Charles PopeLast year, we ran a competition with the MSC asking medical students to create a teaching session on honesty and integrity. Winner of the competition, Charles Pope, shares his reflections on taking part, and why honesty and integrity are such important values for medical students.

Prior to entering this competition, the teaching I had received on honesty and integrity tended to focus on the big things: case studies of doctors who had stolen controlled drugs, or misled patients with dangerous consequences, or altered records to cover up mistakes. These are all very important and well-publicised examples of dishonesty in practice, but to a group of students just beginning their careers, they all seem (hopefully) irrelevant.

It’s just a little white lie…

So what would medical students find relevant? For me, it’s the little things. The time you’re on placement, tired and tempted to tell a little white lie to get home a bit earlier. Or when you’ve got so much to submit it’d just be easier to make up one patient case. The small dishonesties that appear harmless and in many cases may go undiscovered.

The issue is, the GMC’s guidance is just as relevant for these small, seemingly-innocent mistruths as it is for the big lies. Any decision can have unintended consequences. Any lie can adversely affect patient care, relationships with colleagues, and the reputation of the profession at large. A student may be horrified to find that what they thought was a harmless dishonesty can have very serious disciplinary consequences on them personally.

Come clean or try and get out of trouble?

Hence the teaching session, in which students role-play scenarios of wrongdoing or honest mistakes during a day at clinical placements, and have the opportunity to come clean, or to attempt to lie their way out of trouble. To keep it realistic, I based these scenarios on real life examples, although I’m going to assure any future employers reading that none involved me personally. The outcomes of the students’ decisions are due to a coin flip, to reflect how you can never fully predict how others will respond to your actions.

Given that I’m writing about honesty, I’ll come clean now and admit that the style of the session was not entirely original; it was inspired by the popular tabletop game Dungeons and Dragons, in which players also role-play as characters in a fictional setting, make decisions and rely on random chance to determine outcomes. While role-playing games like D&D traditionally focus on battling monsters and finding treasure, their structures can easily be adapted for more everyday tasks like taking blood and getting signed off as competent to demonstrate inhaler technique. With simulation being used more frequently to teach clinical skills and management of acute medical scenarios, I wonder if role-playing games could be used to explore ethical topics.

Encouraging honesty and integrity

I’ve had the opportunity to present the session, both to educators at a conference, and to medical students at my university. In our discussions, the students identified additional common examples of opportunities for honesty or dishonesty that I hadn’t considered. We also spoke about systems in place that seem to make dishonest behaviour the easier and quicker option; an example was the issue of gaining official permission for a day off placement, requiring several forms, emails and proof of a valid reason, as opposed to simply not turning up and playing the odds that no one will miss you.

In today’s culture of quality improvement, I think there’s scope for looking at addressing these systems, so there are fewer barriers for individuals being honest. This would require open and non-judgemental dialogue between educators and students, and I’d be very pleased if my teaching session could be useful as an ice-breaker.

This competition has made me think a lot about a topic that I hadn’t hugely considered beforehand, and I hope it helps other students on their journey to being good doctors. I’m very much looking forward to putting what I’ve learnt into my clinical practice this year!

Charles Pope is a final-year medical student at Cardiff University. He graduates in July and is hoping to continue with the Foundation Programme in Wales.