AGMP 2024 Guidance for Medical Students PDF

Achieving good medical practice: guidance for medical students Contents The duties of doctors registered with the General Medical Council................................................... 3 About this guidance.............................................................................................

Achieving good medical practice: guidance for medical students Contents The duties of doctors registered with the General Medical Council................................................... 3 About this guidance............................................................................................................................... 5 What does this guidance cover?........................................................................................................ 5 Domain 1: Knowledge, skills and development.................................................................................... 8 Being competent................................................................................................................................ 8 Providing good clinical care................................................................................................................ 9 Maintaining, developing and improving your performance............................................................ 10 Managing resources effectively and sustainably............................................................................. 13 Domain 2: Patients, partnership and communication....................................................................... 14 Treating patients fairly and respecting their rights.......................................................................... 14 Treating patients with kindness, courtesy and respect.................................................................... 17 Sharing information with patients................................................................................................... 18 Supporting patients to make decisions about treatment and care................................................. 19 Communicating with those close to a patient.................................................................................. 20 Caring for the whole patient............................................................................................................ 20 Safeguarding children and adults who are at risk of harm.............................................................. 21 Helping in emergencies.................................................................................................................... 21 Making sure patients who pose a risk of harm to others can access appropriate care................... 21 Being open if things go wrong.......................................................................................................... 22 Domain 3: Colleagues, culture and safety.......................................................................................... 23 Treating colleagues with kindness, courtesy and respect................................................................ 23 Contributing to a positive working and training environment......................................................... 24 Demonstrating leadership behaviours............................................................................................. 25 Contributing to continuity of care.................................................................................................... 26 Delegating safely and appropriately................................................................................................. 26 Recording your work clearly, accurately and legibly........................................................................ 27 Keeping patients safe....................................................................................................................... 28 Responding to safety risks................................................................................................................ 29 The GMC is a charity registered in England and Wales (1089278) and Scotland (SC037750). You are welcome to contact us in Welsh. We will respond in Welsh, without this causing additional delay.  Managing risks posed by your health............................................................................................... 32 Domain 4: Trust and professionalism................................................................................................. 35 Acting with honesty and integrity.................................................................................................... 35 Maintaining professional boundaries............................................................................................... 36 Communicating as a doctor.............................................................................................................. 36 Managing conflicts of interest.......................................................................................................... 39 Cooperating with legal and regulatory requirements...................................................................... 39 Professionalism - key areas of concern............................................................................................... 41 Behaviour outside of medical school............................................................................................... 41 Annex: Professionalism and fitness to practise processes in medical schools and HEIs.................. 45 gmc-uk.org 2 The duties of doctors registered with the General Medical Council Patients must be able to trust doctors with their lives and health. To justify that trust you must make the care of patients your first concern, and meet the standards expected of you in all four domains.* Knowledge, skills and development  Provide a good standard of practice and care, and work within your competence.  Keep your knowledge and skills up to date. Patients, partnership and communication  Respect every patient’s dignity and treat them as an individual.  Listen to patients and work in partnership with them, supporting them to make informed decisions about their care.  Protect patients’ personal information from improper disclosure. Colleagues, culture and safety  Work with colleagues in ways that best serve the interests of patients, being willing to lead or follow as circumstances require.  Be willing to share your knowledge, skills and experience with colleagues, whether informally or through teaching, training, mentoring or coaching.  Treat people with respect and help to create a working and training environment that is compassionate, supportive and fair, where everyone feels safe to ask questions, talk about errors and raise concerns.  Act promptly if you think that patient safety or dignity may be seriously compromised.  Take care of your own health and wellbeing needs, recognising and taking appropriate action if you may not be fit to work. * General Medical Council: Good medical practice www.gmc-uk.org/professional-standards/professional-standards- for-doctors/good-medical-practice/the-duties-of-medical-professionals-registered-with-the-gmc gmc-uk.org 3 Trust and professionalism  Act with honesty and integrity, and be open if things go wrong.  Protect and promote the health of patients and the public.  Never unfairly discriminate against patients or colleagues.  Never abuse patients' trust in you or the public's trust in your profession. gmc-uk.org 4 About this guidance The General Medical Council (GMC) and the Medical Schools Council (MSC) have published this guidance for medical students to outline the standards expected of them - both inside and outside of medical school. Achieving good medical practice: guidance for medical students shows how the principles and values of Good medical practice apply to you as a medical student. Understanding how the core guidance for doctors applies now and in your future career will help you be a good student and, in the future, a good doctor. The guidance has been updated to reflect the content of Good medical practice 2024, and includes enhanced advice on assessment and managing uncertainty. What does this guidance cover? Maintaining a high standard of professional behaviour Your studies will bring you into contact with patients and members of the public, who can be physically and emotionally vulnerable. Because of this, and the fact that you'll be joining a trusted profession, we expect you to understand that there is a difference in the standard of behaviour expected of students on courses that bring them into contact with patients and the public. Specifically, your behaviour at all times, both in the clinical environment and outside of your studies, must justify the confidence that patients and the public place in you as a future doctor. We and your medical school will support you in your journey from student to doctor, which includes teaching and assessment on professionalism. As a medical graduate, you'll need to register with the GMC and get a licence to practise before you can begin work as a doctor if you wish to work in the UK. The GMC won't register medical graduates who are not fit to practise medicine. In addition to this guidance, we've also produced guidance for medical schools and medical students on managing professionalism and fitness to practise concerns. It outlines the processes that medical schools should follow if they're worried about a student's professionalism or fitness to practise medicine. Examples of the kinds of behaviour that are a cause for concern and may lead to formal processes being used are outlined in the Professionalism - key areas of concern section of this guidance. gmc-uk.org 5 About Good medical practice Good medical practice * sets out the principles, values, and standards of care and professional behaviour expected of all doctors registered with the GMC, and physician associates (PAs) and anaesthesia associates (AAs) once regulation starts. It is an ethical framework, which supports them to deliver safe care to a good standard, in the interests of patients. We work closely with doctors, PAs and AAs, patients and others to develop Good medical practice, so it is a shared agreement of what the professional standards should be. Doctors who are registered with the GMC are expected to be familiar with Good medical practice, and to use the guidance when making decisions with patients about their care. Doctors must use their professional judgement to apply the standards in Good medical practice to their day-to-day practice. This means working out which of the professional standards are relevant to the specific circumstances they are facing, and using their knowledge, skill and experience to follow them in that context. Doctors must act in good faith and in the interests of patients, and be prepared to explain and justify their decisions and actions. Using this guidance Patients need good doctors - training to be a good doctor starts as a medical student. During your studies, you'll learn the importance of professionalism and the principles and values set out in the GMC's core guidance for doctors, PAs and AAs - Good medical practice - and the more detailed guidance that supports it. In this guidance, the GMC and the MSC (referred to as 'we' throughout the guidance) show how the principles and values in Good medical practice apply to you as a medical student, to help prepare you for your future role as a doctor. Much of this guidance is relevant specifically to your work on clinical placements. But professionalism is broader than this and includes all elements of your academic study, as well as the need to be trustworthy and honest. In this guidance, we use the terms 'you must' and 'you should' in the following ways.  'You must' is used to highlight important areas that are strongly linked to Good medical practice, for a legal or ethical duty you’re expected to meet (or be able to justify why you didn’t). * Guidance on standards for doctors can be found at www.gmc-uk.org/professional- standards/professional-standards-for-doctors#good-medical-practice gmc-uk.org 6  'You should' is used to show duties or principles in Good medical practice that either:  may not apply to you or to the situation you’re currently in, or  you may not be able to comply with because of factors outside your control. Throughout this guidance, we also offer more detail and practical tips on how you can meet the requirements we set out. The box below is an example of this. Going above and beyond - taking on the challenge of professional excellence This guidance explains the standards of professional behaviour expected of you during your studies. Good doctors uphold high personal and professional standards of conduct. They are honest and trustworthy, act with integrity, maintain professional boundaries and do not let their personal interests affect their professional judgements or actions. To achieve this you'll need to learn to:  develop healthy ways to cope with stress and challenges (resilience)  recognise and escalate where doubt and uncertainty exist  apply ethical and moral reasoning to your work  work effectively in a team, including being able to give constructive and honest feedback  manage your own learning and development  be responsive to feedback  prioritise your time well and ensure a good work-life balance  prioritise patient safety and act promptly if you think that patient safety or dignity is, or may be, compromised  work collaboratively with colleagues  treat patients with kindness, compassion and respect  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. You may find many of these difficult or challenging to do well but, as with all elements of professionalism, your medical school will help you to develop these skills. Being professional means you'll need to make time to reflect on your experiences, learn continually and apply your learning in practice. You will need to seek out feedback, remain up to date with professional and ethical guidance and be able to adapt to changing circumstances. Your teachers and trainers want you to develop and become an excellent doctor, so you should look to them for guidance and support. gmc-uk.org 7 Domain 1: Knowledge, skills and development Introduction Medical practice is a lifelong journey. Keeping pace with rapidly changing social, legal and technological developments means learning new skills while maintaining others. Sharing knowledge – gained through research and innovation, as well as experience – is fundamental to being a doctor. Good doctors are competent, keep their knowledge and skills up to date and provide a good standard of practice and care. They strive to develop and improve their professional performance. They reflect regularly on their standards of practice and use feedback and evidence to develop personal and professional insight. Being competent 1 As a registered doctor, you'll be expected to be competent in all aspects of your work including, where applicable, formal leadership or management roles, research and teaching. This is so you can give your patients the best standard of care. 2 Registered doctors must recognise and work within the limits of their competence. 3 Registered doctors must be familiar with and follow all laws and regulations relevant to their work as well as any guidance on GMC issues. This will protect patients by making sure they receive safe and lawful treatment and will help doctors to provide the best care possible. 4 As a medical student, you'll learn about relevant laws and professional guidance, as well as your medical school’s policies and procedures, and it's important that you apply that learning when you are in a clinical environment. When undertaking clinical learning, it is your responsibility to know, and proactively find out, about these policies and procedures and apply them in your work. This includes following the relevant laws and guidance when you are on an overseas placement or elective. gmc-uk.org 8 Providing good clinical care 5 Doctors must provide a good standard of practice and care. As a medical student, this applies to you in relation to the time you'll spend with patients on a clinical placement. It also means you should only treat patients or give medical advice when you are under the supervision of a registered healthcare professional. You must:  recognise the limits of your competence and ask for help and advice when necessary  make sure you clearly explain your level of competence to anyone who supervises you on a placement, so you are not asked to do anything you are not trained to do  make sure patients, carers and colleagues are aware that you are a medical student and not a registered doctor  take action if you think you're not being effectively supervised on a clinical placement (see paragraph 7)  engage in a timely fashion with routine evaluation systems provided by your medical school or higher education institution (for example, end of placement questionnaires or staff-student liaison committees). Being professional on placements - practical steps  Always introduce yourself to patients, letting them know your full name and that you are a medical student, including which year you are in.  When you meet a patient for the first time, and every subsequent time you want to join them for any clinical interaction, check if they if they are content to have a student present.  Make sure your ID badge or similar given by your medical school or placement provider is visible at all times.  Dress smartly and in line with dress codes set out by your medical school or placement provider.  Arrive on time for your placement and do not leave your placement early unless you have agreed this with a relevant supervisor and your medical school.  Attend induction sessions if they're offered.  Attend all mandatory training arranged for you while on a placement.  Make sure you know about and follow the rules and guidance specific to your placement, including how you should raise any concerns. If in doubt, make sure you ask if there is anything in particular you should know at the start of your placement.  Be honest with patients if you don't know the answer to their questions. Patients appreciate that you are there to learn. gmc-uk.org 9  Make sure you know who is responsible for directly supervising you on your placement and who has the overall responsibility for medical students in a clinical environment and in the organisation where you are working. This will help you understand where to go if you need help and if you have any concerns you need to raise.  Be aware that while on any elective, in the UK or abroad, students should still apply the advice in this guidance wherever possible. 6 You should only carry out practical procedures on patients if you have sufficient experience and skill to perform them safely, and only under supervision that is appropriate to your level of competence. If you are not sure you are able to carry out a practical skill or procedure competently, you should ask for help from a more experienced colleague, such as a nurse or doctor who is competent in that procedure. The Practical skills and procedures guidance * specifies the practical skill or procedure you need to be able to perform by the time you graduate, including the level of competence required for each one. 7 If you think you are not being properly supervised on a placement, you should stop the work you are doing and raise your concerns with the placement provider and your medical school. This won't impact on your studies and will show that you are a responsible student acting in a professional manner. We also expect you to take prompt action if you have any concerns about possible risks to patients, as set out in Responding to safety risks. Maintaining, developing and improving your performance 8 As a medical student, you'll learn the basic skills and knowledge you need to treat patients, but you are also developing your ability to learn and acquire future skills. As you move through medical school and into postgraduate education and training, you'll continue to build on what you have learnt. For you, this aspect of good medical practice is about participating fully in this learning process. * General Medical Council: Practical skills and procedures www.gmc-uk.org/-/media/gmc- site/education/downloads/guidance/practical_skills_and_procedures_a4_july_2023.pdf gmc-uk.org 10 9 You must:  engage fully with your medical course by attending educational activities, including lectures, seminars and placements, and by completing coursework as directed by your medical school  listen to the advice of your lecturers and supervisors  comply fully with the regulations and other systems or structures provided by your medical school or higher education institution in relation to your studies  respond constructively to verbal and written feedback from patients, lecturers, clinicians and members of the multidisciplinary team by critically reflecting on the feedback and making an action plan to improve where necessary  reflect on what you have learnt and look at ways to improve your own performance  consider how your life experience, culture and beliefs influence your interactions with others and may impact on the decisions you make. What is reflection? You will hear about the concept of reflection and becoming a reflective practitioner throughout your time at medical school. At its core, reflection is thinking about what you've done with the intention of gaining insight, and using the lessons learned to maintain good practice or make improvements where possible. To do this, you need to think about what effect your actions have on yourself and on others, including patients and colleagues, across all aspects of your education and training. For example, when reflecting on an interaction with a patient or a colleague, you could explore:  what you were thinking at the time of the interaction  how you felt at the time and after the interaction  what you can learn from your thoughts and feelings  how to use that learning to improve the way you approach similar situations in the future. Reflection also means responding constructively to feedback from your teachers, trainers and colleagues. Think about what you have been told you can improve and aim to put those improvements into action. This is how medical students and registered doctors learn and improve. gmc-uk.org 11 We have produced The reflective practitioner – a guide for medical students. * Here, we use the views of medical students, doctors and medical educators to explain why reflection is important and show you how you can use it in your daily life as a student and beyond. Engaging in assessment Whilst at medical school you will need to pass many types of assessment including written and clinical exams, reports and workplace-based assessment. This programme of assessment is designed to ensure that you are competent and safe to enter the profession when you graduate. Therefore, it is vital for patient safety that the results of assessments and exams are a valid and reliable measure of your ability. You must engage fully with the assessment process by ensuring any written work you submit is your own and by not attempting to cheat or pass off the work of others as your own in clinical or knowledge assessments. You must not help fellow students to cheat by sharing the content of any exams with them. 10 Registered doctors must take steps to monitor, maintain, develop, and improve their performance and the quality of their work. This includes taking part in systems of quality assurance and quality improvement to promote patient safety across the whole scope of their practice. 11 As a medical student, you'll learn how to participate in and promote activity to improve the quality and safety of patient care and clinical outcomes. You may have the opportunity to take part in audits and reviews. * See www.gmc-uk.org/the-reflective-practitioner---a-guide-for-medical-students gmc-uk.org 12 Managing resources effectively and sustainably 12 Registered doctors must make good use of the resources available to them, and provide the best service possible, taking account of their responsibilities to patients and the wider population. They should choose sustainable solutions when they’re able to, provided these don’t compromise care standards, and consider supporting initiatives to reduce the environmental impact of healthcare. 13 As a medical student, by the end of your studies you should be able to outline the principles of sustainable healthcare and apply it to your medical practice.* See our Sustainability Q&A † for more information. Sustainability decisions made by students need to be in line with medical school policy and/or the clinical environment in which you are placed. * See Outcomes for graduates – Health promotion and illness prevention (para 25): www.gmc- uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/outcomes-for-graduates/outcomes- for-graduates † See www.gmc-uk.org/professional-standards/learning-materials/sustainability-questions-and-answers gmc-uk.org 13 Domain 2: Patients, partnership and communication Introduction The approach and attitude of a doctor can have a lasting impact on a patient. Treating patients with kindness, compassion and respect can profoundly shape their experience of care. Good doctors recognise that patients are individuals with diverse needs, and don’t make assumptions about the options or outcomes a patient will prefer. They listen to patients and work in partnership with them. They do their best to make sure all patients receive good care and treatment that will support them to live as well as possible, whatever their illness or disability. Treating patients fairly and respecting their rights 14 All registered doctors must recognise and respect every patient’s dignity and right to privacy, and treat them fairly and with respect, whatever their life choices and beliefs. 15 As a medical student, you'll learn how to treat patients fairly and respect their rights. Therefore you must:  recognise and respect a patient’s dignity  recognise a patient’s right to choose whether to accept your advice, and respect their right to seek a second opinion  treat patients fairly  treat information about patients as confidential  be clear with patients about the role you'll take in their care. 16 You should discuss with your supervisor and check that the patient has given consent before you carry out any invasive or intimate procedure. * * See GMC guidance Intimate examinations and chaperones: www.gmc-uk.org/professional-standards/professional- standards-for-doctors/intimate-examinations-and-chaperones gmc-uk.org 14 17 Doctors must treat patients fairly, give priority to patients based on their clinical need and must not discriminate against them or allow personal views to affect their relationship with the patient, or the treatment they provide or arrange. They must not refuse or delay treatment because they believe that a patient’s actions or choices contributed to their condition. 18 As a medical student, you won't be expected to make decisions about treatment options. But you mustn't let your own opinions or views affect the way you treat patients and others or the information you give them. Making a conscientious objection 19 Doctors may choose to opt out of providing certain types of treatment because of their personal beliefs and values, as long as this does not act as a barrier to a patient’s access to appropriate care and meet their needs. If a doctor has a conscientious objection to arranging or providing a particular procedure, they must explain this to the patient, tell them about their right to see another doctor and make sure the patient has the information to do so. Doctors must not express disapproval of the patient's lifestyle, choices or beliefs in doing this. You can find more information in the GMC's guidance Personal beliefs and medical practice. * 20 Medical schools should consider adjustment requests for cultural or religious beliefs, but they must balance these adjustments against practical considerations.† For example, they may need to schedule clinical placements or assessments during certain religious festivals or at times of religious observance. 21 As a medical student, you also have the right to hold a conscientious objection to some types of treatment and you should discuss this with your medical school. However, you must achieve the capabilities described in Outcomes for graduates. ‡ * See www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/personal-beliefs-and-medical-practice † See MSC guidance on supporting students of different faiths for further information: www.medschools.ac.uk/media/3049/active-inclusion-challenging-exclusions-supporting-students-of-faith.pdf ‡ See www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/outcomes-for- graduates/outcomes-for-graduates gmc-uk.org 15 Maintaining patient confidentiality 22 Doctors must treat information about patients as confidential, including after a patient has died. 23 However, confidentiality is not absolute, and appropriate information sharing is essential to the efficient provision of safe, effective care. You'll learn about this at medical school, but you need to be aware that you must never share confidential information about a patient with anyone who is not directly involved in their care without the patient's permission. 24 Many improper disclosures are unintentional. You must not share identifiable information about a patient where you can be overheard, such as in a public place or on social media, or include it in any work or logbooks you submit. You must be clear about what confidential information a patient has agreed can be shared with friends and family before you discuss their care. 25 You can find more information about when and how you can disclose personal information about patients - with their consent, where the law requires it and when doctors are able disclose information when it is in the public interest to do so - in the GMC's guidance, Confidentiality: good practice in handling patient information. * As a medical student you will never be responsible for deciding whether information about a patient should be disclosed in the public interest. If you think such disclosure might be appropriate you should speak to your supervisor and discuss the issue with them. 26 You must also follow any policies of your medical school, higher education institution or placement provider to make sure personal information is stored and disposed of securely. How does confidentiality apply to my placements? It's normal to want to talk about things you have seen on clinical placements with colleagues or friends. You'll see unusual medical conditions and may be put in situations where patients experience adverse outcomes. But you must never disclose patient identifiable information without a patient's consent. If you're not sure what to share if you're asked to provide information for an inquiry or logbook, you should ask for advice from your medical school or supervisor before you disclose any information. * See www.gmc-uk.org/professional-standards/professional-standards-for-doctors/confidentiality gmc-uk.org 16 You should also make sure you never discuss patients in a public place or on social media (see Social media dos and don’ts). Even if you don't mention a patient by name, there's a chance that someone nearby (or online, if you're on social media) might know whom you are talking about. If you do want to talk to a colleague, friend or supervisor about what you have seen on a placement, you should only do that in a private place. And you shouldn't mention the patient by name, except to a clinician directly involved in their care. For more information, see our guidance for registered doctors, PAs and AAs - Good medical practice, Confidentiality and Using social media as a medical professional. * For more information on consent, see our guidance Decision making and consent. † Treating patients with kindness, courtesy and respect 27 All registered doctors must treat patients with kindness, courtesy and respect. This doesn’t mean agreeing to every request or withholding relevant information that may be upsetting or unwelcome. It means communicating sensitively and considerately, listening to patients, and trying not to make assumptions. 28 As a medical student, you'll learn how to treat patients with kindness, courtesy and respect. Therefore you must:  communicate sensitively and considerately at all times  listen and respond to patients' views and concerns  try not to make assumptions  recognise that patients may be vulnerable  be alert to signs of pain or distress. * See www.gmc-uk.org/professional-standards/professional-standards-for-doctors/using-social-media-as-a-medical- professional † See www.gmc-uk.org/professional-standards/professional-standards-for-doctors/decision-making-and-consent gmc-uk.org 17 Sharing information with patients 29 The exchange of information between doctors and patients is central to good decision making. Doctors must give patients the information they want or need in a way they can understand. They must listen to patients and encourage an open dialogue about their health, asking questions to allow them to express what matters to them, and responding honestly to their questions. 30 As a medical student, you'll learn how to communicate effectively in a variety of clinical, simulated and non-clinical settings and it is important that you apply your learning in your interactions with patients. 31 When communicating with patients you must:  be honest when you don't know something. As a student, you're not expected to know the answers to all questions a patient may have, but you are expected to listen to them and respect their views. You should do your best to find out the answers to the patient's questions yourself, or pass queries on to someone who will be able to help  make sure that, prior to giving information to patients, you have agreed it with your supervisor and the information is clear, accurate, up to date, and based on the best available evidence  take steps to meet the patient's language and communication needs and other potential barriers to effective communication (for example, pain or anxiety) so you can support them to engage in meaningful dialogue and make informed decisions about their care. You should ask for support to help you communicate effectively if necessary  check the patient’s understanding of the information they’ve been given, and do your best to make sure they have the time, support and resources they need to make informed decisions if they are able to. You should seek help from your supervisor if required  consider and respond to the needs of patients with impairments or disabilities. Not all impairments and disabilities are easy to identify so you should ask patients what support they need, and offer reasonable adjustments that are proportionate to the circumstances, seeking appropriate advice if unsure  treat each patient as an individual. gmc-uk.org 18 Supporting patients to make decisions about treatment and care 32 While you are at medical school, you'll learn that all patients have the right to be involved in decisions about their treatment and care, and be supported to make informed decisions. You’ll also learn how to determine a patient has given consent or you have other valid authority before examining or treating patients. You'll learn that the consent process is about shared decision making between a doctor and a patient, where the doctor uses their specialist knowledge and experience to help their patient consider their options and make an informed decision. 33 Towards the end of your studies, you may be responsible, under supervision, for explaining to a patient what will happen to them. Your supervisor should first explain to the patient how you will be supervised and emphasise that you are part of the clinical team. 34 In some cases, you may take consent for minor procedures such as taking a blood sample or a blood pressure reading. However, you must not take written consent for any procedures, this should be obtained by the doctor or other registered healthcare professional responsible for the treatment. You can find out more about consent in the GMC's guidance for registered doctors, Decision making and consent. Consent - things to remember Patients need to know that you are a student so they can make an informed decision about whether they want you to be involved in their care. Once they know you are a student, you can ask if they're happy for you to talk to them about their health, examine them or carry out a procedure. Remember:  you should not carry out any procedure on a patient without their consent for that specific procedure  if you have any concerns about whether a patient has given consent to you being involved in their care or undertaking any type of procedure, talk to your supervisor about your concerns gmc-uk.org 19  you should be aware that sometimes patients might not have the mental capacity to give consent *  you must respect the decision of patients who do not want you to be involved in their care. Communicating with those close to a patient 35 Doctors must be considerate and compassionate to those close to a patient and be sensitive and responsive in giving them support and information. As a medical student, you must be polite and considerate to anyone close to the patient, such as relatives, carers and friends at all times - not just during a consultation. You should not assume that a patient will want information about their health to be shared with those close to them and should always seek consent from the patient before disclosing any information about them. More detailed guidance can be found on this in Confidentiality: good practice in handling patient information. Caring for the whole patient 36 Doctors must support patients in caring for themselves and empower them to improve and maintain their health. As a medical student, you must:  help patients to access information and support to manage their health successfully  support them to make decisions that improve their health and wellbeing. * See Decision making and consent: If your patient may lack capacity to make the decision www.gmc- uk.org/professional-standards/professional-standards-for-doctors/decision-making-and-consent gmc-uk.org 20 Safeguarding children and adults who are at risk of harm 37 Doctors must consider the needs and welfare of people (adults, children and young people) who may be vulnerable, and offer them help if they think their rights are being abused or denied. More detailed guidance can be found on this: Protecting children and young people * and 0-18 years: guidance for all doctors. † 38 As a medical student, you must promptly speak to your supervisor if you have any concerns about a patient – or someone close to them – who may be at risk of abuse or neglect, or is being abused or neglected. See How to raise a patient safety concern for more information on how to raise a concern. Helping in emergencies 39 Doctors must offer help in an emergency, taking account of their own safety, competence, and the availability of other options for care. 40 As a medical student, before helping in an emergency you should take account of your own safety. You should consider whether you are competent to act and feel able to offer assistance, or decide whether it is better to try to access help for a person in distress. Making sure patients who pose a risk of harm to others can access appropriate care 41 Patients must not be denied care because their condition puts others at risk. If a patient poses a risk to a doctor’s health or safety, they should take all available steps to minimise the risk before either providing treatment themself, or making alternative arrangements for the patient to access care to meet their needs. 42 If, as a medical student, you feel that a patient poses a risk to your health and safety, you should speak to your supervisor before becoming involved in the patient’s care. * See www.gmc-uk.org/professional-standards/professional-standards-for-doctors/protecting-children-and-young- people † See www.gmc-uk.org/professional-standards/professional-standards-for-doctors/0-18-years gmc-uk.org 21 Being open if things go wrong 43 Doctors must be open and honest with patients if things go wrong. If a patient under their care has suffered harm or distress, they should:  put matters right, if possible  apologise (apologising does not, of itself, mean that you are admitting legal liability for what’s happened)  explain fully and promptly what has happened and the likely short-term and long-term effects  report the incident in line with their organisation’s policy so it can be reviewed or investigated as appropriate – and lessons can be learnt and patients protected from harm in the future. 44 As a medical student, you won't be directly responsible for patient care because this responsibility will lie with your supervisor. But if you think any aspect of care that you are involved in has gone wrong, you should tell your supervisor as soon as possible. Your supervisor will support you and, if necessary, will help you to put things right. This may include explaining to the patient what has happened and offering an apology. See also Responding to safety risks. 45 During your medical course, you may witness or be involved in something going wrong with a patient's care, and you may be asked to contribute to an internal inquiry. Although your medical school will normally be told about significant events, you should contact senior staff (for example, your year director or personal tutor) at an early stage, so they can arrange support for you. This will protect patients and allow the clinical team you are working with to respond appropriately. 46 You must contribute honestly and openly to the process. Openness and honesty are key to being a medical student and a safe and trustworthy doctor. You may hear this referred to as your professional duty of candour. The GMC and the Nursing and Midwifery Council have produced joint guidance for nurses and doctors, Openness and honesty when things go wrong: the professional duty of candour. * * See www.gmc-uk.org/professional-standards/professional-standards-for-doctors/candour---openness-and- honesty-when-things-go-wrong gmc-uk.org 22 Domain 3: Colleagues, culture and safety Introduction Culture is determined by the shared values and behaviours of a group of people. Everyone has the right to work and train in an environment which is fair, free from discrimination, and where they’re respected and valued as an individual. Good doctors communicate clearly and work effectively with colleagues in the interests of patients. They develop their self-awareness, manage their impact on others, and do what they can to help create civil and compassionate cultures where all staff can ask questions, talk about errors and raise concerns safely. Treating colleagues with kindness, courtesy and respect 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. gmc-uk.org 23 Contributing to a positive working and training environment 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. How can I handle bias? Biases are the beliefs, attitudes or stereotypes that can affect your understanding, actions or decisions. Often these biases affect the immediate decisions we make about people and situations. Reflective practice involves trying to identify your personal biases and how they influence your thinking and the way you respond to people or situations. Developing this skill is fundamental to making good decisions as a professional. See The reflective practitioner - a guide for medical students. 53 You must not abuse, discriminate against, bully, or harass anyone based on their personal characteristics, or for any other reason. By ‘personal characteristics’ we mean someone’s appearance, lifestyle, culture, their social or economic status, or any of the characteristics protected by legislation, which are:  age  disability  gender reassignment  marriage and civil partnership  pregnancy and maternity  race  religion or belief gmc-uk.org 24   sex  sexual orientation. 54 Doctors must not act in a sexual way towards colleagues with the effect or purpose of causing offence, embarrassment, humiliation or distress. This also applies to you as a medical student in relation to how you interact with your fellow students, medical school staff and the people you work with on clinical placements. You should also be aware that this applies equally in social settings as well as in learning environments. 55 If you witness any of the behaviours described above, you should act – see Raising concerns - What if my concern is about my friends or peers? Demonstrating leadership behaviours 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 - www.gmc-uk.org/about/what-we-do-and-why/data-and-research/research-and- insight-archive/good-conversations-fairer-feedback gmc-uk.org 25 Contributing to continuity of care 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. Delegating safely and appropriately 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. * * See www.gmc-uk.org/professional-standards/professional-standards-for-doctors/delegation-and-referral gmc-uk.org 26 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. 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. Recording your work clearly, accurately and legibly 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. gmc-uk.org 27 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. Recording your work - dos and don'ts Do  make it clear that you're a medical student when you add anything to a patient's notes - you should put your name and year of study so what you write can be checked by a registered health professional  make sure the notes you take are dated, clear, accurate and legible - even if they're not going on a patient's official record  make sure your notes are recorded as soon as possible after your interaction with a patient  get rid of your notes carefully - especially when they relate to patients - using facilities designed for the disposal of confidential material. Don't  write anything you would not want to be made public in notes, logbooks or reports  submit work that is difficult to read or poorly presented  store confidential material in places that aren't secure - this includes digital and paper files. Keeping patients safe 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 gmc-uk.org 28   report suspected adverse drug reactions  respond to requests from organisations monitoring public health. This also applies to you as a medical student. Responding to safety risks 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. The GMC has produced guidance on Raising and acting on concerns about patient safety * and a decision-making tool that will help registered doctors know what to do if they have a concern about patient safety. * See www.gmc-uk.org/professional-standards/professional-standards-for-doctors/raising-and-acting-on-concerns gmc-uk.org 29 How to raise a patient safety concern 75 We recognise that raising concerns about patient care can be difficult. As a medical student, you may not feel comfortable raising issues with supervisors who may be responsible for making assessments of your performance on the placement. You may also feel uncomfortable raising concerns with senior clinicians. This is why you should, wherever possible, follow your medical school's formal policy on raising concerns, which will help you understand how to deal with difficult issues like these. 76 In exceptional circumstances, you may not feel comfortable following the medical school's policy, for example because the person causing the concern is the person you have to raise it with. But you must still find another way to raise your concern. For example, you can talk to a member of staff with whom you have an ongoing relationship, such as your personal tutor or professionalism lead, who can support you. If the concern arises while you are on a placement, you may also find it helpful to refer to the placement provider's raising concerns policy. 77 It can be difficult for organisations to deal with anonymous concerns, because it's harder to investigate the situation if they don't know who made the complaint. Therefore, you should avoid raising concerns anonymously wherever possible. While your medical school will know who raised the concern, they won't necessarily need to name you as the source of concern when they investigate. What if my concern is about my friends or peers? It can be difficult to raise concerns about fellow students, who may be people you work with on projects or placements or your friends. But as a student choosing to join a regulated profession, it is your duty to put patients first and this includes patients you see on placements and those treated by your fellow students in the future. You might be concerned about the behaviour of a fellow student, for example if they:  are rude to a patient  do not contribute to group work you've been assigned  post inappropriate content on social media (see the Social media dos and don'ts box)  are intoxicated when attending a placement, lecture or seminar. It can be even harder to raise concerns about a peer's health, but you must bring this to the attention of your medical school if you are worried about their safety or wellbeing. You should never attempt to treat a fellow student's health condition. When you raise your concerns this will enable your medical school to give them help and support. gmc-uk.org 30 78 If you're not sure whether you should raise a concern formally, you should ask your medical school or an experienced healthcare professional for advice. GMC guidance on raising and acting on concerns acknowledges issues like this. It includes, for example, if the person causing concern is part of the problem or the doctor doesn't have confidence that the concern will be addressed adequately based on previous experiences. You may therefore find this guidance helpful. What should I do if I have a concern about a member of staff at my medical school or clinical placement? 79 It's just as important to raise concerns you have about the staff you work with. For example, a doctor, PA or AA, nurse or other healthcare professional who is or may be:  acting outside their competence  failing to see concerns about their health or not following advice on these concerns. 80 You may also have concerns about the lecturers and staff at your medical school. And while they may not be an immediate risk to patients, your medical school will still want to know if you are concerned about someone's health or wellbeing. They can then take steps to enable the individual to get the support they need. You must always raise concerns in a confidential, non-judgmental way. See the Steps to raise a concern section of the GMC's guidance Raising and acting on concerns about patient safety. Raising concerns - a legal or a moral duty? Medical students are not registered with the GMC and are not employees of their placement providers. This means that neither the GMC nor placement providers can legally require students to raise concerns. However, students do have a formal relationship with their medical school, which will expect them to raise concerns about patient safety, dignity and comfort. Medical students also have a moral responsibility to raise concerns about patient safety, dignity and comfort. Professionalism is not about doing the minimum - it is about doing what is necessary to protect patients. gmc-uk.org 31 Managing risks posed by your health 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 need to be able to determine whether they are well enough to care for their patients, as a 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. gmc-uk.org 32 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. Getting independent medical advice 90 Doctors must seek independent medical advice on issues relating to their own health. As a medical student, you also need to seek independent and objective advice from a GP or other appropriately qualified healthcare professional and not rely on what you have learnt as a medical student or the views of other students, family members or friends even if they are healthcare professionals. It is important that you have access to independent advice and you should register with a GP who is local to your medical school. Your health - dos and don'ts Do  tell your medical school if you have a health condition or you experience significant changes to a stable health condition  get appropriate support - all medical schools have support systems in place to help you, so take advantage of these  register with a GP local to your medical school  seek independent advice if you have a health condition or think your health or personal circumstances may be affecting your studies or training  make sure you follow any treatment plan you are given, and don't make changes to your treatment without consulting your treating physician. * 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. gmc-uk.org 33 Don't  hide it - your medical school will want to help you  diagnose or treat yourself  seek treatment from friends, family or those close to you. Informing your medical school 91 Doctors must declare a health condition to the GMC if it poses a risk to patients, or if there are concerns about the doctor’s clinical care, judgement or conduct that puts patients or public confidence in the profession at risk where the doctor’s health condition may be a contributory factor. 92 As a medical student, you must tell your medical school about any serious health conditions, or any aspect of your health or personal circumstances that could affect your training (especially your placements) or your relationship with colleagues. This is so that your medical school can adequately support you, and they can only do this if they know that you have a health condition. Telling your medical school shows you have insight into the impact your condition may have on patients, your fellow students and yourself. This is a crucial factor that medical schools consider in relation to health and fitness to practise and ability to continue and complete your studies. 93 You may find it helpful to read:  Supporting medical students with mental health conditions * - guidance for medical students and medical schools on dealing with mental health conditions.  Welcomed and valued † - provides advice for medical schools and postgraduate educators on how to support disabled learners and those with long term health conditions. * See www.gmc-uk.org/education/standards-guidance-and-curricula/guidance/supporting-students-with-mental- health-conditions † See www.gmc-uk.org/education/standards-guidance-and-curricula/guidance/welcomed-and-valued gmc-uk.org 34 Domain 4: Trust and professionalism Introduction Patients must be able to trust doctors with their lives and health, and doctors must be able to trust each other. Good doctors uphold high personal and professional standards of conduct. They are honest and trustworthy, act with integrity, maintain professional boundaries and do not let their personal interests affect their professional judgements or actions. Acting with honesty and integrity Honesty 94 Doctors hold a trusted position in society and must make sure their conduct - both professionally and personally - justifies their patients' trust in them and the public's trust in their profession. 95 As a student aiming to join a trusted profession, you have to meet a higher standard of behaviour than other students, who are on courses that don't directly lead to joining a profession. How can I demonstrate honesty? You must behave honestly from the point that you apply to medical school, during your studies and when you start working as a doctor. Here are some practical things you must do to demonstrate you are honest in your work as a medical student.  Don't pass off the work of others as your own, including work generated using artificial intelligence (AI). This is plagiarism.  Don't self-plagiarise by submitting your own previously assessed work.  Be honest about your experience and qualifications. This means you must not give your supervisors or teachers any misleading or false information about your qualifications or experience, or include such information in documents such as CVs and job applications.  When you carry out research, make sure you report findings accurately and truthfully. gmc-uk.org 35  Be honest and trustworthy in all your communications with patients and colleagues. This means you must make clear the extent of your knowledge and check that the information you provide is correct.  Be open and truthful about your health and make use of the processes put in place by your medical school to support you.  Be honest in the work you submit as part of your course. This means you must not claim to have done something, like a practical procedure on a clinical placement, if you have not.  Don't say you have attended teaching sessions or clinical placements if you haven't. And don't ask another student to sign in for you.  Be honest and open in financial and commercial dealings with employers, insurers, indemnifiers and other organisations and individuals. Maintaining professional boundaries 96 Doctors must not act in a sexual way towards patients or use their professional position to pursue a sexual or improper emotional relationship with a patient or someone close to them. 97 As a medical student, your studies will bring you into contact with patients and members of the public, who can be physically and emotionally vulnerable. Because of this, and the fact that you'll be joining a trusted profession, you must not use your position to pursue a sexual or improper emotional relationship with them. This includes situations where a patient or someone close to them tries to initiate a relationship with you. 98 Doctors must not express their personal beliefs (including political, religious and moral beliefs) to patients in ways that exploit their vulnerability or could reasonably cause them distress. This also applies to you as a medical student. Communicating as a doctor All professional communication 99 Doctors must be honest and trustworthy, and maintain patient confidentiality in all their written, verbal and digital communications with patients and colleagues. They must make clear the extent of their knowledge and check that the information they provide is accurate, not false or misleading. This also applies to you as a medical student. gmc-uk.org 36 Public professional communication, including using social media, advertising, promotion, and endorsement 100 When communicating publicly as a doctor – including using social media, advertising services, and promoting or endorsing any services or products, they must:  follow the guidance in the previous section  declare any conflicts of interest  not exploit people’s vulnerability or lack of medical knowledge  make sure what they communicate is in line with their duty to promote and protect the health of patients and the public. This also applies to you as a medical student. See the more detailed guidance Using social media as a medical professional for further information. Social media dos and don'ts Do  check your privacy settings so you know who can see what on the platforms you use. But remember that social media sites cannot guarantee confidentiality whatever privacy settings you use  remember that the apps you use may link to your social media profile and that information from that site may be seen by users of the app  maintain boundaries by not engaging with patients or others about a patient's care through your personal social media profiles or platforms. Instead, if appropriate, use a separate professional platform or profile to respond  remember that once information is published on social media sites you may not be able to control how it is used by others and it can be difficult to remove it from the internet or the site it was originally posted on  use social media to express your views, but don't behave in a derogatory manner to other users and don't post discriminatory content  think carefully about how others, particularly patients both present and future, might perceive your content gmc-uk.org 37  be aware of how to manage and respond to online abuse. If you’re being bullied by a colleague online contact your medical school for advice on the next steps. You can also contact the GMC through our online form or by contacting us by phone or email. * Don't  share information about patients or post information that could identify a patient  misrepresent your skills or level of training to others  post complaints about individuals at your medical school or clinical placement providers – see What should I do if I have a concern about a member of staff at my medical school or clinical placement?. Giving evidence and acting as a witness 101 Doctors must be honest and trustworthy if asked to give evidence in any legal or disciplinary proceedings. They're also expected to report certain matters to the GMC, for example if they receive a caution from the police. 102 As a medical student you are not registered with the GMC, but you have similar responsibilities in relation to your medical school. Medical schools must not graduate any student with a primary medical qualification who they don't consider fit to practise. This means, even if you meet all the competencies and pass your exams, your medical school can only graduate you if they are satisfied you are fit to practise. You'll also need to declare any fitness to practise issues when you apply for provisional registration with the GMC.† Private communication 103 When communicating privately, including using instant messaging services, doctors should bear in mind that messages or other communications in private groups may become public. This also applies to medical students, and you should make sure that you only add content that you would be happy for a wider audience to see. You must also avoid sharing confidential patient information through these services. * www.gmc-uk.org/concerns/supporting-you-with-your-concern/how-to-raise-a-concern-with-us † You can read our guidance on completing the declaration of fitness to practise: www.gmc-uk.org/registration-and- licensing/join-the-register/what-to-tell-us-when-you-apply-guide. gmc-uk.org 38 Managing conflicts of interest 104 Doctors:  must not allow any interests they have to affect, or be seen to affect the way they propose, provide or prescribe treatments, refer patients, or commission services  if faced with a conflict of interest, must be open about it with patients and employers, declare it in line with local arrangements, and be prepared to exclude themselves from decision making  must not ask for or accept – from patients, colleagues or others – any incentive payments, gifts or hospitality that may affect or be seen to affect the way they propose, provide or prescribe treatments, refer or commission services for patients, or offer such incentives to others  should, wherever possible, avoid providing medical care to themselves or anyone with whom they have a close personal relationship. They must seek independent medical advice on issues relating to their own health. This also applies to you as a medical student. Cooperating with legal and regulatory requirements 105 To maintain patient safety, doctors must cooperate with formal inquiries, patient safety investigations, and complaints procedures. They must provide all relevant information and be open and honest. They must also tell the GMC without delay if, anywhere in the world:  they have accepted a caution (or equivalent) from a prosecuting authority  they have been charged with a criminal offence in person or by post  they have been found guilty of a criminal offence. gmc-uk.org 39 106 You have a duty to cooperate with your medical school’s fitness to practise procedures that involve you or your colleagues. You also have a responsibility to tell your medical school immediately, and the GMC when you apply for provisional registration, * if you:  accept a caution † for a criminal offence while you are at medical school  have been charged with or found guilty of a criminal offence while at medical school  have any serious concerns about the impact your health condition might have on your ability to practise. 107 You should tell your medical school or higher education institution if you are the subject of any legal proceedings that could call into question your fitness to practise medicine as a doctor. You shouldn't wait until legal proceedings have been concluded before you do this. 108 If you had any cautions‡ or convictions before you started medical school, and didn’t declare these on admission (unless they are protected), you should do so at the earliest opportunity. Note that the definition of protected cautions and convictions is different between England, Northern Ireland, Scotland and Wales. You need to refer to the definition that applies to the country where your course is based. § 109 You must also tell your medical school, and the GMC when you apply for registration, if there has ever been a determination by a UK or overseas regulatory body that your fitness to practise as a member of that regulated profession is impaired. For example, nursing, dentistry or law. 110 If you have any questions about what you should declare to the GMC or to your medical school, you should seek advice from your medical school, a medical defence organisation or the British Medical Association (BMA). * See the GMC’s guide What to tell us when you apply for further information: www.gmc-uk.org/registration-and- licensing/join-the-register/what-to-tell-us-when-you-apply-guide † A student on a course in Scotland will not have to disclose receipt of a caution to the medical school - because medical schools apply the law pertaining to the country in which they are based and in Scotland cautions do not have to be disclosed. However, a student on a course in Scotland will have to disclose receipt of a caution to the GMC when they apply for registration. ‡ As explained in previous footnote, a student or applicant will not have to disclose a caution to a course based in Scotland upon admission. § Read more about protected cautions and convictions: www.gmc-uk.org/education/standards-guidance-and- curricula/guidance/student-professionalism-and-ftp/protected-spent-cautions-and-convictions gmc-uk.org 40 Professionalism - key areas of concern Behaviour outside of medical school Medical students need to behave professionally outside of work and medical school. This means you should avoid doing things that will undermine the confidence patients have in doctors and the public has in the medical profession. For example, you shouldn't make discriminatory comments about individuals or groups of people in public or on social media. Your medical school will take action if you do something unprofessional, such as get a caution for drunken behaviour, even if it happened outside of the medical school or over the summer holidays. This means you should take responsibility for your actions and be aware that they may have a wider impact on how your medical school views your professionalism. 111 A medical student's behaviour must justify the confidence that patients and the public have in them. Examples of unprofessional behaviour that would be a cause for concern are listed below. Some of these examples apply to the medical school environment, but it's important to remember that you need to behave professionally outside your medical school too. Unprofessional behaviour over a number of different areas, or repeated or persistent unprofessional behaviour, could lead to fitness to practise proceedings. It's important to note that this list is not exhaustive. Cheating or plagiarism  Cheating in examinations * including sharing, or attempting to share any exam material without the permission of your medical school  Signing peers into taught sessions or clinical placements from which they are absent  Passing off the work of others as your own  Forging a supervisor's signature or falsifying feedback on assessments, logbooks or portfolios * For more information on what might be considered exam misconduct please see the AKT Policy Framework www.medschools.ac.uk/medical-licensing-assessment/the-medical-school-applied-knowledge-test-ms-akt gmc-uk.org 41 Dishonesty or fraud, including dishonesty outside the professional role  Falsifying research  Committing financial fraud  Creating fraudulent CVs or falsifying other documents  Misrepresentation of qualifications  Falsifying signatures on documents such as portfolios  Failure to declare relevant misconduct issues or health conditions to your medical school or higher education institution  Wilful withholding or misrepresentation of health conditions (eg blood-borne viruses) Misconduct and health conditions relating to drug or alcohol use  Driving under the influence of alcohol or drugs  Misuse of prescription medication  Alcohol consumption that affects clinical work, the work environment, or performance in the educational environment  Drug use that affects clinical work, the work environment, or performance in the educational environment - this may include legal highs  Dealing, possessing or supplying drugs, even if there are no legal proceedings  A pattern of excessive alcohol use Aggressive, violent or threatening behaviour  Assault  Physical violence  Bullying  Harassment  Stalking  Online bullying or trolling gmc-uk.org 42 Failing to demonstrate good medical practice  Misuse of social media, such as criticising placement providers  Breach of confidentiality  Misleading patients about their care or treatment  Culpable involvement in a failure to obtain proper consent from a patient  Sexual, racial or other forms of harassment or bullying  Inappropriate examinations or failure to keep appropriate boundaries in behaviour  Unlawful discrimination Persistent inappropriate attitude or behaviour  Uncommitted to work or a lack of engagement with training, programme of study or clinical placements  Neglect of administrative tasks  Poor time management  Non-attendance  Poor communication skills  Failure to accept and follow educational advice and unwillingness to learn from feedback given by others  Being rude to patients, colleagues or others  Unwillingness to learn from constructive feedback given by others  Being disruptive in teaching sessions or the training environment  Challenging behaviour towards clinical teachers or not accepting criticism  Failing to answer or respond to communications within a reasonable time Any caution or conviction  Possessing, dealing or supplying illegal drugs  Theft  Physical violence  Fare avoidance  Financial fraud  Child pornography gmc-uk.org 43  Child abuse or any other abuse  Sexual offences gmc-uk.org 44