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Background: Students must be proficient in surgical skills according to General Medical Council and Royal College of Surgeons of England guidelines. If these skills are not appropriately taught, there is a risk of an incoming junior workforce with inadequate surgical skills. This paper aimed to review the literature relating to undergraduate teaching of surgical skills in the UK and summarize future suggested training methods. Methods: The databases MEDLINE, Embase and SCOPUS were searched, and the existing literature relating to methodology of undergraduate teaching of surgical skills in the UK over the past 10 years was summarized. The Medical Education Research Quality Instrument was used to assess research quality. Results: A total of 19 papers were included. Cross-sectional evaluations and survey-based studies highlight a clear deficit in surgical skills teaching in the UK. Medical students are currently unable to fulfil their own learning needs and meet requirements set out by the General Medical Council. This lack of surgical teaching appears to negatively affect student desire to pursue a surgical career. The three main themes for improvement are extracurricular surgical skills days, near-peer teaching and simulation. Each method appeared to improve learning, although no studies utilized medium- to long-term follow-up to demonstrate efficacy and there lacks a clear consensus as to the 'standard' of undergraduate surgical skill education. There was also potential for selection bias and response shift bias in many of the studies assessing pre- and postintervention confidence and opinions. Conclusion: There is a concerning lack of surgical skills teaching that has resulted in medical students and junior doctors not having the necessary surgical skills as per General Medical Council guidance and students feel that their own learning needs are not met. This failure to address the learning deficit may be responsible for the fall in surgical competition ratios. While surgical skills teaching must be improved urgently, more robust evidence is required to evaluate the optimal ways of approaching this issue. Undergraduate medical students must be proficient in certain surgical skills as set out by General Medical Council and Royal College regulations. There appears a deficit in such teaching which we have discussed and attempted to address in terms of alternative methodology reported in the literature that can be used to teach these basic surgical skills. [ABSTRACT FROM AUTHOR]

Aims Newly graduated doctors write a large proportion of prescriptions in UK hospitals but recent studies have shown that they frequently make prescribing errors. The prescribing safety assessment (PSA) has been developed as an assessment of competence in relation to prescribing and supervising the use of medicines. This report describes the delivery of the PSA to all UK final-year medical students in 2016 (PSA2016). Methods The PSA is a 2-hour online assessment comprising eight sections which cover various aspects of prescribing defined within the outcomes of undergraduate education identified by the UK General Medical Council. Students sat one of four PSA 'papers', which had been standard-set using a modified Angoff process. Results A total of 7343 final-year medical students in all 31 UK medical schools sat the PSA. The overall pass rate was 95% with the pass rates for the individual papers ranging from 93 to 97%. The PSA was re-sat by 261 students who had failed and 80% of those candidates passed. The internal consistency (Cronbach's alpha) of the four papers ranged from 0.74 to 0.77 (standard error of measurement 4.13-4.24%). There was a statistically significant variation in performance between medical school cohorts (F = 32.6, P < 0.001) and a strongly positive correlation in performance for individual schools between PSA2015 and PSA2016 ( r = 0.79, 95% CI 0.61-0.90; P < 0.01). Conclusions PSA2016 demonstrated the feasibility of delivering a standardized national prescribing assessment online. The vast majority of UK final-year medical students were able to meet a prespecified standard of prescribing competence. [ABSTRACT FROM AUTHOR]

The article reports that the "Lancet" has retracted the 1998 paper by scientist Andrew Wakefield which suggested a link between measles, mumps, rubella (MMR) vaccine and autism, after the British General Medical Council (GMC) found the scientist guilty of dishonesty and flouting ethics protocols. An online statement published by the "Lancet" stated that the decision of the GMC in 2010 makes it clear that several elements of the paper are incorrect, contrary to the findings of an earlier study. Also noted is the furore created by the study of Wakefield.

The article examines the issues surrounding White Paper's uncovering of the proposal to reforming the health professionals' Trust, Assurance and Safety regulation in Great Britain. The White Paper expressed that to reform, the importance of perceptions must be rightly emphasized as public needs to perceive that the regulatory system is operating in the interests of patients. It also stresses that the General Medical Council's (GMC) four functions must be integrated in the regulatory framework.

Risk-based regulation is growing in popularity and in the UK has official backing as part of the government's modernization programme. State and non-state regulators alike are under pressure to adopt risk-based approaches. With radical reform of the General Medical Council (GMC) in progress, the rhetoric of risk-based regulation is used by both the Department of Health and the GMC, and is evident in the 2007 White Paper Trust, Assurance and Safety - The Regulation of Health Professionals in the 21st Century. This paper focuses on the dilemmas inherent in risk-based approaches to regulation by the GMC. Two sources of difficulty are examined. First, the evidential demands can be heavy and costly. Databases and information sources related to patient safety and the performance of doctors are proliferating, but have important limitations. Second, decisions about which risk factors to include and how to weight them are riddled with difficulties, both technical and normative. One attraction of risk-based approaches is that they seem to offer objectivity, but it is questionable how far this is possible in practice. Risk information is neither generated nor used against a neutral background. In the medical regulation arena, questions of public trust and confidence are crucial: risk-based regulation does not help deal with these. Furthermore, a focus on individual doctors and a certain amount of blame and sanctioning would seem to be integral to regulatory functions of such bodies as the GMC. The paper poses fundamental questions about how blame-free these systems really can be. [ABSTRACT FROM AUTHOR]

The use of 'placebos' in clinical practice is a source of continued controversy for physicians and medical ethicists. There is rarely any extensive discussion on what 'placebos' are and how they work. In this paper, drawing on Louhiala and Puustinen's work, the author proposes that the term 'placebo effect' be replaced in clinical contexts with the term 'positive care effect'. Medical treatment always takes place in a 'context of care' that encompasses all the phenomena associated with medical intervention: it includes the particular method of treatment, the interpersonal relationships between medical staff and the patient and other factors, including physicians' and patients' beliefs in the power of the treatment. Together, these phenomena can result in a full spectrum of therapeutic effects to the patient -- from no effects, to small effects, to large effects. In cases where there are significant therapeutic benefits to the patient, 'positive care effects' may be spoken of. Since the ethical codes of the General Medical Council and the American Medical Association demand transparency with respect to patient treatment and insist on complete openness in 'placebo' usage, the author argues that, as a matter of conceptual rigour and consistency, if the term 'placebo effect' is replaced by 'positive care effect', these ethical codes appear to insist on transparency about all such beneficial components of treatment. Given that this appears to be a counterintuitive obligation, the author concludes the paper with some comments on the clinical consequences of this conceptual revision, including a brief discussion of how this important debate might develop. [ABSTRACT FROM AUTHOR]

Questionnaires provide a useful and versatile tool for new and occasional researchers, and can be applied to a wide range of topics. This paper provides simple guidance on some of the potential pitfalls in developing and running a questionnaire study, and how to avoid them. Each tip is illustrated with a real-life example from the development of a UK-wide questionnaire survey of trainee doctors and their educational supervisors. [ABSTRACT FROM AUTHOR]

Traditional historiography tends to draw a negative picture of British doctors' ethics during the long nineteenth century. The medical professional ethics of this period have been described as self-serving and as a tool to monopolise the health care market. In this paper I attempt to challenge this rather one-sided view by looking into evidence for the practice of medical ethics, not just its normative texts. Focusing on the disciplinary function of the General Medical Council and discussing a variety of its cases, from fraudulent registration, sexual misconduct and breach of confidence to negligence, covering unqualified assistants and advertising, I argue that nineteenth-century medical ethics aimed at supporting the interests of patients and of the public at large as well as the reputation of the profession. [ABSTRACT FROM AUTHOR]

In 2012, medical regulation in the United Kingdom was fundamentally changed by the introduction of revalidation – a process by which all licensed doctors are required to regularly demonstrate that they are up to date and fit to practice in their chosen field and are able to provide a good level of care. This paper examines the implications of revalidation on the structure, governance, and performance management of the medical profession, as well as how it has changed the relationships between the regulator, employer organizations, and the profession. We conducted semi‐structured interviews with clinical and non‐clinical staff from a range of healthcare organizations. Our research suggests that organizations have become intermediaries in the relationship between the General Medical Council and doctors, enacting regulatory processes on its behalf and extending regulatory surveillance and oversight at local level. Doctors' autonomy has been reduced as they have become more accountable to and reliant on the organizations that employ them. [ABSTRACT FROM AUTHOR]

This paper describes an eight month experience with three of the four main assessment tools that will be used to validate the successful completion of the FY1 placement. The practical issues around the implementation of these new tools is of great concern to all involved in the management of postgraduate training and it is hoped that this paper will contribute some of the practical elements so far unavailable from Department of Health sources. [ABSTRACT FROM AUTHOR]

Summary: Background: Monitoring the quality of clinical learning environments (CLEs) is immensely important in medical education. Objective indicators of the quality of the CLE can be used to measure learner perceptions and to inform educational improvements; however, many established tools were not designed for use in clinical settings and are not theoretically grounded. Our aim was to apply a new tool to the new context of a UK setting to explore the perceptions of senior medical students in a number of different CLEs. Monitoring the quality of clinical learning environments is immensely important in medical education Methods: The four‐factor Undergraduate Clinical Education Environment Measure (UCEEM) was translated into English, and used to gather final‐year medical students’ perceptions of four different specialties they had rotated through: Emergency Medicine (EM), General Surgery (GS), Medicine for the Elderly (ME), and Obstetrics and Gynaecology (O&G). The UCEEM was distributed in paper form. Students were asked to complete it in relation to two of the four specialties. Results/findings: Year‐5 medical students (n = 132) returned a completed UCEEM. For opportunities to learn in and through work experience EM was reported the most positively. ME was perceived to be the most prepared for student entry. Students reported being well received by staff and made to feel part of the team within GS, EM and ME, but less so in O&G. Discussion: UCEEM appears to be a useful tool for evaluating medical student perceptions of CLEs. Theoretically robust, UCEEM is straightforward to administer and to score. It has the potential to be used by time‐pressured educators to collect baseline and comparative data for evaluation and improvement purposes. [ABSTRACT FROM AUTHOR]

The requirement for doctors and other medical professionals to undertake periodic performance evaluation is growing. Tools and techniques for such performance evaluation are at an early stage of development, but it is likely that feedback from colleagues and patients will play an important role. The aim of this paper is to evaluate two feedback tools (CFET for colleague feedback and DISQ for patient feedback) for the purpose of periodic performance evaluation of doctors. The data used in this study came from over 200 doctors currently working in hospital settings within the UK. The results indicate that there is close correspondence between the outcomes of manual screening procedures used by the UK General Medical Council (GMC) and the output from the two feedback tools Also, the paper shows that it is possible to combine colleague and patient feedback for a doctor, thereby extending our knowledge of how screening techniques based on questionnaires can produce a multisource view currently not available to manual screeners. The paper concludes that feedback tools such as CFET and DISQ, provided they are grounded in core aspects of good practice, can function as a first level of screening if and when periodic performance evaluation of large cohorts of doctors is carried out. [ABSTRACT FROM AUTHOR]

Feedback from colleagues and patients is a core element of the revalidation process being developed by the General Medical Council. However, there are few feedback tools which have been specifically developed and validated for doctors in primary care. This paper presents data demonstrating the reliability and validity of one such tool. The CFEP360 tool combines feedback from the Colleague Feedback Evaluation Tool (CFET) and the Doctor's Interpersonal Skills Questionnaire (DISQ). The analysis of over 10 000 completed questionnaires presented here identifies that colleague feedback is essentially two-dimensional (i.e. clinical and non-clinical skills) and that patient feedback is one-dimensional. However, items from both scales also effectively predict combined global ratings, indicating that colleagues and patients are identifying similar levels of performance as accessed by the feedback. Doctors who receive low feedback scores may require further attention, meaning the feedback potentially has diagnostic value. Reliable feedback on this tool, as indicated by this analysis, requires 14 colleague responses and 25 patient responses, figures comparable to other MSF tools if CFEP360 is to be used for a high stakes performance evaluation and possible revalidation (generalisability statistic G⩾0.80). For lower stakes performance evaluations, such as personal development, responses from 11 colleagues and 16 patients will still return reliable results (G⩾0.70). [ABSTRACT FROM AUTHOR]

The General Medical Council instructs doctors not to allow their personal beliefs to interfere with their practice. But if attitudes can threaten to impact negatively on a doctor's practice then the question arises: should doctors ever be professionally required to change their attitudes? In this paper I suggest that doctors should be required to amend their attitudes if two conditions are met, namely: (1) the doctor has an attitude that if neglected by the doctor will (or is very likely to) compromise his or her fitness to practise; and (2) the only way in which the doctor can prevent that attitude from compromising his or her fitness to practise is by changing the attitude. I also answer three objections that might be raised against the position that I advance. [ABSTRACT FROM AUTHOR]

Background: Student selected components (SSCs) represent a significant component of medical curricula in the UK and a new approach in medical education. Despite the prominence given to SSCs by the General Medical Council in each of its seminal papers regarding undergraduate medical education, there remains a diverse view of the purpose, outcomes, structure and assessment of SSCs. Many Schools have adopted their own perspective of SSCs and created different but often innovative courses. Aims: This article brings together the Scottish Medical Schools and their experience in organising SSCs, highlights some of the challenges and offers possible solutions to some of the difficulties encountered. Method: The SSC Director from each of the Scottish medical schools each contributed their own '12 Tips'. From these a consensus was achieved. Results: Even though the Scottish medical schools have a wide range of curriculum and timetable formats, there was a great deal of agreement in the challenges and problems encountered in their SSC programmes, as expressed through these 12 Tips. Conclusion: There is much diversity in SSC programmes at different medical schools, although there is also much commonality in the challenges that arise. We hope that this paper will promote thought and discussion amongst those involved, and be useful to those involved in curriculum and programme development and also to those new to medical education. [ABSTRACT FROM AUTHOR]

An excerpt from the booklet titled "Duties of a Doctor," by Great Britain General Medical Council (GMC) is presented.

Understanding workforce pressures within surgery is an inexact science. This paper assembles evidence regarding oral and maxillofacial surgery (OMFS) consultant appointments in the UK and plans for prospective data collection in the future. Information about the number of OMFS specialists joining the UK specialist list was obtained from the General Medical Council and compared to a database of substantive OMFS consultant posts. OMFS consultants were asked to contribute information about their training programmes and consultant appointments (date, interview experience, and sub-specialty interest). This information was collated on Excel© and analysed using WinStat©. Data on OMFS consultant posts advertised in 'NHS Jobs' and the British Medical Journal were collected. The mean (SD) number of specialists joining the specialist list per year is 24.1 (5.2) with a median of 24 and a range of 15 – 36. The number of trainees completing training and numbers joining the OMFS specialist list are in balance at present. The median delay between OMFS specialist listing and appointment as a consultant was 72 days and mean of 169 with the 25th centile of five days, standard deviation of 239 days and maximum of 5.2 years. Of those returning data, 135 (47%) candidates were the sole interviewee and 83 (29%) had one other candidate at their successful interview. The mean application ratio for each post was 1.9 and the median number of candidates was one, mean 1.6 and maximum candidates seven. About half of the posts were filled by trainees from their regional training rotation. Prospective data collection on advertised posts, interviews held, expected retirements/new posts, combined with a route for trainees approaching CCT to highlight their availability may streamline recruitment and allow a more rapid recognition of recruitment problems. [ABSTRACT FROM AUTHOR]

Oral and Maxillofacial Surgery (OMFS) is one of 10 surgical specialties recognised by the General Medical Council (GMC). The GMC states that newly qualified doctors should be familiar with a wide range of specialties and should refer patients appropriately. However, inadequate awareness of and exposure to OMFS in UK medical schools have been widely reported. Two independent investigators conducted a scoping review of all published articles that have evaluated the preparation of students in OMFS in UK undergraduate medical curricula. Our inclusion criteria were UK studies, articles published since inception, OMFS education, and relevance for undergraduate medical students. Data were extracted in accordance with recommendations by the National Health Service (NHS) Centre for Reviews and Dissemination. These were then analysed by qualitative synthesis. Our initial search yielded a total of 351 articles. Following application of the exclusion criteria according to PRISMA guidelines, 11 articles were included in the final analysis. Four main themes were identified: exposure to OMFS in the medical school curriculum, knowledge of OMFS conditions, knowledge of OMFS career progression, and ability to refer OMFS conditions appropriately. A consistent finding was that most medical students felt that they had insufficient exposure to and awareness of the specialty. All the papers recommended the need for change in the existing undergraduate medical curriculum. This review shows an overwhelming need for further development of OMFS in undergraduate medical curricula in the UK. However, there is insufficient primary research to show how best to achieve this. We propose that future research should focus on improvements in the quality of the current teaching methods and the adoption of new innovations to inspire and educate future doctors. [ABSTRACT FROM AUTHOR]

While there has been much discussion of how the scientific establishment's culture can engender research misconduct and scientific irreproducibility, this has been discussed much less frequently with respect to the medical profession. Here the authors posit that a lack of self-criticism, an encouragement of novel scientific research generated by the recruitment policies of the UK Royal Training Colleges along with insufficient training in the sciences are core reasons as to why research misconduct and dishonesty prevail within the medical community. Furthermore, the UK General Medical Council's own data demonstrates a historic inattentiveness to the ease with which doctors can engage in research misconduct. Suggestions are made as to how these issues can be investigated and alternative incentives for career advancement are adumbrated. [ABSTRACT FROM AUTHOR]

Is it ever right to prescribe placebos to patients in clinical practice? The General Medical Council is ambivalent about the issue; the American Medical Association asserts that placebos can be administered only if the patient is (somehow) 'informed'. The potential problem with placebos is that they may involve deception: indeed, if this is the case, an ethical tension arises over the patient's autonomy and the physician's requirement to be open and honest, and the notion that medical care should be the primary concern. This paper examines the case of depression as an entry point for understanding the complexities of the prescription of placebos. Recent important meta-analyses of antidepressants claim that they are not significantly more effective in a clinical setting than placebos. Given that antidepressants have numerous adverse side effects and are hugely expensive, this provocative research has serious potential ethical and practical implications for patients and medical providers. Should placebos be prescribed in place of antidepressants? The case of depression highlights another important issue which medical ethical codes have hitherto overlooked: well-being is not synonymous with being realistic about oneself, one's circumstances and the future. While severely depressed individuals are unduly pessimistic about themselves and the world around them, treatment of depressed individuals can be deemed successful when patients have successfully attained those positive illusions that are indicative of psychological health. This is exactly what successful psychological treatments of depression seem to achieve. It is therefore possible that there may be a limited unavoidable role for deception in medicine. [ABSTRACT FROM AUTHOR]

In their first year of work, newly qualified doctors will care for patients who have palliative care needs or who are dying, and they will need the skills to do this throughout their medical career. The General Medical Council in the United Kingdom has given clear recommendations that all medical students should receive core teaching on relieving pain and distress together with caring for the terminally ill. However, medical schools provide variable amounts of this teaching; some are able to deliver comprehensive programmes whilst others deliver very little. This paper presents the results of a mixed methods study which explored the structure and content of palliative care teaching in different UK medical schools, and revealed what coordinators are trying to achieve with this teaching. Nationally, coordinators are aiming to help medical students overcome the same fears held by the lay public about death, dying and hospices, to convey that the palliative care approach is applicable to many patients and is part of every doctors' role, whatever their specialty. Although facts and knowledge were thought to be important, coordinators were more concerned with attitudes and helping individuals with the transition from medical student to foundation doctor, providing an awareness of palliative medicine as a specialty and how to access it for their future patients. [ABSTRACT FROM AUTHOR]

The General Medical Council's call to modernize medical education prompted the University of Liverpool Medical School to develop a new undergraduate programme, integrating palliative medicine as 'core' curricula. Following successful piloting, the palliative medicine training programme was further developed and expanded. This paper examines whether the additional investment produces improved outcomes. In 1999, fourth year undergraduate medical students (Cohort 1, n=217) undertook a 2-week pilot education programme in palliative medicine. Subsequently, the training programme was refined and extended, incorporating advanced communication skills training, an ethics project and individual case presentations (Cohort 2, n=443). Congruent with the study's theoretical driver of self-efficacy, both cohorts were surveyed pre- and post-programme with validated measures of: (i) self-efficacy in palliative care scale; (ii) thanatophobia scale. No significant differences between cohorts' pre-programme scores were identified. Within each cohort, statistically and educationally significant post-education improvements were recorded in both scales. Further post-education analysis indicated that the extended programme produces significantly greater improvements in all domains of the self-efficacy in palliative care scale (communication, t=-7.28, patient management, t=-5.96, multidisciplinary team-working t=-3.77 at p<0.000), but not thanatophobia. Although improvements were recorded in both cohorts, participation in the extended education programme resulted in further statistically significant gains. Interpreted through the theoretical model employed, improved self-efficacy and outcome expectancies will result in behavioural change that leads to improved practice and better patient care. [ABSTRACT FROM AUTHOR]

Knowledge of the ethical and legal basis of medicine is as essential to clinical practice as an understanding of basic medical sciences. In the UK, the General Medical Council (GMC) requires that medical graduates behave according to ethical and legal principles and must know about and comply with the GMC's ethical guidance and standards. We suggest that these standards can only be achieved when the teaching and learning of medical ethics, law and professionalism are fundamental to, and thoroughly integrated both vertically and horizontally throughout, the curricula of all medical schools as a shared obligation of all teachers. The GMC also requires that each medical school provides adequate teaching time and resources to achieve the above. We reiterate that the adequate provision and coordination of teaching and learning of ethics and law requires at least one full-time senior academic in ethics and law with relevant professional and academic expertise. In this paper we set out an updated indicative core content of learning for medical ethics and law in UK medical schools and describe its origins and the consultative process by which it was achieved. [ABSTRACT FROM AUTHOR]

Current General Medical Council (GMC) guidelines state that any doctor who does not wish to carry out a non-therapeutic circumcision (NTC) on a boy must invoke conscientious objection. This paper argues that this is illogical, as it is clear that an ethical doctor will object to conducting a clinically unnecessary operation on a child who cannot consent simply because of the parents' religious beliefs. Comparison of the GMC guidelines with the more sensible British Medical Association guidance reveals that both are biased in favour of NTC and subvert standard consent procedures. It is further argued that any doctor who does participate in NTC of a minor may be guilty of negligence and in breach of the Human Rights Act. In fact, the GMC guidance implies that doctors must claim conscientious objection if they do not wish to be negligent. Both sets of guidelines should be changed to ensure an objective consent process and avoid confusion over the ethics of NTC. [ABSTRACT FROM AUTHOR]

Background: While all graduates from medical schools in the UK are granted the same licence to practise by the medical professional regulatory body, the General Medical Council, individuals institution set their own graduating examination systems. Previous studies have suggested that the equivalence of passing standards across different medical schools cannot be guaranteed. Aims: To explore and formally document the graduating examinations being used in the UK Medical Schools and to evaluate whether it is possible to make plausible comparisons in relation to the standard of clinical competence of graduates. Methods: A questionnaire survey of all the UK medical schools was conducted, asking for details of graduating examination systems, including the format and content of tests, testing time and standard setting procedures. Results: Graduating assessment systems vary widely across institutions in the UK, in terms of format, length, content and standard setting procedures. Conclusions: We question whether is it possible to make plausible comparisons in relation to the equivalence of standards of graduates from the different UK medical schools, as current quality assurance systems do not allow for formal quantitative comparisons of the clinical competence of graduates from different schools. We suggest that national qualifying level examinations should be considered in the UK. [ABSTRACT FROM AUTHOR]

As the General Medical Council (GMC) is currently in the process of reviewing its ethical guidance onconfidentiality, it is a prescient time to consider the legal and ethical issues inherent in it. This paper examines the question of anonymized data, and highlights the fact that the legal position regarding whether it should be classed as confidential is unclear, with the possibility of a change in the law being very real. Indeed, the article argues that the notion that anonymized data is not confidential can be challenged on both legal and ethical grounds, and thus that the GMC should take this into account in its new guidance. Although identifying the fact that this might have implications for epidemiological research, the article highlights an alternative approach that would allow the conduct of such research while not infringing patients' legally protected human rights. [ABSTRACT FROM AUTHOR]

Summary: The publication of the Government''s White Paper on re-validation and GMC proposals will have a profound effect on urologists and the way they practice. This paper looks at the components of re-validation and ‘Good Medical Practice’ and examines how clinicians, particularly urologists, may be assessed to ensure they remain on the specialist register. [Copyright &y& Elsevier]

Following a series of serious misdemeanours by British doctors, the General Medical Council (GMC) has introduced a system of re-licensing called ‘revalidation’. Annual medical appraisal forms an important cornerstone of the proposed system, but specific guidance is lacking on the content of appraisal for occupational physicians, and the kinds of evidence that they might bring to critical reviews of performance. Two educational bodies, the Revalidation Committee of the Faculty of Occupational Medicine, Royal College of Physicians and the Education Panel of the Society of Occupational Medicine, have jointly developed a set of recommendations on appraisal to further the process. In this paper we summarize the background and present the guidelines promulgated by the Faculty and the Society. [ABSTRACT FROM AUTHOR]

Following a catalogue of serious, highly publicized medical misdemeanours, the General Medical Council (GMC) has introduced plans for a new system of medical licensing in the UK called ‘revalidation’. Under this, the onus will fall on individual doctors, including occupational physicians, to demonstrate their continuing fitness to practice. Doctors will need to show that they meet basic minimum standards in terms of the care they provide, their own continuing professional development, and other aspects of professional life like probity and ethical behaviour. As part of the process, the Faculty of Occupational Medicine, Royal College of Physicians, has produced its own guidance on good medical practice for occupational physicians, following an extensive consultation exercise. This paper summarizes the background to the initiative, the development process and the standards that have been recommended to aid professional accountability. [ABSTRACT FROM PUBLISHER]

Research is the core of evidence‐based practice across all healthcare, in order to ensure optimum patient care. The College of Optometrists is a national standard setting institution for optometric practice in the United Kingdom. However, the standards are only as good as the available evidence, and currently there is little evidence relating directly to optometric practice. The National Institute of Health and Care Research, the General Medical Council and The College of Optometrists, amongst others, have published research strategies describing ambitious plans to expand the scope of healthcare research. The aim of this article is to raise awareness of these government initiatives and consider how they may relate to optometric practice. To improve optometrist research engagement, we need to address the barriers to research and implement strategies to overcome them. There are many opportunities to support research, with different degrees of involvement, from signposting patients to research studies, supporting recruitment or collecting data for a multicentre clinical trial, as well as undertaking an individual research project. Healthcare research is changing and there is scope for more practice‐based research activities in optometry. Research should not be a solo endeavour but a multi‐disciplinary effort. Greater collaborations across all stakeholders, including primary care, secondary care, academia, regulators and industry is needed to make this possible. [ABSTRACT FROM AUTHOR]

The author reflects on the 2007 white paper entitled "Trust Assurance and Safety," which required the medical profession in Great Britain to secure a regular certificate to practice following a series of high profile scandals involving independent reports. The author argues on its two concepts, relicensing and recertification, and the General Medical Council's (GMC) process of revalidation. An overview of how revalidation can be achieved based on the GMC's initial proposals is also offered.

The article reports on the verdict issued by the General Medical Council (GMC), which discredited the research of Dr. Andrew Wakefield which associated measles, mumps and rubella (MMR) vaccine and autism.

In this article, I argue that sexual exploitation in the doctor-patient relationship would be dealt with more appropriately by the law in England and Wales on the basis of a breach of fiduciary duty. Three different types of sexual boundary breaches are discussed, and the particular focus is on breaches where the patient's consent is obtained through inducement. I contend that current avenues of redress do not clearly catch this behaviour and, moreover, they fail to capture the essence of the wrong committed by the doctor-the knowing breach of trust for self-gain-and the calculated way in which consent is induced. Finally, I demonstrate that the fiduciary approach is compatible with the contemporary pro-patient autonomy model of the doctor-patient relationship. [ABSTRACT FROM AUTHOR]

Background: It is now a General Medical Council requirement to incorporate education for sustainable healthcare (ESH) into medical curricula. To date, research has focussed on the perspectives of educators and which sustainable healthcare topics to include in teaching. Therefore, due to this gap in the literature, we have investigated the perspectives of medical students in the UK regarding current and future incorporation of ESH in medical education. Methods: A survey was circulated to 851 clinical year medical students and students intercalating after completing at least one clinical year in a London University. The anonymous survey consisted of sections on the environmental impact, current teaching and future teaching of ESH. Results: One hundred sixty-three students completed the survey. 93% of participants believed that climate change is a concern in current society, and only 1.8% thought they have been formally taught what sustainable healthcare is. No participants strongly agreed, and only 5 participants (3.1%) agreed, that they would feel confident in answering exam questions on this topic, with 89% agreeing that more ESH is needed. 60% believe that future teaching should be incorporated in both preclinical and clinical years, with 31% of participants preferring online modules as the method of teaching. Conclusion: Our study has stressed the lack of current sustainable healthcare teaching in the medical curriculum. There is student demand for ESH, however, uncertainty remains regarding who is best placed to facilitate ESH, how it should be delivered, and whether there is a gender discrepancy regarding sustainable healthcare importance, emphasising the need to close the gap between educational rhetoric and action. [ABSTRACT FROM AUTHOR]

Planetary health is a field that looks at human-caused disruptions to the environment and the effect that these disruptions have on human health. We are living in a world where experts have declared a 'code red' for both the planet and human health - hence, planetary health is an area of increasing and urgent importance. Health professionals of all levels need to be aware of the relationship between climate change and health. Education on this should begin at the medical student level, ideally building on first and second level education for all. Medical students around the world have been calling for teaching in this area, and in many cases are leading the movement. Globally, there is a shift amongst third level educators to provide education on planetary health. In their 2018 Outcomes for Graduates, the General Medical Council in the United Kingdom (UK) introduced a new learning outcome on sustainable healthcare, which has served as leverage for educators in the UK to implement new planetary health teaching. Current teaching on planetary health at the university level in Ireland is inconsistent and inadequate. There are no defined learning outcomes for medical students in Ireland as seen in the UK. In the absence of same, groups such as Irish Doctors for the Environment and the Climate and Health in Medical Education (CHIME) network have been making efforts to develop a framework for planetary health teaching which could be implemented at both a national and international level. This article will discuss the work of these groups so far. It will outline how we can overcome some of the barriers and facilitators to integration, and will also provide examples of learning outcomes that can be incorporated easily into current curricula without requiring significant change. A changing climate requires a changing curriculum, and educators must build on the global momentum with the urgency that this crisis requires. [ABSTRACT FROM AUTHOR]

SUMMARY: The expert witness practice of psychiatrists is under constant scrutiny by the courts and, in the UK, the General Medical Council, as well as within appraisal and revalidation as part of a doctor's overall practice. Regulation and appraisal of expert witness practice must address not only technical competence, including demonstration of a real understanding of the interface between medicine and law, but also ethical probity, including in respect of bias, which is the most challenging appraisal focus. In psychiatry, there is much room for 'values expression', and therefore bias, in the offering of expert opinion. This article first describes various legal and psychological definitions of bias; then addresses the sources and routes to expression of bias within expert witness practice, viewed legally, psychologically and neuroscientifically. Finally, it proposes ways in which inevitable bias can be minimised by the individual practitioner. [ABSTRACT FROM AUTHOR]

Abstract: Harold Shipman, a GP in the North West, became one of England''s most notorious serial killers when he murdered more than 200 of his patients over a 30-year period. The ensuing investigation was highly critical of the General Medical Council''s approach to managing dangerous and incompetent doctors, and called for reform. Subsequently, Sir Liam Donaldson, outlined the principles and steps of revalidation implementation in the UK, based on discussions of the proposals in the Government White Paper, ‘Trust, assurance and safety – the regulation of health professionals in the 21st century’. Many doctors may not be fully aware of the process of appraisal and revalidation as well as the documentations required for these. In addition, it can be confusing to some as doctors in training are already being workplace assessed. The aim of this article is to provide guidance and references to doctors in training in order to prepare for appraisal and revalidation. The General Medical Council, together with the health departments in Scotland, Wales, Northern Ireland and England, and NHS employers, are moving into the implementation phase and will make revalidation a reality. It is planned that revalidation will be launched in late 2012. [Copyright &y& Elsevier]

The 'elusive'1 concept of 'impairment' was introduced into the General Medical Council's Fitness to Practise Procedures in 2002. Its function was ostensibly to bring all forms of fitness to practise allegations against doctors under a unifying concept and thereby reduce procedural complexity. This paper strives to illuminate the application of 'impairment' of fitness to practise with reference to a year of fitness to practise decision making by the General Medical Council (GMC). It concludes that impairment has brought with it a redemptive style of resolving matters of professional discipline which brings significant benefits to doctors, the patient population and society as a whole, but which can also encourage a contrived exchange of remorse, insight and remediation with further implications for professional integrity and truth. [ABSTRACT FROM AUTHOR]

Abstract: The term ‘informed consent’ has been in common usage since the case of Canterbury v Spence was decided in the Californian courts in the 1970s. The basic principle is straightforward: to be in a position to make an informed choice you need to know all the material facts. However, the law is not static and as new situations are presented so the law is developed through cases decided in the courts, in some instances influenced by guidance issued by the General Medical Council, and new statutes enacted by Parliament. This paper reviews the current law on consent in the United Kingdom, taking into account variations in the devolved administrations, the principles that underlie obtaining valid consent, in situations ranging from elective procedures in competent adults to life-threatening emergencies and the treatment of the temporarily or permanently incompetent patient as well as the rights of spouses, relatives and other interested parties. A sound knowledge of the basic principles and how they should be applied is essential for all surgeons and failure to warn is a common component of clinical negligence claims. [ABSTRACT FROM AUTHOR]

The article discusses the case of Scottish physician Michael Munro, who was summoned in 2007 to appear before the General Medical Council (GMC) Fitness to Practise (FTP) Panel on allegations that he hastened the death of two premature and terminally ill newborn infants while working at Aberdeen Maternity Hospital in Scotland. He administered the drug pancuronium to relieve the agonal gasping of the babies, which led to the hastening of their deaths. His act was described as tantamount to euthanasia and no action was taken against him by the GMC.

The article presents comments on the curriculum for the foundation years in postgraduate education and training. For may years doctors in Great Britain have needed to work and satisfactorily complete a pre-registration year after their basic medical qualification in order to obtain full registration with the General Medical Council. In 2002 the Chief Medical Officer for England published "Unfinished Business" which described a new 2-year Foundation Programme of postgraduate training for doctors after basic medical undergraduate training. The first year of the Foundation Programme would roughly equate to the existing pre-registration year, and the second year was to be a new, exciting and innovative year, to `imbue trainees with basic practical skills and competencies in medicine". In 2003 he set up a strategy group to oversee Modernizing Medical Careers, to affect a wholesale reform of postgraduate medical education and training. From August 2005 those new doctors starting their first job after basic medical qualification will need complete two years of a Foundation Programme of Training.

The author reflects on the importance of information confidentiality in dealing with cancer research. He admires the work of epidemiologists in researching for treatments of cancer, however, the latest ruling of the General Medical Council in Great Britain orders the need for the patient's consent and identity. He added that confidentiality protects the patient from untoward disclosure of information that might be used against the patient.

The author reflects on the threat of explicitly identifying the patient's identity for medical research. He said that the guideline of the General Medical Council in Great Britain that requires explicit consent from the patient is impractical and could deprive the improvement of medical services. However, he stated that the new statutory body formed to advise the government on the present condition of medical research would provide opportunity to set things right.

Medical ethical analysis remains dominated by the principlist account first proposed by Beauchamp and Childress. This paper argues that the principlist model is unreflective of how ethical decisions are taken in clinical practice. Two kinds of medical ethical decisions are distinguished: biosocial ethics and clinical ethics. It is argued that principlism is an inappropriate model for clinical ethics as it is neither sufficiently action-guiding nor does it emphasise the professional integrity of the clinician. An alternative model is proposed for decision making in the realm of clinical ethics. [ABSTRACT FROM AUTHOR]

The article looks at various papers and publications related to the development of evidence-informed policy. The paper "Understanding and Influencing Behaviours: A Review of Social Research, Economics and Policy Making in Defra" focuses on how policy development is covering economics, behavioural economics and social research. The British General Medical Council's paper "Good Practice in Research and Consent to Research" focuses on policy development in research.

Focuses on the role of public health services in medical education in Great Britain. Management improvement of the National Health Service; Concerns of the education committee of General Medical Council on the quality of undergraduate medical education; Effective communication between medical schools and health care systems.

Summary: Background: End‐of‐life discussions are associated with improved quality of care for patients. In the UK, the General Medical Council outlines a requirement for medical graduates to involve patients and their families in discussions on their care at the end‐of‐life. However medical students feel ill‐equipped to conduct these discussions. Methods: In 2018, Sheffield Medical School introduced a small group role‐play session on end‐of‐life discussions for all final year medical students. Scenarios were devised to improve confidence in the following learning domains: communicating prognosis with patients and family; ascertaining patient's goals, values and preferred place of death; discussing escalation of treatment, discussing do not attempt resuscitation orders, care in the dying phase of illness and pre‐emptive prescribing. Evaluation was conducted over 16 weeks with a before and after questionnaire. Students rated their confidence in the above learning domains on a Likert‐style scale and explained their ratings in free‐text boxes. Results: There was a 76% response rate to the questionnaire and analysis showed statistically significant improvements in confidence across all learning domains following the session. Qualitative analysis of free‐text responses showed that prior to the sessions, students expressed low confidence due to lack of experience and fear of upsetting patients. After the session students felt they had gained skills but expressed persistent anxiety and a desire for further practice. Conclusions: Our innovation suggests that the opportunity to experience End‐of‐life discussions through role‐play can significantly improve students' confidence in conducting these conversations. However, repeated sessions are likely necessary for students to feel prepared upon graduation. [ABSTRACT FROM AUTHOR]

Abstract: This paper will briefly discuss the duty of confidentiality from an ethical, legal, and professional perspective, especially maternal confidentiality where any analysis should consider the consequences for the patient, the fetus and the father. We will explain why patient confidentiality is considered vital and delineate the ways in which the General Medical Council and the laws of England and Wales protect the rights of patients to privacy. We will also discuss situations where breaches are permissible or mandatory and remind clinicians of traditional challenges that exist in trying to maintain patient privacy. We will consider the issue of confidentiality in the age of the internet. [Copyright &y& Elsevier]

The article discusses various topics published within the issue, including joint investigations between police and adult safeguarding, the findings of research on adult protection committees in England and Wales from 2005-2006, and the guidance issued by the General Medical Council in October.