Recommendation 162

Patient safety as the priority of all education

The General Medical Council should in the course of its review of its standards and regulatory process ensure that the system of medical training and education maintains as its first priority the safety of patients. It should also ensure that providers of clinical placements are unable to take on students or trainees in areas which do not comply with fundamental patient safety and quality standards. Regulators and deaneries should exercise their own independent judgement as to whether such standards have been achieved and if at any stage concerns relating to patient safety are raised to the, [omission] must take appropriate action to ensure these concerns are properly addressed.

The General Medical Council has made it clear that it agrees that this is a fundamentally important principle which is given prominence in its guidance for doctors.  The General Medical Council is considering as part of its review of quality assurance in education how it can be assured of the adequacy and appropriateness of training environments. The General Medical Council will share its proposals in the first half of 2014.


Students and clinicians in training are the eyes and ears of the service today and the safety leaders of the future. As they move around during their training, they can spot where safety doesn’t seem to be a priority, there is poor communication, and the concerns of patients and staff are not being listened to. As the future stars of a stronger safety culture, they need to be trained not only in safe care of the patient in front of them – already central to training – but in all the elements crucial to creating safer clinical systems: understanding human factors, measurement and audit, effective multidisciplinary team working, safe handovers of care, learning from error and near misses, and the tools of improvement science.

Through the Health Education England’s Commission on Education and Training for Patient Safety we will bring together comprehensive proposals for enhancing safety training for all health and care professionals, including producing a film to help staff and learners in the NHS to raise concerns if they experience or witness practice which puts patients at risk.

The General Medical Council, Medical Schools Council, Foundation Programme and Royal Colleges are working across the UK to ensure that medical students and doctors in training are supported to become the leading lights of excellence in safety, with students starting this autumn seen as patient safety champions from day one.The General Medical Council will showcase current best practice at its conference in March and publish a report. The 5000 new Health Foundation NHS Improvement ‘fellows’ will work with medical educators to bring the most up-to-date knowledge on improving safety to the heart of training. The General Medical Council has focused on safety throughout its revised standards for education and training, published for consultation in January 2015, and expanded the questions on safety in its annual survey of all trainees. Through its visits to check the quality of medical education and training, it will work with providers to improve standards and tackle safety concerns, and its regional liaison service will expand its work with students and doctors in training on raising concerns and improving safety.

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.