Professionalism in Doctors
Being a good doctor is about far more than knowing the right answer. It is about who you are when no one is watching — and the good news is, that is entirely within your control.
📥 Downloads
Handouts, summaries, and teaching extras — ready when you are. Perfect for tutorials, self-study, or that last-minute pre-ARCP rescue session.
path: PROFESSIONALISM/PROFESSIONAL VALUES
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15 professionalism.pdf
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17 fitness to practise.pdf
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Assessing Professionalism by Dr Ramesh Mehay.pptx
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duties of the doctor.pdf
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feminist approach to general practice - good for patient centred care.pdf
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fitness to practice and case scenarios (TEACHING RESOURCE).ppt
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professional values - 2 sides of A4.doc
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professional values - scenarios 1 (TEACHING RESOURCE).doc
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professional values - scenarios 2 (TEACHING RESOURCE).doc
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professional values - scenarios 3 (TEACHING RESOURCE).doc
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professional values - scenarios 4 (TEACHING RESOURCE).doc
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professional values and ethical scenarios (TEACHING RESOURCE).doc
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professional values.ppt
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professionalism - what is it.doc
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raising concerns and whistleblowing.docx
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what is a good doctor and how do you make one.pdf
🌐 Web Resources
A hand-picked mix of official guidance and real-world GP training resources. Because sometimes the best pearls are not hiding in the official documents.
Core Official Guidance
Professional Behaviour, Boundaries & Social Media
GP Training & Portfolio Resources
⚡ Quick Summary — If You Only Read One Thing
The Essentials at a Glance
- Professionalism is the set of values, behaviours, and relationships that earn and maintain the public's trust in doctors.
- It operates across three domains: yourself (conduct, behaviour, attitudes), colleagues (respect, support, raising concerns), and patients (honesty, integrity, trust).
- The GMC's Good Medical Practice 2024 sets out four domains: knowledge & skills; communication & teamwork; safety & quality; maintaining trust.
- The RCGP's Fitness to Practise (FtP) capability is about protecting patients by recognising when performance, conduct, or health — yours or a colleague's — creates risk.
- Professionalism applies everywhere — in clinic, in the staffroom, online, and in personal life when behaviour could affect patient trust.
- Assessment drives behaviour: professionalism assessed rigorously, and at the “shows how” level, is more likely to be consistently practised — this is why the SCA tests it directly.
- Doctors must raise concerns about colleagues whose fitness to practise may be impaired — this is a professional duty under GMP 2024, not an optional extra.
- Social media is one of the most common sources of avoidable professionalism concerns. The internet has a very long memory.
🧪 What Is Professionalism?
The Royal College of Physicians defines medical professionalism simply and powerfully:
“Medical professionalism comprises a set of values, behaviours and relationships that underpin the trust the public has in doctors.”
— Royal College of Physicians, 2005
At its heart, professionalism is about trust — and everything that makes that trust possible. It is not just about how you behave in a consultation. It shapes how you speak to a colleague, what you post online, how you handle a complaint, and how you respond when you make a mistake.
The GMC defines professionalism as “the standards of care and behaviour expected of medical professionals.” This is broad by design. Professionalism is not a box to tick — it is a way of being.
Why Does Professionalism Matter?
Patient Safety
Unprofessional behaviour directly causes patient harm. A GMC study found 14% of healthcare staff were aware of specific adverse events caused by colleagues' disruptive conduct, but were too scared to speak up or did not want to feel stupid in case they were wrong.
Public Trust
Medicine depends on patients trusting doctors. That trust is fragile. One doctor's behaviour reflects on the whole profession — which is why standards apply universally.
Fewer Complaints
Open, honest, patient-centred care reduces complaints significantly. Patients who feel respected and included — even when things go wrong — are far less likely to take formal action.
Safer Teams
Respectful workplaces allow junior staff to speak up before errors escalate. A culture of fear suppresses exactly the communication that prevents patient harm.
🏆 So Everyone's a Winner When Behaviour Is Professional
It is worth pausing to ask a simple question: who actually benefits when doctors behave professionally? The answer turns out to be everyone — and understanding that is one of the most powerful motivators there is.
The Doctor Wins
When a doctor creates a culture of openness and mutual respect, colleagues feel safe to speak up before mistakes escalate. Errors get caught early — often before they reach the patient. Patients who feel genuinely understood, explained to clearly and treated with the right attitude, are far less likely to complain or litigate, even when things go wrong. Professionalism, in short, is one of the most effective forms of self-protection a doctor has — far more reliable than keeping your head down and hoping for the best.
The Team Wins
When everyone in a team treats each other with genuine respect, something remarkable happens: people want to come to work. Colleagues look out for one another. Patient safety stops being one person's responsibility and becomes everyone's. The team builds strength — not just as a collection of individuals, but as a cohesive, trusting whole that is far greater than the sum of its parts. That kind of team is resilient, adaptive, and deeply satisfying to be part of.
The Patient Wins
Patients in a professionally run environment are less likely to experience preventable harm. They trust the people looking after them and the processes around them. They feel respected as individuals, not processed as cases. When patients trust their doctors, they share more, engage more, and recover better. The therapeutic relationship itself becomes part of the treatment — and that begins with professionalism.
If all of this flows from professional behaviour — safer patients, a stronger team, fewer complaints, a doctor who drives home knowing they did a good job — then the real question is not why would you bother, but why would you not?
Letting go of hierarchy for its own sake, choosing openness over self-protection, and treating every member of the team as a valued equal are not acts of weakness. They are acts of wisdom — and they make for a considerably happier working life for the decades ahead.
🔺 The Three Domains of Professionalism
Professionalism operates across three interconnected domains. Think of it as a triangle: each side supports the others, and weakness in any one side weakens the whole structure.
🪮 Yourself
Your own conduct, behaviour, and attitudes. How you present yourself, regulate your emotions, seek feedback, maintain competence, and look after your own health.
👥 Colleagues
How you treat everyone in the team — with respect and honesty. Supporting struggling colleagues. Having the courage to raise concerns when performance or conduct puts patients at risk.
💜 Patients
Open, honest, trustworthy care centred on the patient's needs. Integrity in every interaction. Being accountable when things go wrong. Maintaining appropriate professional boundaries.
Before any action that feels professionally uncertain, ask: “Would I be comfortable if my patient, my colleague, and my trainer were all watching this right now?” If the answer to any one of those is no — pause and reconsider.
🏛 The Core Pillars of Medical Professionalism
Research consistently identifies the same key attributes across international frameworks. These are the building blocks of professional practice:
Clinical Competence
Up-to-date knowledge, safe practice, and commitment to lifelong learning.
Ethical Practice
Acting with integrity and honesty, in patients' best interests — especially when it is difficult.
Altruism
Patients' interests come first, above your own convenience, discomfort, or personal benefit.
Self-Awareness
Understanding your own strengths, weaknesses, values, and biases — and how they affect your practice.
Accountability
Taking responsibility for your actions, being open when things go wrong, learning from mistakes.
The CHAIRE Mnemonic
A memorable framework for the core attributes:
📋 GMC Good Medical Practice 2024
Good Medical Practice (GMP) is the professional cornerstone for every UK doctor. The updated version came into force on 30 January 2024 — the most significant revision in over a decade. Every fitness to practise decision since January 2024 is assessed against this version.
The 2024 GMP includes strengthened duties around respectful workplaces, tackling discrimination, raising concerns, and supporting colleagues' wellbeing. It also explicitly addresses social media conduct and remote consultations. If you trained under the 2013 version, invest time reading the updated guidance — these are substantive changes, not a cosmetic refresh.
The Four Domains of Good Medical Practice
Knowledge, Skills & Performance
- Keep knowledge and skills up to date
- Provide a good standard of care
- Reflect and improve performance
- Recognise and work within limits of competence
Communication, Partnership & Teamwork
- Work in partnership with patients
- Treat colleagues with respect
- Communicate honestly and clearly
- Create supportive, inclusive workplaces
Safety & Quality
- Protect and promote patient safety
- Raise and act on concerns
- Contribute to learning from errors
- Support a culture of openness
Maintaining Trust
- Act with honesty and integrity
- Be open when things go wrong (duty of candour)
- Declare conflicts of interest
- Maintain professional boundaries
- Use social media responsibly
The Five Key Updates in 2024
The 2024 GMP explicitly strengthens the duty to create and maintain respectful workplaces. Doctors are now expected to recognise and actively address discrimination and unfairness, not simply avoid it themselves. Bullying, harassment, and discriminatory behaviour — including subtle forms — are professional failures, not management issues to be ignored.
Renewed emphasis on treating patients with genuine kindness, courtesy, and respect, and working in authentic partnership with them. The 2024 GMP includes specific guidance on remote and digital consultations — a direct response to post-pandemic practice. Meeting patients' individual communication needs and supporting shared decision-making are highlighted throughout.
New, clearer duties to tackle discrimination in how patients and colleagues are treated. Doctors must not discriminate on the basis of any protected characteristic and must challenge discrimination they witness — even if they are not the direct target. This applies to both overt discrimination and more subtle forms of bias.
Doctors in leadership roles — including senior trainees supporting juniors — have specific duties to champion fairness and inclusion. This means enabling others to speak up, taking feedback seriously, and addressing systemic barriers. Leading by example is a professional obligation, not a personality preference.
Clearer guidance on handing over care safely, delegating appropriately, and ensuring patients are not left vulnerable during care transitions. In general practice, this includes appropriate safety-netting, clear documentation, and ensuring patients who need follow-up actually receive it.
🎓 RCGP: The Fitness to Practise Capability
Within the RCGP curriculum, professionalism is assessed primarily through the Fitness to Practise (FtP) capability — one of 13 specific capabilities you must demonstrate throughout GP training.
“This is about professionalism and the actions expected to protect people from harm. This includes the awareness of when an individual's performance, conduct or health, or that of others, might put patients, themselves or their colleagues at risk.”
The Five Themes of the FtP Capability
Regular, honest review of your own practice against the standards expected of a GP. Using GMP as a practical benchmark, not just a regulatory document. The key is not perfection — it is honest self-appraisal and genuine commitment to improvement. Log entry ideas: Reflecting on supervisor feedback; reviewing your prescribing; identifying a knowledge gap and making a plan.
Demonstrating how you apply the four domains of GMP actively in practice — not just knowing what they say. This includes recognising ethical or professional dilemmas and describing how you reasoned through them. Understanding how your personal values interact with your professional duties.
Teamwork, collaboration, and conduct within the practice team. Contributing positively — covering for colleagues, offering support, sharing expertise, completing your share of administrative work. Unhelpful or obstructive behaviour is an FtP concern even if clinical care remains technically adequate.
Any teaching responsibility — supervising students, presenting at HDR, contributing to practice education — falls under FtP. Preparing properly, providing honest feedback, being a safe and constructive role model. Being a good role model is itself a professional duty.
GMP 2024 explicitly states that doctors should care for their own health. Recognising when you are struggling and seeking help is a professional responsibility, not a weakness.
Support Resources: BMA Wellbeing Support: 0330 123 1245 | Practitioner Health Programme (England): 0300 030 5300
What ARCP Panels Look For
| What Earns Positive Ratings | What Raises Concerns |
|---|---|
| Honest self-appraisal with specific examples | Denial or minimisation of concerns |
| Clear learning from mistakes | Repeated errors without reflection or change |
| Seeking feedback and acting on it | Dismissing or ignoring feedback |
| Recognising limits and asking for help | Practising beyond competence without disclosure |
| Positive engagement with training process | Poor attendance, disengagement, persistent lateness |
| Transparent about health concerns affecting work | Concealing impairment that puts patients at risk |
- Reflect on a time you recognised a gap in your own performance — and what you did about it.
- Describe a situation where you supported a colleague who was struggling (without breaching their confidentiality).
- Write about a time you raised a concern about patient safety — however minor — and how you handled it.
- Reflect on your own health or wellbeing during a stressful period and how you managed it professionally.
- Describe a situation involving an ethical or professional conflict and how you reasoned through it.
✅ What Professional Behaviour Looks Like Day to Day
Professionalism is not one big dramatic gesture. It is the accumulation of small, consistent choices every single day.
- Treating every patient with the same care and respect, regardless of how complex or frequent their presentations.
- Being honest with patients when things go wrong — the duty of candour — rather than hedging or deflecting.
- Recognising when a situation is beyond your competence and seeking help promptly. This is a strength, not a failure.
- Maintaining appropriate professional boundaries with patients at all times.
- Documenting clearly and honestly. Records are both a professional and legal responsibility.
- Offering patients the same quality of care whether you are tired, stressed, or in your last consultation of the day.
- Treating every member of the practice team with equal respect — receptionist to partner, nurse to pharmacist, cleaner to manager.
- Being reliable: arriving on time, completing tasks you have agreed to, not leaving colleagues to clear up after you.
- Giving honest, constructive feedback when asked — and receiving it graciously when offered.
- Raising concerns about a colleague's performance, conduct, or health when patient safety is at risk. This is a professional duty, not a personality choice.
- Avoiding negative talk about colleagues in front of patients — even if you believe the criticism is deserved.
- Engaging honestly with the assessment process — not presenting a curated, idealised version of yourself in log entries.
- Completing assessments, log entries, and PDPs on time and with genuine reflection — not as administrative chores.
- Accepting feedback from supervisors and using it constructively, even when it is uncomfortable.
- Attending teaching and HDR sessions consistently. Unexplained absences are a professionalism concern, not just an inconvenience.
- Never plagiarising or misrepresenting your learning in your portfolio. This is a serious FtP matter.
Doctors are not 'off duty' in the way most professionals are. The GMC is explicit: your professional registration can be affected by conduct outside work if it undermines public trust in doctors.
- Criminal convictions — including those unrelated to medicine — may need to be disclosed to the GMC.
- Behaviour in public or online that a reasonable member of the public would find deeply offensive can attract regulatory attention.
- This does not mean doctors have no private life — it means they are held to a higher standard of public trust, which comes with certain constraints.
⚠️ Professionalism Breaches & Raising Concerns
What Counts as a Professionalism Concern?
| Level | Examples | Likely Response |
|---|---|---|
| Low level | Persistent lateness; missing teaching without explanation; late ePortfolio tasks; dismissive manner with reception staff; poor communication with colleagues | Informal discussion; learning plan; logged concern with scheme |
| Moderate | Repeatedly dismissing feedback; inappropriate behaviour toward staff; failure to follow educational advice; poor insight into clinical errors; recurring unprofessional conduct | Formal educational discussion; supported educational plan; ESR flagging |
| Serious | Dishonesty; fraud; substance misuse affecting practice; significant patient safety incidents; discrimination; serious breach of confidentiality; sexual misconduct; criminal conviction | ARCP outcome 6/7; potential GMC referral; Responsible Officer involvement |
- Serious or repeated mistakes in patient care
- Fraud or dishonesty (including in documentation or qualifications)
- Abuse of professional position, e.g. sexual relationships with patients
- Serious breaches of patient confidentiality
- Violence, sexual assault, or criminal convictions
- Discrimination against patients or colleagues
- Drug or alcohol misuse affecting clinical practice
- Persistently inappropriate attitudes that cannot be remediated
Your Duty to Raise Concerns — GMP 2024 Is Explicit
GMP 2024 has significantly strengthened this obligation. Doctors now have a clear duty to speak up when they observe poor practice, unsafe conditions, or discriminatory behaviour. Failing to raise a genuine patient safety concern when one has been identified can itself be a fitness to practise matter.
- “I might be wrong.” → You do not need to be certain. A genuine concern raised in good faith is all that is required.
- “I don't want to get them in trouble.” → A colleague whose impairment risks patient harm needs support, not silence.
- “It's not my place as a trainee.” → GMP 2024 makes no exception for seniority. This duty applies from the moment you are registered.
- “I'll wait and see if it happens again.” → Early, documented, good-faith concerns are handled far better than delayed reports of a pattern.
The CUDSA Model — Having the Conversation
Endorsed by the GMC's Respect Protects programme. Use it when a direct colleague conversation is appropriate — keeping focus on behaviour, not personality:
When a colleague is struggling and causing concern, there are really two things happening at once: a patient safety issue and a human welfare issue. Both need to be addressed. The professional response is not to choose between them — it is to hold both simultaneously: “I care about you, and I also cannot stand by while patients may be at risk.” That combination of compassion and professional courage is precisely what GMP 2024 is asking for.
- Step 1: Document the concern clearly — factually, without embellishment, noting date and what you observed.
- Step 2: Consider a direct conversation with the colleague (if safe and appropriate) — use the CUDSA model.
- Step 3: Escalate to your trainer, TPD, or clinical supervisor if direct conversation is not appropriate or has not resolved the concern.
- Step 4: Use the formal speaking-up process if needed — NHS Freedom to Speak Up Guardians, or the GMC's own reporting route.
🔄 Revalidation & the Bigger Picture
Revalidation is the process by which all licensed UK doctors demonstrate, every five years, that they are up to date and fit to practise. For GP trainees, completing training successfully counts as your first revalidation. The professional habits you build now — honest self-appraisal, engaging with feedback, raising concerns, maintaining your own health — are exactly the habits that serve you through a career of revalidation.
| Stage | Professionalism Requirement |
|---|---|
| During training (ST1–ST3) | Demonstrate FtP capability via FourteenFish ePortfolio; engage honestly with WPBA and ESR processes; complete ARCP reviews transparently |
| On CCT | First revalidation occurs at or around point of CCT for most trainees |
| As a qualified GP | Annual appraisal with Responsible Officer; five-year revalidation cycle; supporting information portfolio aligned to GMP 2024; complaints and significant events form part of the evidence |
GP trainees already have the gold standard of professional oversight built into their training. Every COT, CBD, MSF, and PSQ is professional evidence. Every log entry is a professionalism record. Every ESR is a revalidation rehearsal. Trainees who engage genuinely — rather than treating these as administrative chores — find revalidation as a qualified GP far easier, and their professional practice far richer. The cycle of assess → reflect → coach → improve that you build in training is the same cycle that sustains you as a GP for your entire career.
🚧 Common Pitfalls — Things That Catch People Out
Thinking professionalism is only about big scandals. Most fitness to practise concerns begin with small, repeated lapses — persistent lateness, dismissive attitude to feedback, poor communication. These are taken seriously from the start because the pattern they suggest is serious.
Confusing anonymisation with safety. Removing a patient's name does not make a case anonymous. Ward, date, diagnosis, and clinical context together can identify a patient — even to the patient themselves. This is the “Jigsaw Problem” of patient identification.
Not treating all colleagues with equal respect. How you treat the receptionist, the cleaner, and the phlebotomist matters as much as how you treat the consultant. GMP 2024 is explicit: all team members deserve respect. Colleagues notice. Patients notice. ARCP panels are told.
Believing “closed” social media groups are private. Screenshots have ended careers. Content posted in a private group has no guarantee of remaining there. Behave online as if it is public, because one day it might be.
Treating the FourteenFish ePortfolio as a box-ticking exercise. Assessment that is treated as a bureaucratic chore produces box-ticking. Assessment treated as a genuine developmental tool produces genuine development. Your ARCP panel can tell the difference immediately.
Assuming “it's not my place” to raise concerns as a trainee. GMP 2024 makes no exception for seniority or career stage. The duty to raise genuine patient safety concerns applies to every registered doctor — including you, from day one of training.
📈 Does Assessment Change Professional Behaviour?
This is one of the most important questions in medical education. The short answer is: assessment alone is not enough — but assessment combined with structured feedback and reflection is powerful.
Workplace-based assessments like CBDs and MSFs raise trainees' awareness of professionalism. But awareness alone does not reliably produce lasting behavioural change. What makes the real difference is when assessment is paired with:
- Specific, constructive feedback from credible assessors who apply standards consistently
- Structured reflection — a guided process of unpacking what happened and why
- Coaching or mentoring — ongoing, personalised support to implement change and revisit progress
Assessment Must Drive Learning
One of the most important insights in professional education is simple but profound:
“Assessment drives learning. If you want to change professional behaviour, make it assessable — and assess it at the level of 'shows how', not just 'knows how'.”
Think about the driving test. Rigorous assessors with consistent high standards do not just evaluate driving — they raise it. Candidates who know they must demonstrate competence to a credible, uncompromising standard will develop that competence. The same applies to professionalism in medicine. When assessors apply professional standards consistently and rigorously, trainees rise to meet them. Assessment that is treated as a bureaucratic box-tick produces box-ticking. Assessment treated as a genuine developmental tool produces genuine development.
Miller's Pyramid — Why “Knows How” Is Not Enough
Professionalism must be assessed at the shows how level to be meaningful:
The SCA assesses clinical, communication, and professional skills together in 12 simulated consultations. Professionalism is not assessed as a separate domain — it is woven through every case. Being open and honest maps to data gathering. Person-centred care maps to clinical management. Empathy, respect, and relating to the patient run throughout. If you do not demonstrate professional behaviours in the SCA, you will lose marks — which is exactly as it should be. Assessment drives behaviour.
Coaching, Mentoring, Teaching — What Is the Difference?
| Approach | Who sets the goals? | How it works | Best for |
|---|---|---|---|
| Teaching | The teacher | Transfers knowledge or skills directly. More directive. Content-led. | Knowledge gaps; specific skills that need explicit instruction |
| Coaching | The trainee (with facilitation) | Asks powerful questions; helps the trainee develop their own insight; revisited iteratively over time. Not directive — empowers the trainee to own their growth. | Developing self-awareness; building insight; changing entrenched behaviours |
| Mentoring | The mentor, based on expertise | Uses experience and knowledge to set direction; more advisory; still supportive but more prescriptive than coaching. | When the trainee lacks insight to identify their own goals; professional direction-setting |
| Structured reflection | Shared | A guided process of analysing an experience — what happened, why, and what to do differently. Can be solo or with a supervisor. | Embedding learning from specific events; FourteenFish log entries; post-CBD tutorials |
If a CBD reveals a professionalism concern — poor consultation behaviour, dismissive manner, failure to consider patient ICE — the form alone will not change anything. What makes a real difference is a follow-up mini-tutorial: a short, safe-space conversation where you help the trainee unpack what they were thinking, why they responded that way, and what they could do differently. That structured reflection, revisited in subsequent CBDs, is where real professional growth happens. The assessment creates the opening. The conversation is where the learning occurs.
💡 Insider Wisdom — What Trainees Say
This section distils recurring patterns from UK GP trainee communities, deanery handbooks, BMA guidance for IMGs, and trainee experience research. Every point has been cross-checked against RCGP, GMC, and NHS guidance. Nothing here contradicts official advice — it enriches it.
🌟 The RCGP Progression Descriptors — What Does “Good” Actually Look Like?
From the RCGP GP Curriculum (updated August 2025). These are the official word pictures used at ESR and ARCP. Know them — and use them to benchmark yourself.
| Level | Attitudes & Behaviour | Managing Performance Factors | Wellbeing & Balance |
|---|---|---|---|
| ⚠️ Underperformance | Does not comply with professional codes. Fails to meet deadlines or contractual obligations. Does not recognise limits of own ability. | Subject to multiple complaints. Repeatedly fails to cope with job demands or manage time. | Repeated unexplained or unplanned absence from professional commitments. |
| 🟡 Needs Further Development Expected by end of ST2 |
Understands and follows GMC duties. Complies with professional codes, showing awareness of own values. Applies relevant ethical and legal frameworks. | Shows insight into personal health or habits that might affect patient care. Demonstrates willingness to change after feedback. | Monitors own performance and shows insight into personal needs. Demonstrates awareness of colleagues’ needs. |
| ✅ Competent for Licensing Required by CCT |
Evaluates clinical care and justifies actions to patients, colleagues, and professional bodies. Reacts promptly and impartially to concerns about self or colleagues. Works within limits of own ability. | Identifies and notifies appropriate person when performance, conduct, or health may put others at risk. Responds appropriately to complaints. Takes effective steps on personal health issues. | Achieves balance between professional and personal demands. Proactive approach to own health and wellbeing. |
| ⭐ Excellent | Encourages an organisational culture in which health and wellbeing of all members is valued and supported. Anticipates system or practice areas requiring improvement and proactively rectifies them. | Fosters a supportive environment where colleagues can share difficulties and reflect on performance. Uses mechanisms to learn from complaints and improve patient care. | Promotes the wellbeing and health of all colleagues and staff, both individually and collectively. Anticipates situations impacting work–life balance and minimises adverse effects. |
📊 What Triggers Professionalism Concerns in GP Training?
Illustrative proportions based on published GMC data and UK GP training research. Not every concern leads to formal action — early intervention resolves most.
Illustrative proportions based on GMC annual data and UK GP training research patterns.
⚠️ How a Small Lapse Becomes a Big Problem — and How to Stop It
Two pathways. Same starting point. Very different endings. The only difference is how quickly and honestly the concern is addressed.
Small lapse noticed
Persistent lateness, dismissive manner, or a pattern of poor documentation.
Not raised
Trainer hopes it resolves itself. Trainee has no idea there is a concern.
Pattern forms
Concern becomes a documented trend. Other colleagues notice.
ESR flags it formally
Educational Supervisor Report records the concern. ARCP is informed.
Formal process begins
Supported learning plan, possible extension of training, or worse — depending on severity.
Small lapse noticed
Same starting point — a lapse in punctuality, manner, or documentation.
Trainer raises it promptly
Brief, honest, private conversation. Not a formal report — just a conversation.
Trainee reflects and responds
Writes a log entry. Identifies the reason. Names a plan for change.
Progress reviewed in next CBD
Trainer documents the improvement. The pattern is closed, not open.
Resolved — professional growth evidenced
ARCP sees self-awareness, improvement, and trajectory. No formal process needed.
🎯 What Trainees Wish They Had Known
Patterns drawn from UK GP trainee communities, deanery handbooks, and the BMA’s IMG Advice Guide (2025). All consistent with RCGP and GMC guidance.
Reliability is assessed from day one. Persistent lateness and missed deadlines are noticed and remembered long after any clinical competence issue fades. Punctuality is visible immediately; competence takes months to assess. Being reliable is one of the cheapest and most effective professional acts available to you.
Say thank you. Apologise when you need to. The BMA’s 2025 IMG Advice Guide records experienced clinicians across UK specialties unanimously citing basic courtesy — thanking the nurse, apologising when you are late — as the quality most remarked upon in trainee MSF feedback. It costs nothing and returns everything.
Asking when you don’t know is the professional act. Trainees who struggled most often tried to cover uncertainty rather than seek help. This is counterproductive and dangerous. Practising beyond your competence without disclosure is an FtP concern. Asking for help is not.
Your trainer is watching — but so is everyone else. How you speak to the receptionist when your trainer is not in the room is the truest test of your professionalism. Your colleagues notice. The MSF will reflect it. Trainees are repeatedly surprised by what finds its way into their supervisor reports.
Your ePortfolio is a professional document, not a homework file. A consistent pattern from UK trainee communities: log entries that describe events without genuine reflection routinely fail ARCP scrutiny. ARCP panels are looking for insight and trajectory, not word count. One excellent entry beats ten adequate ones.
Work–life balance is a professional duty, not a personal indulgence. GMP 2024 states this explicitly. Trainees who neglect their own wellbeing make more errors and experience more complaints. Getting the balance right is not about being kind to yourself — it is about being safe for patients.
One social media post can follow you for your entire career. A consistent pattern across the MDU case study library and UK trainee communities. The internet does not forget. Neither do the colleagues who screenshotted it. Behave online as if your name, your trainer’s name, and the GMC logo are all visible in the corner of the screen.
Silence is never neutral. Not challenging a colleague’s unprofessional behaviour is itself a professional choice — and under GMP 2024, potentially a fitness to practise concern. The discomfort of speaking up is always less than the cost of staying quiet when it mattered.
🌎 For IMGs: Five Things That Feel Different in the UK
Drawn from the BMA IMG Advice Guide (2025), Yorkshire & Humber Deanery IMG resources, and Bradford VTS trainee community guidance. These are the five adjustments IMGs most consistently describe as professionally significant.
1. The NHS is less hierarchical than most health systems
Nurses, pharmacists, and allied health professionals are valued partners, not subordinates. Treat them as the experienced colleagues they are. Many of your nurses will have worked in general practice longer than you have been a doctor — listen to them, especially if they raise a concern. The BMA guide quotes an ED consultant bluntly: “Most of your nurses have done the job longer than you have been in medical school.” In the UK, treating every colleague with equal respect is not just courtesy — it is professionally assessed.
2. Raising concerns about colleagues is expected, not disloyal
In many healthcare systems, raising a concern about a senior colleague is culturally unthinkable. In the UK, under GMP 2024, it is a professional duty. Cultural norms around deference and hierarchy are not accepted as a reason not to act. This can feel uncomfortable at first — and that discomfort is entirely normal. It does not mean you should stay silent.
3. Reflective practice is assessed, not optional
In many training systems, clinical description is rewarded. In UK GP training, clinical description alone is not enough. What were you thinking? What would you do differently? How did this change your practice? These are the questions your FourteenFish log entries must answer. Many IMGs find this shift the hardest of all — because it requires a kind of honest self-critique that may feel unfamiliar, even risky. In the UK, it is the foundation of professional development.
4. Being open when things go wrong is protective, not dangerous
The duty of candour — being open and honest with patients when something goes wrong — may feel counterintuitive if your previous training taught caution about any admission of error. In the UK, openness is legally and professionally required. More importantly, it works: patients who are told honestly what happened, and why, are far less likely to complain or litigate than those who feel information was withheld. Transparency is protection, not vulnerability.
5. The patient is an active partner in decisions
Shared decision-making is not a courtesy in UK general practice — it is assessed in the SCA and required by GMP 2024. The patient’s values, preferences, and priorities are part of the clinical decision, not an obstacle to it. This does not mean patients decide everything; it means you explore what matters to them and incorporate it into your plan. The UK model expects you to involve the patient as an intelligent adult, not reassure them as a passive recipient of care.
🎓 For Trainers — Teaching Professionalism That Actually Works
Professionalism cannot be taught through a lecture or a textbook alone. It is caught as much as it is taught — through role modelling, honest conversation, and thoughtful supervision. But there is also an evidence base for what works, and it is worth knowing.
The Assessment-Behaviour Change Cycle
Research in medical education consistently shows that assessment alone is not sufficient to change professional behaviour. What drives real, lasting change is the full cycle:
Rigorous, credible assessment
Assessors who apply standards consistently and honestly. When assessors are well-trained and do not inflate marks, trainees know that the standard is real and rise to meet it — just as strict driving examiners produce better drivers.
Specific, honest feedback
Not a vague “good effort” but precise, behaviour-focused feedback: what was observed, what the standard requires, and what needs to change. Structured feedback using word descriptors (as in CBD and COT) is a foundation, not the endpoint.
Structured reflection
A deliberate, guided process of unpacking what happened and why. Log entries help raise awareness but rarely drive change alone — the reflective conversation around them is what matters. Lillevang (2020) validated a structured reflection tool (the GAR) specifically for GP training.
Coaching and/or mentoring
Ongoing, personalised support that revisits the theme over time. Coaching helps the trainee develop their own insight — asking powerful questions rather than prescribing answers. Mentoring is more directive: the mentor uses their expertise to set goals and guide the trainee towards them. Both are valuable; which you use depends on whether the trainee has insight yet.
Review and repeat
The coaching or mentoring is not a one-off conversation. Return to the theme in subsequent CBDs and tutorials. Track whether behaviour has changed. This iterative cycle — assess, reflect, coach, review — is what produces lasting professional growth.
If a CBD reveals a professionalism concern — a dismissive manner, failure to explore ICE, poor empathy — the form alone will not change anything. What makes a real difference is a follow-up mini-tutorial: a short, safe-space conversation where you help the trainee unpack what they were thinking, why they responded that way, and what they could do differently. That structured reflection, revisited in subsequent CBDs, is where professional growth actually happens. The assessment creates the opening. The conversation is where the learning occurs.
Assessor Training Matters — Enormously
Assessment that is treated as a bureaucratic box-tick produces trainees who treat it as a box-tick. When assessors are well-trained, apply standards consistently, and give honest feedback — even when that feedback is uncomfortable — trainees understand that the standard is real. Research shows that untrained assessors tend to give inflated scores and vague narrative feedback, while trained assessors give more accurate, criterion-based assessments. The lesson is simple: invest in assessor training, and calibration sessions between trainers, as a prerequisite for any professionalism assessment programme.
- IMGs may not be familiar with the UK expectation of openly raising concerns about colleagues — this may conflict with cultural norms around hierarchy. It needs explicit discussion, not assumption.
- Many trainees underestimate how much their behaviour outside the consulting room — in the staffroom, on the phone, online — is observed and discussed.
- The concept of professional accountability — taking responsibility for errors rather than deflecting — is not universally trained. Some trainees have learned defensiveness as a protective strategy in other systems.
- Self-care as a professional duty is often overlooked. Trainees who are struggling often mask it rather than seek help, partly because they have not been explicitly told that getting help is the professional thing to do.
- Trainees often assume professionalism is assessed separately from clinical performance. In the SCA and in WPBA, they are inseparable — make this explicit early.
Tutorial Discussion Scenarios
Your fellow registrar has been arriving late, seems distracted in consultations, and you have heard several complaints from reception staff about her manner. She has said nothing to you. What do you do — and what are your professional obligations?
Explores: raising concerns, colleague wellbeing, professional duty vs personal loyalty, CUDSA model, escalation pathways.
A friend forwards you a screenshot of a WhatsApp message from a “private” group for GP registrars. It describes “the most difficult patient this week” in enough detail that you think you might recognise who it is. The person who posted it is not in your scheme. What, if anything, do you do?
Explores: confidentiality, the Three Ps of social media, duty to raise concerns, decision-making under uncertainty.
“If I asked three people who work closely with you — one patient, one colleague, and one receptionist — to describe your professionalism in one word, what do you think they would say? Is there any word you would be uncomfortable hearing?”
Explores: self-awareness, feedback acceptance, professional identity. Particularly powerful for trainees who score highly clinically but less consistently interpersonally.
Share a de-identified example of a superficial log entry linked to the FtP capability — one that describes what happened without genuine reflection. Ask the trainee: “What would make this entry actually evidence the capability? What is missing? And if an ARCP panel read this today, what would they conclude?”
Teaches: the difference between description and reflection; what ARCP panels actually look for; why log entries that are box-ticking fail to produce change.
The most powerful teaching of professionalism is what trainees observe in their trainers. How you handle a difficult complaint, how you respond to a colleague who has made an error, how you treat the reception team — all of this teaches far more than any tutorial. Be intentional about it. Occasionally narrate your reasoning: “I'm going to ring the patient myself rather than sending a letter — in a situation like this, direct personal contact is the more professional approach, even though it takes longer.” This makes the invisible visible and gives trainees a professional model to internalise.
🎭 Professionalism in the SCA — Scenario Types
The SCA assesses clinical, communication, and professional skills together in 12 simulated consultations. Some cases specifically test how you handle professionally challenging situations — these are not primarily about clinical knowledge, but about your values, judgment, and interpersonal responses.
Cases may involve a patient, a carer, or a third party such as a colleague, nurse, or ANP. The scenarios below are realistic examples — each tests different aspects of professionalism.
In professionalism-heavy SCA cases, examiners look for: how you balance empathy with appropriate professional action; whether you listen fully before responding; whether you know when to involve others (trainer, practice manager, HR); and whether you avoid making promises you cannot keep. Being human and being professional are not in conflict — they should be the same thing.
Scenario 1: The colleague who confides in you
A fellow GP registrar catches you after morning surgery and says: “I need to talk to you. I've been drinking more than I should and I don't think I'm safe to be seeing patients some mornings. I don't know what to do.”
What examiners look for: That you listen empathetically without judgment; acknowledge how difficult it was to speak up; take the concern seriously; explain honestly that this affects patient safety and cannot remain entirely private; encourage self-referral to the Practitioner Health Programme; and make clear — gently but honestly — that you have a professional duty to escalate if the situation does not improve. Do not promise secrecy you cannot guarantee.
Scenario 2: The ANP trainee who is struggling
An Advanced Nurse Practitioner trainee working in your practice asks to speak to you privately. She says: “I'm really struggling. I don't think I'm confident enough to be seeing patients without supervision, but my supervisor keeps saying I'm fine and telling me to get on with it. I'm worried I'm going to hurt someone.”
What examiners look for: Acknowledgement and validation of her concern — this is courageous to raise; genuine exploration of what she finds difficult; recognition that this is a patient safety issue; practical advice about escalation (practice manager, her training programme director, Freedom to Speak Up Guardian); reassurance that she is right to raise this and that you will support her. Do not simply reassure her that she will be fine.
Scenario 3: The receptionist who is being bullied
Lisa, your practice receptionist, asks to speak to you. She says: “I didn't know who else to go to. Dr Jones has been horrible to me for months — shouting at me in front of patients, swearing at me twice this week, and making sarcastic comments about my work. It's really affecting me. I'm dreading coming in.”
What examiners look for: That you take this seriously and immediately validate her experience; you do not minimise or make excuses for the colleague's behaviour; you acknowledge the impact on her wellbeing; you explain clearly that this behaviour is unacceptable under GMC standards; you advise her to speak to the practice manager or use the Freedom to Speak Up process; you offer support and follow-up. You do not attempt to investigate or discipline the colleague yourself — that is not your role or within your authority.
Scenario 4: Witnessing dismissive behaviour toward a patient
You overhear a consultation through a thin wall. A senior partner repeatedly interrupts a patient, says “You're just anxious, there's nothing wrong with you”, and ends the consultation abruptly. The patient leaves visibly upset. The partner walks past you and says, “God, these patients. How are you getting on?”
What examiners look for: Recognition that this behaviour falls below professional standards; that you do not simply ignore it or collude with the dismissive comment; a considered response — either a brief professional comment in the moment, or raising it with your trainer or TPD. Awareness of your own position as a trainee is relevant when deciding how to escalate. You are not expected to confront a senior partner directly — but you are expected to do something.
Scenario 5: A patient who feels their previous GP was dismissive
A patient presents and says early in the consultation: “I want to make a complaint about Dr Brown, who I saw last week. He barely looked at me, dismissed my concerns, and I've been up all night worrying. I want you to sort it out.”
What examiners look for: Acknowledging the patient's distress; listening without becoming defensive on behalf of a colleague; not making a judgement about a colleague without hearing their account; explaining the complaints process clearly and calmly; focusing the consultation on the patient's current health concern; not making promises about what will happen to the other doctor.
Scenario 6: A patient who wants to connect on social media
A patient you have seen several times says warmly: “You've been so helpful, I'd love to follow you on Instagram and keep in touch. Can I add you?”
What examiners look for: Warmth and kindness in the response — not dismissiveness; a clear, honest explanation of why you cannot accept the request (professional boundaries under GMP 2024); no suggestion that the patient has done anything wrong; a brief explanation of how to maintain ongoing care through the practice. Declining a request without damaging the therapeutic relationship is exactly what is being tested here.
Scenario 7: You discover a prescribing error you made
You review a patient's notes before their appointment and realise you prescribed the wrong dose of metformin six weeks ago. The patient is attending today for a diabetes review. There have been no apparent adverse effects, but the dose has been subtherapeutic throughout.
What examiners look for: Open acknowledgement of the error to the patient early in the consultation — this is the duty of candour under GMP 2024; a clear explanation of what happened and what the consequences have been; a genuine apology; a clear plan to correct it; signposting to the complaints process if the patient wishes. Do not be defensive. Do not minimise. Do not make the patient feel it is their fault for not noticing.
Scenario 8: Countersigning something you are uncomfortable with
A GP partner asks you to countersign a patient's insurance form that includes a statement you believe is inaccurate — it implies the patient has had investigations you cannot find evidence of. The partner says, “Don't worry, I've been their GP for years and I know the history.”
What examiners look for: That you do not simply comply to avoid conflict with a senior colleague; that you raise your concern clearly but respectfully; that you explain you cannot sign something you cannot verify; that you suggest reviewing the records together before signing; that you handle the situation without aggression or accusation. Honesty and integrity (GMP Domain 4) are directly tested here.
Key Phrases for Professionally Challenging Consultations
- “Thank you for telling me — I know that took courage.”
- “I want to support you, and I also need to be honest with you about what this means in terms of patient safety.”
- “I'm not going to tell you everything is fine when it isn't — you came to me because you wanted to do the right thing, and I'm going to help you do that.”
- “The most important thing right now is getting you the right support. Have you heard of the Practitioner Health Programme?”
- “Before we go further, there's something I need to tell you — I made a mistake with your medication and I want to be open with you about that.”
- “I'm sorry. I want to explain exactly what happened and what we're going to do about it.”
- “I know this isn't what you were expecting to hear today, and I completely understand if you're upset.”
- “You have every right to make a formal complaint if you wish — and I can explain how to do that.”
- “I really appreciate that you feel positive about our appointments — that means a lot. I do need to be honest though: as your doctor, I need to keep our relationship on a professional footing, and that means I'm not able to connect on social media.”
- “I hope you can understand — it's not about you personally at all. It's about making sure I can always give you the best care.”
- “What I absolutely can do is make sure you know how to get in touch with me through the practice whenever you need to.”
- “Thank you for telling me — I can hear how distressing that experience was for you.”
- “I'm not in a position to comment on what happened in that consultation, but I want to make sure your concerns are heard properly.”
- “You do have the right to make a formal complaint, and I can explain how that process works.”
- “What's most important to me right now is that we address what's worrying you today — can we start there?”
❓ Frequently Asked Questions
From the moment you hold a GMC registration, the professional standards in Good Medical Practice apply to you in full. There is no reduced expectation for trainees. Concerns may be managed initially through the training pathway rather than directly by the GMC, but the standards themselves are identical. Trainees are held to the same ethical and professional obligations as all other registered doctors.
Low-level concerns are typically handled within the training programme first — through an informal discussion with your trainer or TPD, with a learning plan agreed. You should be informed of the concern and given the opportunity to respond. More serious concerns may escalate to the ARCP panel or, in the most serious cases, to the GMC. The key factor at every stage is: do you have genuine insight into the concern, and is there a credible plan for change?
Seek advice before deciding — from your trainer, your TPD, or your medical defence organisation. You do not need to have a concluded view before raising a concern. A good-faith concern raised in order to seek guidance is entirely appropriate. GMP 2024 is clear: the test is whether your concern is genuine and reasonable — not whether you have gathered definitive proof.
FtP evidence does not require dramatic scenarios. You can evidence it through: reflecting on a time you recognised the limits of your competence and asked for help; writing about how you responded to difficult feedback; describing a time you supported a struggling colleague; reflecting on how you managed your own wellbeing during a stressful period. The key is genuine reflection on your professional values and behaviour — not a description of what happened. If your entry describes events but does not analyse them, it will not evidence the capability regardless of how well-written it is.
Yes — and being aware of this is itself professional insight. Common differences include: the expectation to raise concerns openly about colleagues (rather than defer to hierarchy); patients as active partners in decisions rather than passive recipients of care; the reflective writing culture that rewards honest self-critique rather than self-promotion; and the duty of candour (being open with patients when something goes wrong). None of these are uniquely British, but they are emphasised here more explicitly than in many other training systems. Ask your trainer about anything unfamiliar: showing awareness of potential differences is exactly the right professional response.
Yes — professionalism is genuinely assessed in the SCA, woven through every consultation. The SCA assesses “clinical, professional, and communication skills” together in 12 simulated cases. Being honest and open maps to data gathering. Person-centred care maps to clinical management. Empathy, respect, and relating to the patient run throughout. If you treat professionalism as a box to tick rather than a genuine approach to practice, examiners will see it in your consulting style immediately. Assessment drives behaviour — which is exactly why the SCA includes it.
Not reliably, on its own. Research consistently shows that workplace-based assessments raise trainees' awareness of professionalism but do not automatically produce lasting behavioural change. What makes the real difference is when rigorous assessment is paired with specific, honest feedback; structured reflection (unpacking what happened and why); and ongoing coaching or mentoring that revisits the theme over time. The assessment creates the opening. The follow-up conversation — the coaching mini-tutorial, the reflective discussion — is where the learning actually occurs. This is why a good trainer does not simply hand back a CBD form. They use it as the starting point for a genuine developmental conversation.
✦ Final Take-Home Points
- Professionalism operates across three domains: yourself, colleagues, and patients. Weakness in any one weakens the whole structure.
- GMC Good Medical Practice 2024 is the definitive professional standard — read it as a practical tool for self-reflection, not just a regulatory document. Every fitness to practise decision is now assessed against it.
- The RCGP's Fitness to Practise capability is assessed throughout training — evidence it through genuine, reflective log entries in FourteenFish, not administrative descriptions.
- Assessment drives learning. If you want to change professional behaviour, make it assessable — and assess it at the shows how level, not just knows how. The SCA does exactly this.
- Assessment alone is not enough. The combination of rigorous assessment, honest feedback, structured reflection, and coaching or mentoring is what produces lasting professional change. A good CBD without a good follow-up conversation is a missed opportunity.
- Professionalism is visible in the small things: how you treat the receptionist, how you respond to feedback, how you behave when you think no one is watching. These are the things that define professional identity in practice.
- Social media is one of the most avoidable sources of fitness to practise problems. Apply Good Medical Practice online exactly as you would in the consulting room — Powerful, Public, Permanent.
- Raising concerns about a colleague is one of the hardest and most important professional duties. GMP 2024 has made this obligation explicit: failing to raise a genuine patient safety concern can itself be a fitness to practise matter. Good faith is the standard, not certainty.
- Looking after your own health is a professional duty, not a weakness. If you are struggling, seeking help is the right thing to do — for your patients, your colleagues, and yourself.
- The habits you build in training shape your professional identity for your entire career. Invest in them now. They last far longer than any exam result.
Bradford VTS · Created by Dr Ramesh Mehay · For trainees, trainers, and TPDs everywhere · Disclaimer
📱 Professionalism & Social Media
Social media is one of the most significant sources of avoidable professionalism concerns for doctors today — particularly those in training. GMC Good Medical Practice 2024 now contains explicit guidance on social media, applying the same professional standards online as in face-to-face practice.
Powerful, Public, and Permanent. What you post can be shared without your knowledge, seen by patients or employers, and remain accessible for years. Even posts made under privacy settings or pseudonyms have been traced back to doctors and referred to the GMC.
A GP registrar posted in a “closed” Facebook group for doctors in training about an interesting case, including an extract from a radiology report. Some patient details remained visible on the report. Another group member took a screenshot and reported it to the GMC. An investigation followed. Closed groups are not confidential. Screenshots take seconds. The internet does not forget.
Five Rules That Will Protect You Online
Never post about patients
Not even vaguely. Not even “anonymised.” The Jigsaw Problem: date, ward, diagnosis, and clinical context together can identify a patient even when no name is used.
Pause before anything controversial
Ask: “Would I be comfortable if my trainer, a patient, or the GMC saw this?” If not — do not post it.
Do not accept patients as personal “friends”
The GMC advises against this. It blurs professional boundaries and creates situations that are difficult to manage for both parties.
Treat anonymity as unreliable
Anonymous accounts can be traced. Pseudonyms are not protection. Behave online as if your full name is visible at all times.
Declare conflicts of interest
If you are promoting a product, organisation, or service, state any connection clearly. GMP 2024 requires this — this applies online exactly as it does in person.