still qualify, but only be half as good a doctor as the other three hundred who have not been ill. That’s not going to work and that can be tough for some students.
Do you ever worry about overwhelming students with too many guidelines?
There is a school of thought that there is too much guidance. I am conscious since I’ve been at the GMC that our guidelines are not always as accessible as they could be. They can be very wordy and not easy to read on a smartphone, for example. I’m still a practising doctor, so I have a good idea of what comes into doctors’ inboxes. People have a limited attention span and there are only so many hours in the day.
We have a duty to doctors and must not overwhelm them. But we also have a duty to the public and to respond when people ask us for guidance on an issue. So we have to get the balance right, which is not to overload doctors but give them the right amount of information they need to treat patients well.
What do you think are the common misconceptions students have about the role of the GMC?
It’s the same misconceptions that doctors often have. Many people seem to think that we have one role: to strike doctors off.
But we actually do four things: we maintain a register and we say who gets on the register to practise; we offer guidance, which helps doctors stay on the register; we cover undergraduate and postgraduate medical education and training; and finally we take doctors off the register if we need to keep patients safe.
We are keen to prevent and stop doctors from getting into trouble in the first place. Our primary function is to protect patients but supporting doctors and medical students is how we achieve that.
What are the next steps in terms of publishing the new guidance and measuring its success?
Our first step is to analyse the responses that we received during our consultation [which closed at the end of November 2015]. We will then finalise the guidance and we plan to publish it in spring 2016 before it comes into effect at the start of the next academic year.
We’re going to work closely with medical schools to make sure the new guidance is accessible to students and we’ll measure its success by collecting information from the medical schools every year. We want this to be a helpful resource for students, something they turn to when they have a question about what it means to be a good doctor.Matthew Billingsley, editor, Student BMJ,
Competing interests: None declared
Provenance and peer review: Not commissioned; not externally peer reviewed.
Cite this as: Student BMJ 2015;23:h6722