The case for student GMC registration

Wai-Ching Leung considers the advantages

In professions such as dentistry¹ and law, students must satisfy the relevant professional organisation that they are of good character and health to be registered as a qualified professional. By contrast, medical students are automatically entitled by law to registration with the General Medical Council on graduation.² Traditionally, the role of the university is mainly to assess students' academic and clinical ability, although the university should also ensure that students acquire the appropriate professional attitude during the course.³ Difficulties arise if a medical student performs well both academically and clinically in the course but is known to have conduct or health problems sufficiently serious to call into question his or her fitness to practise. The public is not adequately protected by this system, as there are no mechanisms to prevent such students from being registered as doctors or to monitor any remedial actions that are taken.

In 1996 the joint group of the committee of vice-chancellors and principals and the General Medical Council education committee was set up to advise on what arrangements universities should make relating to guidance from the General Medical Council on student health and conduct. Two years later they published their concluding report.⁴

The report's recommendations

The solutions recommended were to create a new "offence" and a new procedure under university regulations. The new offence is "any conduct which renders that student a person not fit to be admitted to and practise that profession or calling" if enrolled on a course leading directly to a professional qualification or to the right to practise a particular profession or calling. The new procedure is that "for health or behavioural reasons... students who are deemed unfit to practise and to gain professional qualification and registration may be transferred to alternative courses or intermit their programmes of study." This new offence and procedure would apply to medical students and probably to students in nursing, dentistry, and teaching. The joint group rightly justified its recommendations by

• the nature of the qualifications that the universities have agreed to confer
• the role of universities to take into account suitability to practise when selecting students for such courses
• the duty of universities to protect the public from excessive risks.

Problems with the recommendations

In many ways, these recommendations are unsatisfactory. Firstly, there is no reason why the public should have confidence in policing by universities. Universities may have interests in increasing their student completion rates for both financial and public image reasons. Secondly, each university would encounter these problems very infrequently. Therefore, it is unlikely that they would have the appropriate expertise either to understand the issues relating to each profession or to make a sound judgment in each case. Thirdly, as there are no explicit criteria for what constitutes "fitness to practise," it is unlikely that universities would achieve consistency in implementing the recommendations. There is a danger that some university vice-chancellors may be overcautious and bar students unnecessarily from completing the degrees, while others may turn a blind eye to obvious problem students. Fourthly, there is no continuity before and after the students qualify. Many problem students, especially those with health problems, require continuous monitoring rather than a single decision about withdrawal from a course. However, universities have no power to monitor the students after they qualify. Fifthly, there is perceived unfairness between students in the same university studying different subjects. Is it desirable for medical students to be perceived as "ethically superior" to students in other disciplines? Finally, while it is clear that students who pose a danger to patients should be withdrawn from medical courses by universities, there are students (for example, those with health problems leading to poor personal organisation) who are safe to complete the course and be awarded the degree but not necessarily safe to practise as doctors. These students should not be denied the opportunity to make use of their medical qualifications in alternative careers.

The way forward

Student registration with the GMC appears to be the ideal solution. All medical students should be required to register with the GMC free of subscription fees. Any concerns about the students' fitness to practise should be referred to and dealt with by the GMC under existing procedures. This would avoid the problems outlined above and ensure that the system is sound, consistent, and fair.

There are other advantages to student GMC registration. Firstly, as the GMC plays a central role in shaping the undergraduate medical curriculum,³ a register of medical students would offer a golden opportunity for the GMC to disseminate systematically its guidance and educational material early on in doctors' careers. Secondly, the public gives a much higher degree of trust to medical students than to non-professionals, as evidenced by strong public criticism when a consultant surgeon allowed a 16 year old work experience schoolboy to assist in an operation. The consultant was immediately suspended pending investigation.⁵ Student GMC registration will help to support such public confidence.

Wai-Ching Leung, senior registrar in public health medicine, epidemiology and public health, Newcastle General Hospital
Email: wai_chingleung@hotmail.com


studentBMJ 2000;08:259-302 August ISSN 0966-6494

1. Joint Group of the CVCP's Medical Committee and the General Medical Council (GMC's) Education Committee. Medical and dental student health and conduct: final report. London: CVCP, 1998.
2. Dentists Act 1984, s 15(3). London: HMSO.
3. Medical Act 1983, Part II. London: HMSO.
4. General Medical Council. Tomorrow's doctors: recommendations on undergraduate medical education. London: GMC, 1993.
5. Mihill C. Schoolboy "assisted in operation." The Guardian, 2 August 1997.