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A case study highlighting your professional responsibilities as a student

in Student life

A case study highlighting your professional responsibilities as a student

The week before the spring break was one not to be forgotten for the five dental students who shared a flat in a rough but economic part of town. Although the week had started perfectly normally things started to go downhill on Monday night.

Having competed all of his assignments and modules, he was already in holiday mood. All that faced him this week was some morning clinics and Tuesday was only radiology so he did not consider that he was really treating patients as he only had to take the radiographs. So when the invitation came to join some friends for a cheap Monday student night he was well up for it.

With five pints of Stella on board, Matthew returned to the flat at midnight following a quick detour via the kebab shop.

The following morning whilst driving to the university in his trusty old wreck he was hit from behind by a driver whose love of texting had obviously overcome his sense of safety. Matthew, having seen in his mirror the distinct flash of a mobile phone slamming into the windscreen, decided to call the police who attended the accident. Unfortunately whilst sitting in close proximity to the policeman the smell of mature ‘Eau de Stella’ was hard to miss and, in line with his duties, the officer asked the student to take a breathalyser test. The test showed him to be over the legal limit and Matthew was arrested and escorted to the police station.

There can be a lot of pressure if you are required to re-sit a professional exam and Salima was struggling to reach deadlines for completing the required modules. Her intention had been to work late into the night in order to submit the required module ahead of the deadline. Having discussed her difficulty in finishing the project, one of her flatmates offered her sight of her own submission in order to help her along. Whilst the initial temptation was to copy her colleague’s work and submit it under her name she had resisted this. However by 3.30 am the idea of passing off another’s work as her own seemed slightly more acceptable and temptation got the better of her.

Salima dragged herself out of bed to submit ‘her work’ before the 9.00 am deadline and she was most grateful to her course-mate for allowing her to have access to her work.

On Wednesday this student went downstairs to pick up the post and eagerly opened an envelope from an insurance company about a claim that she had made for a laptop that had been stolen from her room when the flat had been burgled some months before. She had felt very uncomfortable about this claim, which had been made on the insistence of her brother. He had lost his new laptop that same week and suggested that when the burglary of the flat occurred she could add the laptop to the list of goods stolen because he had not had enough time to take out his own insurance. At the insistence of her brother she had reluctantly agreed to this little white lie.

Hoping that the envelope might contain a cheque for the claim that had been submitted she was somewhat shocked to read the letter from the insurers which indicated that the receipt she had provided for the laptop was dated after the burglary.

On Thursday this particularly laid-back student made a rare daylight appearance. His approach to certain aspects of the course was based on an ability to read and digest textbooks with ease, supported by a frantic cramming approach before any professional exam. As this approach had proved successful in the first part of the course, his confidence grew with his lack of attendance and so did his notoriety. When he arrived at the dental school where he was supposed to be treating patients on clinic, he noticed that his pigeonhole had a rather official looking letter from the dean’s office.

On the Friday of this unusual week this particular student had arranged to go clubbing for most of the weekend, confident in the knowledge that he could sleep it off on Monday because the holidays would have started. His favourite haunt was frequented by students and locals alike, and it was rare for there to be any problems. However, on this particular night some of his friends were being particularly loud and having taken several illegal substances they had lost most of their inhibitions. Some of the local testosterone did not take kindly to the friendly approaches that were being made to their ‘other halves’ and a fight broke out. The club called in the police who arrived before Tom had a chance to leave. The police decided to search everyone on the premises and whilst standing next to one of his friends, Tom had a package thrust into his pocket together with a plea from his friend who said he had already been cautioned and if found in possession again might face jail. Tom was now in a dilemma about what to do. Before he could decide, he felt two hands on his shoulders lifting his arms in to the air before patting him down. The package was revealed with a quantity of ecstasy tablets inside.

What a week
Certainly this was not an ordinary week, but nor was it over:
•    Matthew was cautioned for drink driving and received a fine and a one year driving ban. He was also charged with driving without insurance since many insurance policies are invalid if the driver is intoxicated.
•    Salima was called into the school office together with her colleague where it was established that she had copied the course work that had been produced by her friend and the fact was recorded in her dental school record.
•    Sara, and not her brother, became the subject of a criminal investigation into a fraudulent insurance claim.
•    Omar, who had been hoping to slip through his course under the radar, was disappointed to find himself subject of a disciplinary hearing within the university.
•    Tom was arrested and charged with possessing of drugs with intent to supply.

Are these stories so very unlikely, or is there a little familiarity in each of them?

These flatmates had previously all been high achievers, successfully obtaining the grades required to enter dental school and to date they had all completed their professional exams. The events of this week however, not only invited criticism from the university’s internal disciplinary process, but they also bring into question their ability to Register upon qualification.

Did you know?
What many students may be unaware of is that, whilst they do not currently have to be registered during their degree course, with the General Dental Council, the Council expects the conduct of every dental student to reflect the principles that are set out in their guidance document ‘Standards for Dental Professionals’. The six key principles referred to in the guidance are listed in Table 1 and any conduct that fails to match them can result in, not only a disciplinary procedure being initiated by the university, but also a fitness to practise procedure based on principles laid down by the GDC.

Table 1
•    Putting patients’ interests first and acting to protect them.
•    Respecting patients’ dignity and choices.
•    Protecting the confidentiality of patients’ information.
•    Cooperating with other members of the dental team and other healthcare colleagues in the interests of patients.
•    Maintaining professional knowledge and competency.
•    Being trustworthy.

Dental school obligations
The GDC’s document entitled ‘Student Fitness to Practise’ emphasises that the dental school who awards a dental degree is effectively confirming that the student is fit to practise as a registrant of the GDC.   Therefore, whilst the student is at University their behaviour and attitude as well as their education and training should be professional and reflect that of a registered dentist.

The GDC suggests that the dental schools should have procedures in place to identify students whose behaviour of health gives concern; to take action to help students improve their behaviour and to make sure that students are a risk to patients are identified as early as possible and appropriate action taken.

The expected standards
Upon first considering the standards you may feel that it is somewhat unfair for a student to be expected to behave as a registered professional, both at work and at play.  The perception of many is that, yes, one has to be professional within the work environment but why should my behaviour outside the surgery have any impact upon my ability to earn a living as a dental practitioner?

The answer is that the “regulation” of professionals, including  students, has been significantly increased as a result of several high profile cases that had undermined the public confidence in healthcare workers e.g. Dr Harold Shipman.

Each University will have its own disciplinary process and therefore the dental student potentially faces double jeopardy in that the additional fitness to practise process may be carried out within the same environment.

One of the difficulties with the new procedure is establishing what will be the threshold level, in other words, what do have to do to trigger this additional process.  Unfortunately this does appear to be something of a grey area and it will be for the investigators and panels drawn from staff that will assess each case to determine steps that should be taken.  The investigation will be carried out on the basis of the “balance of probabilities” reflecting civil law rather than criminal law where “beyond all reasonable doubt” applies.

The outcome of a student fitness to practise hearing can include:

a)    Student receives no warning or sanction
b)    A warning is provided as there is evidence of misconduct, but the student’s fitness to practise is not impaired and does not require any sanctions.
c)    The student’s fitness to practice is judged to be impaired and they receive a sanction.  Beginning with the least severe sanctions are conditions or undertakings, suspension from the dental course or expulsion from the dental     school.  Student obligation, if any, determination is made against an individual student then there is a duty to declare that when registering with the GDC after qualification.  Obviously the difficulty in obtaining registration once qualified will increase with the severity of the indiscretion.

The five scenarios set out above are based upon examples of allegations that the GDC have referred to in their document.  Therefore they represent real live issues and whilst they may seem somewhat extreme, young colleagues do unfortunately find themselves in potentially damaging situations which in the past may not have carried the same risk as they do now.

As any older colleague will tell you the five years spent at University are generally regarded as being some of the happiest of times.  There may be some retrospective rose tinted glasses which forget the build up to exams and deadlines but it is a time that should be enjoyed and the introduction of fitness to practise procedures for students should not detract from that in any way.

It is though important to remember that the playing field is not level and you have significantly more responsibilities than perhaps the other students you may be friends with or share accommodation with who are not on a professional course such as dentistry.

There is a danger that dental students do not understand the implications of “student fitness to practise”; however student members of Dental Protection can be assured of the appropriate information, advice and support in relation to such processes.  With regard to our famous five above it is reasonable to say that the new process does allow for the submission of mitigating circumstances and each of the individual situations would invite a different level of severity.  There is no tariff against which one can predict the outcome of an individual hearing and representations prior to application for registration would have to be made.

Far better, however, to be aware of one’s responsibilities in the eyes of patients colleagues and the GDC from the very outset.  You are entering a profession and in terms of the GDC it is fair to say that you are regarded as a professional even during fresher’s week.  Know your responsibilities and accept the elevated regard to which you are held accountable and hopefully a trouble free registration will follow.

Dental Protection has more than 50 dento-legal advisers to support you if you receive a complaint.
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