The BMA says a punitive and inconsistent approach to enforcing “professionalism” standards is damaging students’ trust in university leadership and discouraging them from speaking openly about problems affecting their wellbeing and patient care.
The report, Broken Trust: Medical Students’ Experiences of Professional Standards in the UK, is based on a UK-wide survey of 2,573 medical students and Freedom of Information data obtained from British medical schools.
It found that 45.3% of respondents would feel uncomfortable raising a concern within their medical school, while 40% would be uncomfortable speaking up during a clinical placement.
Professional standards are set by individual medical schools using guidance published jointly by the General Medical Council and the Medical Schools Council. They are intended to prepare students for the standards of conduct expected of registered doctors.
Students can be investigated over concerns about their conduct, with serious cases potentially leading to Fitness to Practise proceedings and affecting their future medical careers.
However, many students told the BMA that the current approach has developed into a “tick-box” system focused on attendance, administrative requirements and minor breaches of expected behaviour rather than professional development and support.
More than 70% of students who had experienced a professionalism concern felt that the description of their conduct had been unfair. Some respondents believed the process had been used disproportionately when students provided critical feedback or challenged decisions made by their medical schools.
Students also questioned why minor administrative issues appeared to receive considerable attention while more serious concerns, including sexual harassment, racism and sexism, were not always addressed effectively.
One fourth-year medical student described the effect that a professionalism investigation had on their mental health while they were receiving treatment for anorexia.
They said: “I had been making real progress in treatment for anorexia, but the suspension process, lack of support, and punitive attitude from the school caused a serious relapse and left me in a state of despair. I felt completely dehumanised, isolated, and unsafe to reach out for help.”
Other students reported feeling pressured to attend university or clinical placements while ill. One said they were forced to travel to university while vomiting to demonstrate that they were genuinely unwell. Another said they attended a placement while sick because they feared their attendance record would prevent them from completing the academic year.
A further respondent said they received a professionalism warning after complaining about a placement assignment that breached their medical school’s travel policy. Although the complaint was later upheld, the student said they were told that making the complaint instead of being “willing to give it a go” had been unprofessional.
The report also raises concerns about the effect of professionalism rules on students’ lives outside medical education. Two-thirds of respondents said they would feel unable to participate openly in lawful political activism or protest because they feared it could damage their future career.
This is despite the GMC making clear that medical students are entitled to hold political opinions.
Elgan Manton-Roseblade, co-chair of the BMA’s medical students committee, said: “It’s heartbreaking to hear how much anxiety these systems are causing. ‘Professionalism’ should be about learning how to be a safe, compassionate doctor, but right now it’s used as a disciplinary threat that risks silencing students.”
Committee deputy chair Callum Williams warned that a reluctance to speak up during medical school could continue when students enter the NHS.
“We can see that students are genuinely scared and reluctant to speak up about issues, and the risk is that as they approach NHS work, this could increasingly translate into a fear of raising vital patient safety concerns,” he said.
“Repeated descriptions of trivial issues as unprofessional whilst serious conduct issues are often not addressed undermines students’ trust in professional standards. Medical schools must start treating their students for who they are: the future of our health service, with real lives that deserve flexibility and respect.”
Freedom of Information responses collected for the report also revealed considerable differences in how medical schools record and enforce professionalism standards. Several institutions did not track basic disciplinary data, despite GMC guidance stating that they should do so.
Where information was available, referral rates for lower-level concerns and potentially career-altering Fitness to Practise investigations varied considerably between medical schools.
The BMA is calling for national reform to make the system fairer and more constructive. It says students must not be disadvantaged for raising concerns in good faith and that speaking up should be recognised as a professional responsibility.
It also wants medical schools to adopt more flexible attendance policies, protect lawful political expression and publish data about professionalism concerns and Fitness to Practise investigations, including an analysis of how different demographic groups are affected.