1 July 2013
Patient care suffering because of senior practitioners' professionalism lapses
- Study identifies lapses in professionalism behaviours by senior healthcare practitioners as contributing to decline in patient
care
- Medical students feel 'emotional stress', not being able to challenge their superiors and sometimes complying with them
The professionalism lapses of a minority of senior healthcare practitioners, charged with teaching healthcare students across
the NHS, are contributing to a decline in patient care and dignity. This is the finding of an eight-year programme of research,
led by Cardiff University and the University of Dundee.
The research explored the professionalism dilemmas experienced by healthcare students from across five countries - England,
Wales, Scotland, Northern Ireland and Australia - and collected over 2,000 anonymous stories of professionalism lapses from
more than 4,000 student participants.
Research co-author and Director of Medical Education Research at Cardiff University, Dr Lynn Monrouxe, said: 'Our research
has highlighted that some senior healthcare practitioners across the UK fail to ensure proper patient care and dignity in
the presence of students.
'Healthcare students are explicitly taught what comprises professional values and behaviours, but a large part of
learning to become a healthcare professional occurs within the NHS as students observe their seniors - who act as powerful
role models - interacting with patients.
'During our research, common professionalism lapses reported by medical, dental, nursing, physiotherapy and pharmacy
students included clinicians' and students' poor hygiene practices; talking to or about patients inappropriately;
confidentiality breaches; students practising on patients without valid consent and going beyond the limits of
their own competence.' (See notes to editors for examples of student narratives)
As a result of Dr Monrouxe and Professor Rees's work, medical schools across the UK are now beginning to change ethical
guidelines around students' interactions with patients. Newcastle School of Medicine confirmed the scale of the problem
at their school and were moved to review their own policies and procedures, based on the study's recommendations.
Roger Barton, Professor of Clinical Medicine and Director of Medical Studies at Newcastle University, said:
'The lessons from Lynn Monrouxe and Charlotte Rees' research will be at the foundation of teaching, and students
will have regular opportunities to share and discuss the dilemmas they have come across. This will support students to
re-commit to the professionalism values taught during formal learning.'
Dr Monrouxe expounds the idea that some senior practitioners, having been trained many years ago, belong to a
different culture of medicine with different approaches to care. She added: 'Many healthcare students, at some stage
in their workplace learning, will find themselves witnessing or participating in a practice which falls short of
the ethics and professionalism they've imbued in their own formal training.'
Co-author of the studies, Professor Charlotte Rees, University of Dundee, added: 'Confronted with these situations
students often report experiencing distress; they are freshly instilled with the knowledge of correct practice but
feel unable to challenge their superiors given the hierarchical culture of the workplace. Future healthcare professionals
find themselves caught in a clash between the strong ethical code taught at healthcare schools and the sometimes
failing ethics of the workplace.
'Students' narratives tell us that these lapses in professionalism by some senior healthcare professionals, is
sometimes reproduced by students themselves, contributing to a decline in patient care and dignity - and to the potential
perpetuation of harsh practical training methods with the next generation of healthcare workers.'
The research programme identifies a need for healthcare schools to provide students with a safe environment to share
their concerns and anxieties with ethical role models. In such an environment students could share best practice and
resist bad practice. It also stresses that cultural change should occur from within clinical settings. Patients,
patient advocates, students and healthcare professionals should engage in a constructive dialogue to examine how language,
practices and values occurring within clinical settings can be developed to improve patient safety and dignity.
Notes to Editors:
Here below are some excerpts taken from anonymous student interviews, who were asked to recall medical workplace dilemmas:
One medical student complained of '[...] unprofessional embarrassing behaviour when treating a dementia patient, involving
physical unnecessary restraint of the patient and a member of the clinical team filming the incident on his camera phone.'
A pharmacy student spoke of his first day on the job: '[...] I heard someone shout across the dispensary 'addict on the floor,
addict on the floor' and that meant an addict was in the shop, and they weren't allowed in the shop [...] they were told just
to go straight out of the shop and to use their separate entrance in front of the customers - a whole room full.'
Students also complained of abuse from senior clinicians. Testimonies cited verbal abuse, humiliation in front of patients
and students being made to do menial and unpleasant jobs as punishment. A female medical student recalls an incident where
she was unfairly chastised by a consultant, which left her wanting to give up her studies:
'Unfortunately the consultant spotted me and said 'you there' the decoration. Why did you even come to med school?
Do you have a brain in that pretty head? What you need to do is put down that Heat magazine, climb out of bed with
your boyfriend, and do some work.' He doesn't know me at all. I was horrified and was considering leaving med school
at that point. This shouldn't happen in our modern education.'
For further information please contact:
Tomas Llewelyn Barrett
Public Relations
Cardiff University
Tel: 029 20 875 596
Mobile: 07950792532
E-mail: BarrettTL1@cardiff.ac.uk
Or:
Grant Hill
Press Officer
University of Dundee
Nethergate, Dundee, DD1 4HN
TEL: 01382 384768
E-MAIL: g.hill@dundee.ac.uk
MOBILE: 07854 953277
Cardiff University
Cardiff University is recognised in independent government assessments as one of Britain's leading teaching and research
universities and is a member of the Russell Group of the UK's most research intensive universities. Among its academic
staff are two Nobel Laureates, including the winner of the 2007 Nobel Prize for Medicine, University Chancellor Professor
Sir Martin Evans. Founded by Royal Charter in 1883, today the University combines impressive modern facilities and a
dynamic approach to teaching and research. The University's breadth of expertise encompasses: the College of Humanities
and Social Sciences; the College of Biomedical and Life Sciences; and the College of Physical Sciences, along with a
longstanding commitment to lifelong learning. Cardiff's three flagship Research Institutes are offering radical new
approaches to neurosciences and mental health, cancer stem cells and sustainable places.
The University of Dundee
The University of Dundee is internationally recognised for its excellence in life sciences and medical research. The
University has a top-rated medical school with research expanding from "the cell to the clinic to the community". Dundee
was voted best in the UK for student experience in the 2012 Times Higher Education Student Experience Survey. See
www.dundee.ac.uk for further details.
For media enquiries contact:
Grant Hill
Press Officer
University of Dundee
Nethergate, Dundee, DD1 4HN
TEL: 01382 384768
E-MAIL: g.hill@dundee.ac.uk
MOBILE: 07854 953277 |
