Extreme medical misconduct: 49 UK-registered doctors involved in child pornography, dealt with by the General Medical Council 2012-2020.

BACKGROUND: Between 1 June 2012 and 31 December 2020, there were 49 cases considered by the Medical Practitioners Tribunal Service where a doctor's misconduct involved child pornography. The determinations concerning these cases provided the data for analysis. FINDINGS: In 47/49 (96%) the regulatory outcome was erasure from the GMC's Medical Register, ending the doctor's career. 12 doctors had been imprisoned for 1 to 20 years, and 19 given suspended prison sentences. In 33/49 (67%) cases the indecent images of children included one or more video recordings. Some of these were of children (including very young infants) being raped, sometimes for prolonged periods, the video recordings sometimes indicating that the child could be seen to be in extreme pain. INTERPRETATION: The high proportion of erasures reflected the gravity of these cases, coupled with the fundamental incompatibility of sexual misconduct involving children with a career in medicine.

The outcome of applications for restoration to the Medical Register following disciplinary erasure.

In the period 1 January 2012 to 30 June 2020, 76 doctors whose names/entries had been erased from the UK Medical Register by a disciplinary tribunal applied for restoration, and 23 out of 76 (30.3%) applications granted. In 5 of the 53 of those refused restoration, the tribunal suspended indefinitely the right to make further applications. The most frequent reasons for refusal were failure to demonstrate insight (seen in 96%), failure to demonstrate remediation (seen in 79%), and failure to demonstrate that knowledge and skills were up to date (24.5%). Success was more common in UK graduate applications (14/29 - 48.3%) than non-UK graduate applications (9/37 - 24.3%), and in those legally represented (16/29 - 55.2%) than in those without legal representation (7/29 - 24.1%), but the data does not indicate the reasons for these differences. Disciplinary erasure need not necessarily be for life as doctors who learn from their experience, change their ways, and provide evidence of genuine insight and remediation along with up to date knowledge and skills can successfully be reinstated on the register.

Is lack of integrity a useful concept when dealing with health and social care pre-registration student fitness to practise cases?

Health and social care regulators in their guidance to pre-registration students and registrants emphasise the importance of honesty and integrity. While the term honesty is generally understood, the meaning of integrity is less familiar, and for many years, there has been disagreement as to whether there is any difference between "dishonesty" and "lack of integrity." To explore the possible application of lack of integrity to student behaviour, we present cases that illustrate what might be considered to demonstrate a lack of integrity. As with other allegations, if there is to be a finding of fact then an allegation of lack of integrity and its basis need to be clearly set out in advance of any hearing. If the term lack of integrity is to be useful, guidance from the regulators will need to explain the meaning of the term. If, however, agreement as to the meaning cannot be reached, maybe the term "integrity" should no longer be a standard accompaniment to the term "honesty."

Fitness to practise procedures for medical students.

Medical students who exhibit severe forms of adverse behaviour (including criminal matters), sometimes accompanied by mental health problems, are likely to be seen by their medical school's fitness to practise committee, a topic explained in this review.

Refusal to grant provisional General Medical Council registration to U.K. medical graduates.

In the last five years, 2010-2014, there have been 17 instances when an application for provisional registration by a U.K. medical graduate was refused by the General Medical Council because the Registrar considered that the applicant's fitness to practise was impaired. While this number is small, the fact that this can happen is largely unappreciated by medical students and their teachers, the prevailing false assumption being that passing finals and graduation is the final hurdle before taking up a Foundation Programme post. It is a poorly recognised fact that just because a university fitness to practise committee has concluded that a student is fit to practise there is no guarantee that the General Medical Council will come to the same decision. This paper explains the reasons for these refusals and makes suggestions for students and medical schools.

Unprofessional behaviour in medical students: a questionnaire-based pilot study comparing perceptions of the public with medical students and doctors.

BACKGROUND: Evidence suggests that doctors and medical students use different strategies to evaluate unprofessional behaviour. Anecdotal evidence suggests that the public and profession may judge misdemeanours differently. AIMS: To explore whether members of the public will judge examples of medical student misconduct more harshly than medical students and doctors. METHODS: This was a pilot cross-sectional survey of the public, medical students and doctors. For 10 hypothetical examples of medical student misconduct and one of appropriate conduct in a questionnaire, participants were asked to (1) indicate the level of acceptability and (2) to choose the sanction they considered most appropriate for each. RESULTS: Overall, doctors were harsher than students and the public were harsher than doctors in their choice of sanctions. The most lenient outcomes were selected by students for deception in an examination, nonattendance and dishonesty. The most punitive were chosen by the public for forgery, criminal conviction, misrepresenting qualifications, alcohol and drug misuse and lack of insight. CONCLUSIONS: The public judge misdemeanours among medical students more harshly than do medical students and medical professionals. This implies that views of lay members should be sought by medical schools when promoting professionalism and considering cases of medical student misconduct.

Medical student fitness to practise committees at UK medical schools.

BACKGROUND: The aim was to explore the structures for managing student fitness to practise hearings in medical schools in the UK. We surveyed by email the named fitness to practise leads of all full members of the UK Medical Schools Council with a medical undergraduate programme. We asked whether student fitness to practise cases were considered by a committee/panel dedicated to medicine, or by one which also considered other undergraduate health and social care students. FINDINGS: All 31 medical schools responded. 19 medical schools had a fitness to practise committee dealing with medical students only. Three had a committee that dealt with students of medicine and dentistry. One had a committee that dealt with students of medicine and veterinary medicine. Eight had a committee that dealt with students of medicine and two or more other programmes, such as dentistry, nursing, midwifery, physiotherapy, dietetics, social work, pharmacy, psychology, audiology, speech therapy, operating department practice, veterinary medicine and education. CONCLUSION: All 31 UK medical schools with undergraduate programmes have a fitness to practise committee to deal with students whose behaviour has given rise to concern about their fitness to practise. The variation in governance structures for student fitness to practise committees/panels can in part be explained by variations in University structures and the extent to which Universities co-manage undergraduate medicine with other courses.

Inverted appendix mistaken for a polyp during colonoscopy and leading to intussusception.

A spectrum of appendiceal diseases, ranging from simple mucous distension to acute perforated appendicitis, are seen in patients with CF. We report a 6 year old boy with CF and recurrent periumbilical pain. During colonoscopy, a fleshy pedunculated mass at the junction of the ascending colon and caecum was mistaken for a polyp and excised. However, histopathological examination suggested it was a segment of inverted appendix. The remnant of the inverted appendix was subsequently found to be associated with an intussusception.

Association between novel GM-CSF gene polymorphisms and the frequency and severity of atopic dermatitis.

BACKGROUND: Genetic factors are known to be important in determining an individual's predisposition to atopic dermatitis. The specific genes that are clinically important in this process are still largely unknown. OBJECTIVE: Because dendritic cells initiate immune responses and thus are critical to the priming of an individual to potential allergens, we hypothesized that genetic factors controlling the activity of these cells determine an individual's propensity to atopic dermatitis. METHODS: We studied known functional polymorphisms of the IL-1beta and TNF-alpha genes and describe novel polymorphisms of the GM-CSF gene in 113 children with atopic dermatitis and 114 controls. All 3 factors are known to be important modulators of the function of skin Langerhans' (dendritic) cells. RESULTS: The inheritance of a homozygous GM-CSF -677*C/C genotype was associated with complete absence of severe atopic dermatitis within this cohort of children (P <.001). Furthermore, the odds ratio of having atopic dermatitis in children who were not of this genotype was 7.5 (2.2-25). CONCLUSION: The GM-CSF genotype is an important genetic marker predicting an individual's predisposition to atopic dermatitis.

Age-related prevalence and antibiotic resistance of pathogenic staphylococci and streptococci in children with infected atopic dermatitis at a single-specialty center.

BACKGROUND: Skin staphylococci and streptococci are known to exacerbate atopic dermatitis, but the prevalence changes that occur with age are unknown. This study examined the age-related prevalence and antibiotic resistance of these pathogenic bacteria in children with atopic dermatitis and suspected skin infections. OBSERVATIONS: Medical records of 150 children with atopic dermatitis referred to a regional center, who had skin swabs taken for suspected infection, were studied retrospectively. All patients carried Staphylococcus aureus. The prevalence of methicillin sodium-resistant (P =.05) and fusidic acid-resistant (P =.001) S aureus tripled from infancy to school age. Lancefield groups A and G streptococci were the other pathogens found. The prevalence of group A streptococci was highest in children aged 3 to 6 (53%), compared with 11% of infants and 21% of patients aged 9 to 16 (P =.002). CONCLUSIONS: Significant differences in the age-related prevalence of group A streptococci skin carriage and antibiotic resistance of S aureus isolates occurred in this group of children with atopic dermatitis and suspected skin infections. Skin swabs to determine bacterial type and antibiotic sensitivities provide an important guide to antibiotic prescribing in these children.