GMC Domains

• THE DOCTOR AS A SCHOLAR
  • TD 8: APPLICATION OF BIOMEDICAL SCIENTIFIC PRINCIPLES, METHOD AND KNOWLEDGE
    • Medical knowledge: ANATOMY (TD 8.1)
    • Medical knowledge: PHYSIOLOGY (TD 8.2)
    • Medical knowledge: BIOCHEMISTRY (inc. Metabolism) (TD 8.3)
    • Medical knowledge: CELL BIOLOGY (TD 8.4)
    • Medical knowledge: MOLECULAR BIOLOGY and GENETICS (TD 8.5, 8.6)
    • Medical knowledge: PATHOLOGY (TD 8.7)
    • Medical knowledge: CANCER
    • Medical knowledge: IMMUNOLOGY and INFLAMMATION (TD 8.8)
    • Medical knowledge: MICROBIOLOGY and INFECTION (TD 8.9)
    • Medical knowledge: PHARMACOLOGY (TD 8.10)
    • Medical knowledge: NUTRITION (TD 8.11)
    • Medical knowledge: CLINICAL FEATURES of DISEASE (TD 8 b)
  • TD 9: APPLICATION OF PSYCHOLOGICAL PRINCIPLES, METHOD AND KNOWLEDGE
    • Medical knowledge: PSYCHOLOGY (TD 9 a-g)
  • TD 10: APPLICATION OF SOCIAL SCIENCE PRINCIPLES, METHOD AND KNOWLEDGE
    • Medical knowledge: SOCIOLOGY (TD 10 a-e)
  • TD 11. PRINCIPLES, METHODS AND KNOWLEDGE OF POPULATION HEALTH
    • Medical knowledge: PUBLIC HEALTH and GLOBAL HEALTH (TD 11 a-j)
  • TD 12; APPLICATION OF SCIENTIFIC METHOD AND APPROACHES TO MEDICAL RESEARCH
    • Medical knowledge: EPIDEMIOLOGY
    • Medical Knowledge: SCIENTIFIC METHOD & RESEARCH
• THE DOCTOR AS A PRACTITIONER
  • TD 13: CARRY OUT A CONSULTATION WITH A PATIENT
    • Clinical skills: HISTORY (TD 13 a-b)
    • Clinical skills: PHYSICAL EXAMINATION (TD 13 c)
    • Clinical skills: MENTAL STATE EXAMINATION (TD 13 d)
  • TD 14: DIAGNOSE AND MANAGE CLINICAL PRESENTATIONS
    • Clinical skills: INTERPRETING FINDINGS AND INITIAL ASSESSMENT (TD 14 a-b)
    • Clinical skills: PLANNING AND INTERPRETING INVESTIGATIONS (TD 14 c-d)
    • Clinical skills: MAKING A DIAGNOSIS and CLINICAL JUDGEMENT (TD 14 e-f)
    • Clinical skills: FORMULATING A TREATMENT PLAN (TD 14 g)
    • Clinical skills: SURGERY and ANAESTHETICS (TD 14 g)
    • Clinical skills: SUPPORTING PATIENTS and IDENTIFYING ABUSE and NEGLECT (TD 14 h-i)
    • Clinical Skills: CARE OF PATIENTS AND RELATIVES AT END OF LIFE (TD 14 j)
  • TD 15: COMMUNICATE EFFECTIVELY WITH PATIENTS AND COLLEAGUES
    • Clinical skills: INTERACTION WITH PATIENTS (TD 15 a-b)
    • Clinical skills: MANAGING INFORMATION (TD 15 c)
  • TD 16: PROVIDE IMMEDIATE CARE IN MEDICAL EMERGENCIES
    • Emergency Management of Patients (TD 16 b-e)
  • TD 17: PRESCRIBE DRUGS SAFELY, EFFECTIVELY AND ECONOMICALLY
    • Clinical skills: PRESCRIBING DRUGS SAFELY AND EFFECTIVELY (TD 17 a-h)
  • TD 18: CARRY OUT PRACTICAL PROCEDURES SAFELY AND EFFECTIVELY
    • Clinical skills: DIAGNOSTIC PROCEDURES (TD 18 a)
    • Clinical skills: THERAPEUTIC PROCEDURES (TD 18 b)
  • TD 19: USE INFORMATION EFFECTIVELY IN A MEDICAL CONTEXT
    • Clinical skills: EVIDENCE BASED MEDICINE
• THE DOCTOR AS A PROFESSIONAL
  • TD 20: BEHAVE ACCORDING TO ETHICAL AND LEGAL PRINCIPLES
    • Professional issues: ETHICS and LAW (TD 20 a-g)
  • TD 21: REFLECT, LEARN AND TEACH OTHERS
    • Professional Issues: PERSONAL LIMITS OF CARE (TD 21e)
    • Professional issues: LEARNING (TD 21 a-d)
    • Professional issues: TEACHING AND MENTORING (TD 21 f)
  • TD 22: LEARN AND WORK EFFECTIVELY WITHIN A MULT-PROFESSIONAL TEAM
    • Professional issues: WORKING IN TEAMS (TD 22 a-c)
  • TD 23: PROTECT PATIENTS AND IMPROVE CARE
    • Professional issues: DUTIES OF A DOCTOR (TD 23 a-b)
    • Professional issues: MEDICAL FRAMEWORK IN THE UK (TD 23 c)
    • Professional issues: RISK MANAGEMENT and PATIENT SAFETY (TD 23 d)
    • Professional issues: GOVERNANCE, QUALITY MATTERS and AUDIT (TD 23 e)
    • Professional issues: PERSONAL ATTITUDES and SELF CARE (TD 23 f-j)

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TD 20: BEHAVE ACCORDING TO ETHICAL AND LEGAL PRINCIPLES: Professional issues: ETHICS and LAW (TD 20 a-g)

Index

• Ethics and Law

• Ethics and Law
  • General Outcomes for Medical Professionalism
    1. Deal effectively with uncertainty and change. (YR5intro)
    2. To be aware which groups are protected by the Equality Act (HSPH2)
    3. Recognise the rights and the equal value of all people and how opportunities for some people may be restricted by others’ perceptions. (YR5intro)
    4. Explain the different models of the psychology of clinical decision making. (GEP/HSPH)
    5. Respect patients' rights to hold religious or other beliefs and take these into account when relevant to treatment options (Yr2intro)
    6. Specify why the privileges associated with being a medical student carry with them the responsibility to respect the rights and dignity of patients (FM1)
    7. Define medical ethics, and outline the basic principles of the GMC Good Medical Practice. ()
    8. To be aware of what is meant by discrimination as defined in the Act (HSPH2)
    9. To be aware of the main tenets of the public sector equality duty and the Human Rights Act (HSPH2)
    10. Describe circumstances within healthcare in which it would be appropriate to be 'economical' with the truth. ()
    11. Demonstrate a precise knowledge of the complaints procedure ()
    12. Apply and critically analyse ethical and legal theory to ethico-legal dilemmas/issues encountered in professional practice. ()
    13. Offer leadership in ethical and legal matters in clinical practice. ()
    14. Provide education and supervision for colleagues and students in relation to ethical and legal matters. ()
  • The Meaning of Ethics and its Relation to the Law
  • Moral Philosophy
    1. Explain the interface between medical ethics and medical law
    2. Understand the difference between 'ethical' and 'moral'. ()
    3. Differentiate between ordinary autonomy and freedom of choice within social rules, and critical autonomy, which enables freedom of choice between such rules.
    4. Describe clinical cases where non-adherence is a problem for therapeutic management; state moral arguments for discrimination on the grounds of non-adherence in the distribution of scarce medical resources.
    5. Understand basic concepts of philosophical ethics. ()
    6. Articulate moral arguments against discrimination on the grounds of non-adherence in the distribution of scarce medical resources.
    7. Describe different moral theories, and be able to apply them to different situations. ()
    8. Explain the importance of moral arguments and their limitations. ()
    9. Summarise three moral/practical steps that should always be taken in negotiating non-adherence with patients.
    10. Give arguments for and against patients paying for their own health care if their condition has been a direct result of their lifestyle
    11. Understand the nature and outline the various forms of an ethical problem; identify examples of ethical problems in medicine (FM1)
    12. Apply and critically analyse ethical and legal theory to ethico-legal dilemmas/issues encountered in professional practice. ()
    13. Outline the major moral theories and their criteria of identifying goodness (FM1)
    14. Give examples of how each of these theories could be applied in medico-ethical decision making (FM1)
    15. Describe the shortcomings of moral theories and suggest how they could be overcome (FM1)
  • Sociology and History of Biomedical Ethics
  • Legal, Moral, Ethical Responsibilities of Patient Care
    1. Explain the ethico-legal importance of the duty of confidentiality. ()
    2. Describe the official history of our medical ethics. ()
    3. Define medical ethics, and outline the basic principles of the GMC Good Medical Practice. ()
    4. Outline the possible implications of breach of these duties both for the patient as well as for the student/doctor. ()
    5. Describe some unorthodox historical accounts of our medical ethics. ()
    6. Provide the major arguments against denial of NHS treatment from such patients. ()
    7. Be aware of Child Protection issues (I&I 4)
    8. Compare the local standard to acceptable standards elsewhere of information that should be offered to patients. ()
    9. Understand the explanatory power as well as shortcomings of the aforementioned historical theories and narratives. ()
    10. Compare the local standard to acceptable standards elsewhere of information that should be offered to patients.
    11. Articulate the rights of competent patients as regards refusal of medical interventions.
    12. Articulate the rights of competent patients as regards refusal of medical interventions. ()
    13. Offer a theory that can overcome the problems of the existing historiography. ()
    14. Understand the importance of getting the history of our medical ethics correct, especially vis-a-vis its possible moral implications. ()
    15. Specify the moral and legal problems of respecting a patient's right not to be told the truth. ()
    16. Specify the moral and legal problems of respecting a patient's right not to be told the truth. (CSP3)
    17. Offer leadership in ethical and legal matters in clinical practice. ()
    18. Provide education and supervision for colleagues and students in relation to ethical and legal matters. ()
    19. Maintains a professional approach to the older person. (HCOE4)
    20. Gives consideration to various myths and stereotypes related to older people. (HCOE4)
    21. Advocates against ageism and recognise that it can affect the optimal care of older patients. (HCOE4)
    22. Recognises the heterogeneity of older persons and that each person needs to be viewed as an individual. (HCOE4)
    23. Can describe the ethical and legal issues including: advance directives; euthanasia and assisted suicide; safeguarding; withdrawal and withholding of medical treatment; cardiopulmonary resuscitation decisions. (HCOE4)
    24. Can describe the principles of autonomy, mental capacity to make decisions and the concept of Best Interests, Deprivation of Liberty Safeguards (DOLS). (HCOE4)
    25. Can describe the legislation in each jurisdiction which outlines and protects these principles. (HCOE4)
  • Good Medical Practice: Ethico-Legal Responsibilities of Patient Care
    1. Demonstrate professional behaviour when undertaking independent tasks (GP5)
    2. Demonstrate the importance of making decisions in partnership with colleagues and patients (GP5)
    3. Respect all patients, colleagues and others regardless of their age, colour, culture, disability, ethnic or national origin, gender, lifestyle, marital or parental status, race, religion or beliefs, sex, sexual orientation, or social or economic status. G (YR5intro)
    4. Describe the harm principle and the limits to autonomy (CSP3)
    5. Be polite, considerate, trustworthy and honest, act with integrity, maintain confidentiality, respect patients’ dignity and privacy, and understand the importance of appropriate consent. (YR5intro)
    6. Define ‘ethnicity’, ‘culture’ and ‘racism’.
    7. Understand and accept the legal, moral and ethical responsibilities involved in protecting and promoting the health of individual patients, their dependants and the public − including vulnerable groups such as children, older people, people with learnin (YR5intro)
    8. Recognise the duty to take action if a colleague’s health, performance or conduct is putting patients at risk. (YR5intro)
    9. Identify the conflict between the individual and society in the context of risk to others (CSP3)
    10. Identify notable patterns of ill-health in relation to ethnicity.
    11. Outline the steps a doctor should take to ensure that the DVLA is informed about dangerous drivers (CSP3)
    12. Offer explanations for ethnic differences in health.
    13. Describe the principles of ‘culturally competent’ health care practice.
    14. Discuss the outlook for low birth weight babies and identify some of the ethical issues
    15. Explain the ethical and practical guidelines for interviewing patients (MedSoc1)
    16. Debate ethical issues pertinent to primary care (GPCC3)
  • Management of Medical Information: Truth Telling & Confidentiality
    1. Explain in what respects truth-telling is important both to patient and doctor/student. (CSP3)
    2. Explain in what respects truth-telling is important both to patient and doctor/student. ()
    3. Give classical justifications for and against deception and assess the strength and weaknesses of both. ()
    4. Give classical justifications for and against deception and assess the strengh and weaknesses of both. (CSP3)
    5. Describe circumstances where the duty can be relaxed. ()
    6. Relate personal experience of deception to the concepts of rights and corresponding 'strict' duties and to the moral impropriety of professional deception. ()
    7. Specify the potential ethico-legal consequences of lying to patients. (CSP3)
    8. Describe circumstances within healthcare in which it would be appropriate to be 'economical' with the truth. ()
    9. Describe circumstances within medicine and surgery in which it would be appropriate to be economical with the truth (CSP3)
    10. Specify the moral and legal problems of respecting a patient's right not to be told the truth. ()
    11. Specify the moral and legal problems of respecting a patient's right not to be told the truth. (CSP3)
    12. Anticipate and appropriately respond to situations where patients ask you as a medical student (or doctor) to be truthful about their condition, treatment and prognosis (CSP3)
    13. Outline good policies on breaking bad news (CSP3)
  • Ethico-Legal Aspects of Fitness to Drive
  • Informed Consent
    1. Outline the legal implications of a failure to obtain valid consent when such consent should be obtained. ()
    2. Engage in relevant HIV pre-test discussions to assess relative risk of infection and enable patients to make an informed decision on testing (both in GU setting and outside of GU) (I&I 4)
    3. Outline the legal implications of a failure to obtain valid consent when such consent should be obtained.
    4. Can describe the principles and practice of informed consent
    5. Explain why obtaining consent is an integral part of successful clinical relationships and the key tenets of GMC policy (FM1)
    6. Describe the acceptable legal standard of the information that should be offered to patients in the UK when obtaining valid consent.
    7. Understand the concept of opt-out testing and the settings in which opt-out testing are conducted. (I&I 4)
    8. Describe the acceptable legal standard of the information that should be offered to patients in the UK when obtaining valid consent. ()
    9. Compare the local standard to acceptable standards elsewhere of information that should be offered to patients.
    10. Compare the local standard to acceptable standards elsewhere of information that should be offered to patients. ()
    11. Differentiate between explicit and applied consent, indicating when each is important (FM1)
    12. Articulate the rights of competent patients as regards refusal of medical interventions.
    13. Articulate the rights of competent patients as regards refusal of medical interventions. ()
    14. Demonstrate how to obtain consent from a patient for interviewing them (MedSoc1)
    15. Specify when consent may not or should not be obtained and how one should proceed in such cases.
    16. Specify when consent may not or should not be obtained and how one should proceed in such cases. ()
  • Misconduct, Medical Negligence and Malpractice
    1. Describe the duty of care and who has it (CSP3)
    2. Outline the legal conditions for negligence to be established (CSP3)
    3. Explain the Bolitho modification of the Bolam test (CSP3)
    4. Describe situations or res ipsa loquitur (CSP3)
    5. Explain the legal standard of evidence in negligence cases (CSP3)
  • Distributive Justice: Allocation of medical Resources & Research Ethics
    1. Outline the main principles outlined in the Declaration of Helsinki.
    2. Describe the particular standard of valid consent applied in research as opposed to consent for clinical procedures.
    3. Outline the provision pertaining to Placebo-Controlled Trials (PCT).
  • End of Life Ethics
    1. Give arguments for and against hastening death of patients in various circumstances
    2. Outline the duties and prerogatives of doctors and the rights of competent patients in relation to the hastening of death and specify the circumstances where they apply
    3. Outline the difference between various forms of hastening death and distinguish between the ethico-legally acceptable ones from those which are unacceptable
    4. Specify the provisions of acceptable Advance Directives, action based on the rule of double effect, DNAR orders, withdrawal of life-saving treatment and non-treatment decisions
    5. Explain the role of relatives in relation to withdrawal of treatment in incompetent adults
    6. Define ethical issues such as the end of life decision.
    7. Explain why the cardiac arrest team is NOT called for all patients that have cardiorespiratory arrest. (CR3)
    8. Discuss how the decision not to call the arrest team is made and describe how the patient and their family should be involved in this process (CR3)
  • Ethics in Paediatrics
    1. Identify three distinct groups of minors in relation to mental capacity, consent and refusal of treatment. (CSP4b)
    2. Describe the medical law pertaining to minors and the tension reflected therein between respect for their autonomy and acting in their best interests. (CSP4b)
    3. Explain the legal concept of parental responsibility and its relevance to the consent question. (CSP4b)
    4. Explain how conflicts between the interests of minors and their guardians ought to be resolved. (CSP4b)
    5. Specify when consent may not or should not be obtained and how one should proceed in such cases. ()
    6. Specify when consent may not or should not be obtained and how one should proceed in such cases.
  • Ethics and Organ Transplantation / Donation
  • Ethics in Obstetrics and Gynaecology
    1. To understand and practice legal responsibilities of health care workers who are HIV positive
    2. To understand and practise confidentiality and be aware of current legislation concerning confidentiality with particular reference to sexual and reproductive health & HIV medicine
    3. To understand and practise legal responsibilities relevant to sexual activity and sexual health and HIV care (e.g. issues of consent, disclosure, providing care for minors, people with learning difficulties, suspected abuse, rape)
    4. Demonstrate knowledge of laws, and systems of professional regulation through the GMC and others, relevant to medical practice, including the ability to complete relevant certificates and legal documents and liaise with the coroner or procurator fiscal wh (YR5intro)
    5. Argue pro and con termination of pregnancy. (CSP4b)
    6. Understand and accept the legal, moral and ethical responsibilites involved in protecting and promoting the health of individual patients, their dependants, the public and vulnerable groups such as children, older people and people with mental illness
    7. Know about and keep to the GMC’s ethical guidance and standards including Good Medical Practice, the ‘Duties of a doctor registered with the GMC’ and supplementary ethical guidance which describe what is expected of all doctors registered with the G (YR5intro)
    8. Know and comply with GMCs ethical guidance and standards including Good Medical Practice; Duties of a Doctor Registered with the GMC, and supplementary ethical guidance which describes what is expected of all doctors registered with the GMC
    9. Understand the biological basis for assisted reproductive technologies and embryo development ()
    10. Describe the legal status of the foetus. (CSP4b)
    11. Summarise the legal framework of IVF and embryo research in the UK ()
    12. Demonstrate knowledge of laws and systems of professional regulation through the GMC and others relevant to medical practice; including the ability to complete relevant certificates/legal document and liaise with the coroner / procurator fiscal
    13. Discuss the ethical issues raised by such infections (GEP/HD)
    14. Understand some of the ethical issues around genetic data and potential risks to the individual
    15. Explain the concept of personhood and describe its relation to the morality of abortion. (CSP4b)
    16. Discuss conflicting opinions on the justification for the generation and use of human embryos for research ()
    17. Describe the legal conditions of lawful abortion as outlined in the Abortion Act 1967 (1990). (CSP4b)
    18. Identify ethical issues surrounding the use of human embryos for research and treatment ()
    19. Explain the legal status of the woman and of her husband/partner regarding abortion. (CSP4b)
    20. Consider the religious views of patients who seek IVF and other fertility treatments ()
    21. Describe the duties and rights of the doctor in relation to abortion. (CSP4b)
    22. To state the moral difficulties posed by serious personality disorder for the care of those so affected (PSYCH4)
    23. Access the new embryo ethics teaching website and give feedback on its utility ()
    24. Outline the principles of the HFEA 1990 concerning research on embryos. (CSP4b)
    25. Identify legal and ethical issues in reproductive medicine, prenatal screening and genetic counselling. (CSP4b)
  • Disability Discrimination Act
    1. Explain the purpose of the Disability Discrimination Act
  • Ethics in Psychiatry
    1. The legislative requirements for compulsory admission
    2. Explain the ethically pertinent difference between mental and non-mental illness
    3. Describe the key Sections of the Mental Health Act (including Section 2, Section 3, Section 5(2), with specific reference to admission, compulsory treatment. (PSYCH4)
    4. Know how the structure of the Act is designed to try to protect the civil liberties of detained patients. (PSYCH4)
    5. Outline the hazards that are particular to psychiatry.
    6. Know the conditions for detention of a patient Consider dilemmas of confidentiality and detaining patients. (PSYCH4)
    7. Describe the principles and the outcomes of the "care in the community" programme
    8. To describe the key Sections of the Mental Health Act, with specific reference to admission, compulsory treatment and to provide a moral justification for them.
    9. Outline the principles of establishing mental capacity in sectioned patients as outlined in the Mental Capacity Act 2007.
    10. Know the indications for, and appropriate steps to be taken when compulsory admission under the Mental Health Act into hospital is required. (PSYCH4)
    11. Describe the three sections of involuntary admission as outlined in the Mental Health Act 1983 (2007).
    12. Appreciate moral difficulties posed by serious personality disorder and for the care of those so affected. (PSYCH4)
    13. Outline the conditions that need to be met for involuntary admission.
    14. To specify the implications of serious mental disorder for the interpretation of the duties of clinical care.
    15. Explain the ethical-legal difference between formal and informal patients and between patients with mental illness and those who suffer from organic brain syndromes.
    16. Deal with dilemmas of confidentiality and detaining patients.
  • Transplant Ethics
    1. Describe the causes of the organ crisis
    2. Describe the evolution of transplant ethics since 1968. (CSP4b)
    3. Describe extent and explain the causes of the "organ crisis". (CSP4b)
    4. Argue the pros and cons of a regulated market in organs
    5. Suggest non-commercialist solutions for the organ crisis
    6. Outline the possible solutions or approaches to the organ crisis. (CSP4b)
    7. Describe the different global trends in organ commercialism, transplant tourism and organ trafficking and outline the principles of the Declaration of Istanbul, the European law, and the UK Law concerning organ commercialism. (CSP4b)
    8. Argue pros and cons of a policy of implied consent (opt-out), for organ donation upon death
    9. Argue pro and con a regulated market in organs. (CSP4b)
    10. Argue pro and con a policy of implied consent (opt-out) for organ donation upon death. (CSP4b)
    11. Explain why altruistic living unrelated donation (LURD) is a legal FICTION (CSP4b)
  • Ethics and Mental Illness
    1. Specify when consent may not or should not be obtained and how one should proceed in such cases.
    2. Specify when consent may not or should not be obtained and how one should proceed in such cases. ()
  • Elective
    1. Understand the sustainability of delivering healthcare in resource poor settings
    2. Be aware of the importance of local culture, language and prevalence of local diseases and determinants of health
    3. Familiarise yourself with different ethical scenarios; be able to describe an appropriate response to common ethical scenarios when working abroad
  • Truth Telling
  • Personal Accountability
    1. Outline the possible implications of breach of these duties both for the patient as well as for the student/doctor. ()
    2. Demonstrate a precise knowledge of the complaints procedure ()
  • Research Ethics
    1. Understand the historical context of the Declaration of Helsinki. ()
    2. Describe some classical examples of abuse in biomedical research and specify why they are abuses. (CSP3)
    3. Explain the change in ethics and law that has occured in the last four decades (CSP3)
    4. Summarise the legal framework of IVF and embryo research in the UK ()
    5. Outline the main principles of the Declaration. ()
    6. Outline the key international and national codes that currently regulate acceptable research (CSP3)
    7. Identify problems in the Declaration. ()
    8. Discuss conflicting opinions on the justification for the generation and use of human embryos for research ()
    9. Describe the work of research ethics committees and the structure of a research protocol. (CSP3)
    10. Identify ethical issues surrounding the use of human embryos for research and treatment ()
    11. Identify common moral faults in the design of research protocols and explain why they are faults (CSP3)
    12. Describe the standards of confidentiality in relation to the publication of research outcomes (CSP3)
    13. State the circumstances in which biomedical research could be, or ought not to be, conducted on vulnerable individuals (minors and mentally incapacitated patients) (CSP3)
  • Management of Conflict of Interest

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