Dreary. I know. However, albeit boring, professionalism is an incredibly important aspect of medicine as it can have huge implications on your eligibility to qualify and work as a doctor. It is therefore worth understanding what it means to be professional in medicine and the standards expected of students and doctors to avoid any trouble. Although the GMC acknowledges that there are differences between the standards expected of medical students and doctors, there are many similarities as students are effectively the doctors of tomorrow.
GMC stands for the General Medical Council which is the independent regulator for UK doctors. Their role revolves around protecting patients in the UK and so they decide which doctors can work in the UK, oversee medical education and most importantly to this article, set the standards for medical students and doctors to follow in their career. As a medical student, if there are no issues, you will have very little contact with the GMC until you graduate, which is when you apply to the GMC for provisional registration to work in the UK. The process of applying for provisional registration involves students declaring any fitness to practise concerns which have occurred in medical school (more about this later), which the GMC will assess to decide if you are fit to work.
Professionalism is a very broad term, but in simplicity it is a term used to describe how doctors should behave to ensure good care for patients. This is described more specifically by the GMC, who have created a document known as ‘Good Medical Practice’ which outlines the values and behaviours expected of doctors (https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice) and medical students (https://www.gmc-uk.org/education/standards-guidance-and-curricula/guidance/student-professionalism-and-ftp/achieving-good-medical-practice). It makes for rather unexciting bedtime reading but it is important that you have a quick read to make sure you aren’t caught out by it, as there can be some strict rules that aren’t so obvious. This is because the GMC state that a medical student’s behaviour is subject to greater scrutiny than students of other fields because they must avoid acting in such a way that the trust patients have in doctors is undermined. This behaviour can extend beyond your life as a student/doctor and into your personal life too, which makes it all the more important to read the above documents as this is often overlooked.
If your professionalism is brought into question by your medical school then there is a wide range of potential outcomes, starting from just a simple warning all the way to a fitness to practise investigation (FTP). For each incident, the medical school will thoroughly investigate the case and decide whether the evidence calls into question a student’s fitness to practise as a future doctor or not. If they do not believe it does, then the medical school will deal with the issue internally with a warning or a form of remediation (such as a reflection essay). If they do deem it to be serious then it will be referred to an external fitness to practise panel who will decide on what sanctions need to be placed, which at the extreme end can be expulsion from the medical course (this is incredibly rare and a last resort). Any outcomes of these panels must be declared to the GMC upon graduation when applying for provisional registration as mentioned earlier. The process is summarised by the chart below.
There are some clear and obvious behaviours that will bring your professionalism into disrepute such as criminal convictions, drug / alcohol abuse, bullying, fraud, cheating etc. However, there are also some grey areas that are more open to interpretation and require a bit more of a discussion with your medical school. Most commonly, medical schools will raise ‘low-level’ concerns. These include being consistently late for placement, handing in work late, or missing mandatory lectures. Schools will have a threshold for a number of low-level concerns at which a student’s fitness to practise should be questioned. This is based on factors such as the nature of the concerns, the student’s previous behaviour, which year of study they are in and whether the behaviour is a risk to the public or undermines public trust in the profession. Other low-level concerns can include: a rude outburst to patients, disruption in teaching, failing to accept criticism, incorrectly gaining consent as a doctor and not a medical student, plagiarism etc. More recently, and of increasing importance are concerns surrounding the use of social media; the GMC have some guidance on this and we will briefly discuss a case later.
There is full list of what is deemed as misconduct on the GMC website linked earlier and they summarise it with the statement ‘A doctor whose conduct has shown that they cannot justify the trust placed in them should not continue in unrestricted practice while that remains the case.’. The following is a non-exhaustive list of common reasons for impaired practice:
Visit here for some talked through case studies - https://www.gmc-uk.org/-/media/documents/professionalbehaviourcasestudies-dc10903_pdf-73316932.pdf
Because of the risk of ‘undermining the public trust in the profession’ doctors and medical students are held to a higher standard compared to other people. A recent example of this is the story of an NHS consultant paediatric anaesthetist who used his wife’s free TFL travel card during lockdown, including to travel to the hospital for work. For the offence he was fined £500 + £297 for the cost of travel that he paid. He acknowledged, reflected on and apologised for the offence. However, as well as this fine from TFL, the GMC got involved and also gave him a six-month suspension from work as they stated that his actions risked undermining the reputation of the profession. This would have been very unlikely in any other profession and led to outrage by fellow healthcare professionals who felt that this was unfair on him and to the children who would inevitably have their surgery delayed as a result. Read more here: https://www.lbc.co.uk/news/james-ip-nhs-doctor-suspended-free-travel-tfl/
An increasingly risky place for doctors / medical students is social media. The GMC have fairly strict rules on social media as linked here: https://www.gmc-uk.org/-/media/documents/gmc-guidance-for-doctors---doctors-use-of-social-media_pdf-58833100.pdf. On social media there is a fine balance to find between freedom of speech and the public’s expectation of how a doctor should behave. A recent example is a freshly graduated doctor who was fired from his position on the BMA council as a result of his tweets and is being currently investigated for further punishment. Tweets he made during his time in medical school between 2020 and 2022 were unearthed by The Sun newspaper who described him as a ‘radical BMA Leader behind the crippling junior doctor strikes’. Previous tweets that were brought up include his tweet calling out fellow medics for their ‘willingness to prop up white supremacists rhetorics’ on Twitter and that ‘Asians and minority ethnic groups are sometimes the biggest purports of white supremacy’. The doctor has claimed that these comments have been taken widely out of context and continues to defend his opinion. You can make your judgement as to how harsh the BMA were by checking out two versions of this story with very different outlooks on it: https://www.dailymail.co.uk/health/article-11998219/Militant-BMA-member-pushed-doctor-strikes-thinks-Britain-white-supremacist-patriarchy.html
Medical defence organisations are invaluable in helping students and doctors with professionalism concerns. They provide indemnity which helps protect you against professionalism issues that may occur during medical school or your working life as a doctor. They offer medico-legal advice for any fitness to practise investigations and can even be present at your hearing to offer support. This is offered for FREE for all medical students and so it is highly recommended that you join a medical defence organisation like the MDU as soon as possible when starting medical school (more on medical indemnity: https://medmentor.co.uk/blog/do-medical-students-need-medical-insurance )
Fitness to practise procedures do not need to be carried out just because a student is ill, even if it is very serious. It is only a professionalism concern if the student does not follow medical advice to minimise the risk to themselves and colleagues or if it may compromise patient safety because they lack insight (e.g. drug/alcohol addiction).
Professionalism is an important part of being a doctor, and this will be drilled into you during medical school. The best way to be professional is to behave as how you would want a doctor who treated your close family member / friend to. If you follow this mindset, you are unlikely to go far wrong. Remember that medical schools do not want to caution students and will always try to support students who are struggling with any academic or pastoral issues, so please ask for support early. A good mantra is that if you are considering asking for help/advice, then you should ask for it.