NHS professionalism study shows decline in care

THE poor professional standards of a minority of senior healthcare workers, acting as mentors for medical students, are contributing to a decline in patient care and dignity, according to a new report by researchers at Dundee and Cardiff universities.

Dr Monrouxe suggested that some senior practitioners belonged to a different culture of medicine with different approaches to care. Picture: PA

The eight year study by researchers at the two universities has uncovered evidence of senior healthcare practitioners, charged with teaching healthcare students across the NHS, talking about patients in their charge inappropriately, breaching confidentiality rules, and allowing students to practise on patients without valid consent.

The study has also revealed that medical students are suffering from “emotional stress” because they are are unable to challenge their superiors - caught in a conflict between the strong ethical code they are taught at healthcare schools and the “failing ethics” they occasionally witness in the workplace.

‘Professionalism dilemmas’

A spokesman for Dundee University explained: “

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..

“It finds that 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.

“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.”

Dr Lynn Monrouxe, the study’s co-author and Director of Medical Education Research at Cardiff University, 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.

‘Role models’

“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.”

She revealed: “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.”

‘Different culture of medicine’

Dr Monrouxe suggested that some senior practitioners, having been trained many years ago, belonged to a different culture of medicine with different approaches to care. And she continued: “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.”

Professor Charlotte Rees, another leading member of the research team from Dundee University, said: “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.”

She added: “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.”

‘Safe environment’

A Dundee University spokesman said: “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.

“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 lessons learned from the research were already being taken on board at the university.

He 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.”