Recommendation 160

Encouraging openness in trainees

Proactive steps need to be taken to encourage openness on the part of trainees and to protect them from any adverse consequences in relation to raising concerns.

The General Medical Council has made clear its commitment to build on the progress to date in this area (the inclusion of a patient safety question in the National Training Survey, the development of new guidance on raising concerns and the introduction of a new confidential helpline for doctors), and recognises it needs to do more to raise awareness and encourage openness. Among other things the General Medical Council is running ‘professionalism’ events at all medical schools every year. The General Medical Council will also shortly be publishing a report highlighting the issue of bullying of trainees (which can lead to a culture in which trainees feel unable to raise concerns), illustrated by case studies showing the impact of such behaviour and how it can be tackled.


The encouragement of openness in trainees and protecting them from the potential adverse consequences of raising a concern was included in the 2014 Health Education England mandate. Health Education England has established a project group to deliver this. An audit has identified that systems are in place across LETBs and HEIs to allow students and learners to feedback on their experiences.  In some cases, they can use a central online space for all placement related information, allowing students, LETBs and educators to access key information about their experiences.  Students have strongly fed back that they value the various routes they have to discuss issues with those supporting them in their learning and are keen to maintain a duty of candour.  Work is currently underway to develop, test and agree a standard set of core questions to be used with learners and a national set of principles for data collection to provide further consistency.  Health Education England has also strengthened the routes to provide learner/trainee related information to the Care Quality Commission inspections. Trainee/learner feedback is also shared at system-wide Quality Surveillance Groups on a regular basis, so this is considered alongside other quality and safety measures. Further discussions involve how Health Education England can improve opportunities for non-medical undergraduates and post-graduate medical trainees where they are not already included in existing systems used for other students. The project is also monitoring the progress of RCP-led work to develop a ‘trip advisor-style’ website to seek real time feedback from junior doctors that may provide additional information to triangulate with existing sources.

The General Medical Council’s review of standards of medical education and training, has considered this recommendation by developing the draft standards in a way that emphasise the importance of ensuring the learning environment has a confidential process for raising concerns about the safety of patients or learners.

It is very hard for staff to raise concerns where senior clinicians are dismissive, unsympathetic or worse. Doctors will be expected when they revalidate to demonstrate how they act on concerns raised with them, how they are reflecting on their practice and feedback from patients and colleagues, how they are fulfilling their professional duty of candour and supporting colleagues to do so too, and how their leadership skills and behaviours are contributing to creating an open safety culture that puts patients first.

Additionally, the General Medical Council has commissioned the Rt Hon Sir Anthony Hooper to undertake a review of how it deals with doctors who raise concerns in the public interest. The review is expected to make recommendations as to how the General Medical Council’s current guidance and processes might be adapted to reflect the needs of all doctors, including those in training, who raise concerns and ensure they, are appropriately supported. The review will hear the views of those who may have suffered as a result of raising concerns, as well as the perspective and experience of employers, trade unions and professional leaders. The review is expected to complete shortly.