Janet Smith, the judge who chaired the Shipman inquiry, has called for students to be put on the UK General Medical Council's medical register to establish that they have the right values and attitudes to practise patient centred medicine.
Speaking at a GMC conference on medical education earlier this week, she said the fifth report of the inquiry highlighted the need to ensure that people become fit and proper doctors and that they have the right characteristics to be of service.
Drawing on her own experience of barrister training—during which students can be “rejected” before qualification—she said: “I do think that both your profession and mine should be pretty tough on students who present with a history of past misconduct or, indeed, those who get into trouble while on the course. That may sound harsh, but I think it is generally accepted that past behaviour is the best predictor of future behaviour and that the main objective must always be the protection of the public.”
However, she stressed that spotting “unsuitables” is a very small problem, and although registration might help to forge a closer relationship between the GMC and course tutors it was “not the whole answer” in ensuring fitness to practice. She said that students need to be taught about the relationship between doctors and society, including the potential conflict between patients' wishes and doctors' public duty, their duty to court when giving evidence, and their duty to the public interest. She added that ethical issues should be taught from the start of the medical school curriculum.
“It would be useful and sensible to have some means of weeding out failing students who have not managed to catch on to and absorb essential ethical principles which they will be expected to practise throughout their career,” she said.
She also criticised the “depressingly low” standards in death certification and a lack of developed principles and ethics guiding doctors' behaviour. During the Shipman inquiry Dame Janet said she found that doctors may “bend the rules” to avoid an inquest. “Research shows a high level of mistakes made by certifiers at all levels of doctors, from housemen to consultants and including GPs. The same research also shows that there are some ethical issues involved,” she said. “There seems to be in general a poor understanding of the importance of accurate death certification.”
Peter Rubin, chairman of the GMC's education committee, said that the GMC currently has no statutory or legal powers over the conduct and behaviour of medical students and that the GMC is taking Dame Janet's calls for student registration very seriously. “We want to consult widely about the views around the country about registration. Our role is to protect the public, and we're always looking for ways we can enhance that role,” he said.