FROM this year, medical students in Queensland must sign Queensland Health’s Student Deed Poll, a seven-page document, before they are allowed to undertake clinical placements.
The deed poll is a legally binding document that outlines how medical students should behave with regard to “confidential information”, defined in length at the beginning of the document as encompassing almost anything pertaining to Queensland Health.
Appropriate professional standards of behaviour are an essential requirement for medical students and doctors, and most students are asked to sign a code of conduct or similar document as part of the process to ensure professional behaviour standards are upheld. However, the Queensland Health document raises a number of issues regarding how these standards of behaviour are enforced.
Specifically, the Queensland Health Student Deed Poll has been branded in the media as a “gag order”, with concerns the document prohibits students from speaking publicly about its terms and imposes harsh penalties for any breaches.
The Australian Medical Students’ Association (AMSA) is concerned that the document provides for disciplinary action — including exclusion from placements with Queensland Health services — without requiring that any alleged breach of the deed poll be substantiated.
Specifically, clause 23 of the deed poll stipulates that “in the event of a breach or threatened breach of the terms of this Deed Poll, Queensland Health shall be entitled to seek the issue of an injunction … without the necessity of proving that any actual damage has been sustained or is likely to be sustained by Queensland Health.”
Exclusion from Queensland Health services could jeopardise students’ ability to complete their medical degrees.
The document also has the potential to create significant barriers to students speaking out in the public interest. As medical students are not classified as employees of the health service in which they are placed, there is a serious question as to whether they would be protected by whistleblower legislation that allows employees to alert relevant bodies to issues of public significance.
In Australia, medical students and doctors are registered with the Medical Board of Australia (MBA) and this body is responsible for developing standards, guidelines and codes of medical professionalism. The MBA has existing systems for notification and management of unprofessional or inappropriate medical student behaviour, including systems for feedback of information to the relevant universities.
The responsibility for disciplinary action against medical students should be primarily with the MBA and the relevant university, not with state health services. Additional requirements from health services duplicate processes are unnecessary and, where they extend beyond the limits of the universities and MBA, have the potential to be unfair for students.
AMSA has been working with the Queensland Medical Students’ Council (QMSC), formed by the four Queensland medical schools to act as a communication and representative body for Queensland medical students, which has been canvassing the views of medical students through elected student representatives. QMSC has found the vast majority of Queensland students have signed the Student Deed Poll without any formal complaint.
However, concerns have been expressed about the process by which students were informed of and asked to sign this document, which arguably would best be understood with the advice of a lawyer.
These concerns include students being asked to sign within a short time frame and without access to adequate information on the potential implications of signing.
It is also critical that students and staff involved in teaching and supervision are consulted in the development of such documents that have potentially serious consequences.
It is particularly concerning that, while medical student representatives were not consulted, Queensland Health disclosed to AMSA that nearly all Australian universities were involved in the development of this document. Such national consultation raises the question as to whether there are plans to implement this document more widely in the future.
Patient safety and confidentiality are the highest priority and standard for medical student professionalism, and must be maintained.
However, it remains unclear how the Queensland Health Student Deed Poll might affect students and why it is necessary in a system that already has multiple avenues for maintaining professional standards.
Mr James Churchill is the president of the Australian Medical Students’ Association.
Posted 26 March 2012