Module 4

MODULE 4

CONTINUING MEDICAL EDUCATION (CME) PROGRAMMES

1. CONTINUING MEDICAL EDUCATION- WHAT IT MEANS?

Continuing Medical Education or CME as it is popularly known as, consists of educational
activities which helps to maintain, supplement as well as increase the knowledge, skills, and
professional performance and relationships that a physician uses to discharge his professional
duties with respect to the patients, the public, or the profession. In a simpler language, it is
any way from which medical practitioners learn about the profession or the developments
therein, after the formal completion of their course. It is a new form of continuing education
or CE which helps the medical practitioners to maintain their competence in the field as well
as learn about new forms of diseases, techniques to cure them, new technologies used in the
feild of medicine, best practices in myriad situations in their profession. The concept of CME
is something very new and innovative and caters to the need of the present medical practices,
as there are variety of advancements taking place in the medical profession with the extensive
use of new technologies in the field.

Continuing Medical Education programme serves the following purposes-

v Provides opportunities to improve knowledge, skills and practices of medical
practitioners involved at different levels of medical practice.

v Designs and implements educational programmes for postgraduate students in various
specializations of medical sciences

v Conceptualizes, prepares and distributes useful self-learning materials for various
target groups covered under the programme of CME

v Helps in developing various print and non-print learning resource materials keeping in
mind the training needs and educational requirements

CME can be in the form of any live discussion, publications, online videos, audios or any
other electronic media. The content used in the program is developed, evaluated and provided
by the faculty who are experts in the field being discussed in the session.

2. IMPORTANCE OF CME PROGRAMME

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It is a well known fact that becoming a physician, nurse or other health care specialist
requires several years of education. But, the learning doesn’t end once the person gets a
license and board certification and practice begins, rather the actual learning starts from there
and continues through continued medical education.

CME plays a vital role by enabling a medical practitioner to learn and discover feasible ways
of improving the services delivered to the patients and effectively manage a career in the
medical industry.

Continuing medical education allows health care providers in-

v Improving their skills in providing medical care
v Staying at par with the current developments taking place in their area of specialty
v Fulfilling licensing/certification requirements (credits)
v Addressing real-world challenges they face day to day
v Gaining professional growth and a way to advance career status
v Learning effective medical team management skills
v Earning membership in professional organizations

It is therefore, very crucial for the medical professionals to stay current and in compliance
with changes that are taking place like the technological advancements. Today’s
professionals should take measures to incorporate a ‘life-long learning’ philosophy within
themselves that enhances effectiveness and more quickly solves problems, rather than
sticking to the age old traditional, autocratic management styles.

Even a failure to adhere to the current standard of care is construed as medical negligence and
can give rise to an actionable claim for damages against a medical professional. Continuing
Medical Education which help physicians keep themselves updated about increasing
advances in healthcare is often recommended as one of the ways to avoid a medical
malpractice claim.1

3. REGULATIONS MANDATING CME IN INDIA


1 Raveesh BN, Nayak RB, Kumbar SF. Preventing medico-legal issues in clinical practice. Ann Indian Acad
Neurol [serial online] 2016 [cited 2018 Oct 30];19, Suppl S1:15-20. Available
from: http://www.annalsofian.org/text.asp?2016/19/5/15/192886.

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Regulation 1.2.3. of the Indian Medical Council (Professional Conduct, Ethics & Etiquette)
Regulations 2002 makes it mandatory for registered doctors to participate in CME programs
for 30 hours in every five years. Regulation 1.2.3. is reproduced below:

A physician should participate in professional meetings as part of CME programme,
for at least thirty hours every five years, organised by reputed professional academic
bodies or any authorised organisations. The compliance of this requirement shall be
informed regularly to MCI or State Medical Councils as the case may be.
Following the notification of the above regulation by the MCI, legislations creating State
Medical Councils have been amended, making certificates conferring CME credit hours
mandatory for renewal of practitioners’ registration. For instance, Section 19 of Karnataka
Medical Registration Act, 1961 was amended in 2003, making it mandatory to put in at least
30 credit hours in CME for every five years in order for a registered practitioner to be eligible
for re-registration.

Such requirement for re-registration is presently practised by 9 out of 26 State Medical
Councils in India, namely:

1. Goa
2. Kerala
3. Karnataka
4. Maharashtra
5. Rajasthan
6. Tamil Nadu
7. Uttar Pradesh
8. Gujarat
9. Punjab2

4. ACCREDITATION FOR OFFERING CME PROGRAMS

In order to obtain CME credit hours, the program offered should be accredited by the
respective State Medical Council. Applications for accreditation are normally entertained
from the following organisations:


2 Swaptagni Das, Manan Shah, Amey Mane, Et Al. Accreditation in India: Pathways & Mechanisms, J EUR
CME. 2018: (7): 1454251.

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1. All recognised Medical Colleges

2. Indian Medical Association- State & District chapters

3. National Academy of Medical Sciences

4. Specialists’ Associations (National level or State Chapters)

5. All recognised Post Graduate Medical Institutions

6. Central & State Government Hospitals, District Hospitals, training centres in

Department of Health & Family Welfare, Defence and Railways

7. International Conference of Professional bodies

8. National conference of Professional bodies

9. State level conference of National Organisations

10. Professional bodies of repute functioning at District, City, State level in their

respective areas of specialities. 3

The Karnataka Medical Council has clearly specified that the following programmes shall not
be considered as CME:

1. CME organised by drug/ medical equipment company for the purpose of promotion of
drug/ medical equipment.

2. CME hosted by private nursing homes/ hospitals/ individuals for the purpose of
branding/ marketing

3. CME for self promotion/ advertisement. 4

5. PROCEDURE FOLLOWED FOR ACCREDITATION OF CME PROGRAMS

As of now, the State Medical Councils (SMC) decide to accredit programs and award credit
hours depending on the quality of the subject matter, and the status and credibility of the
speaker. Guidelines in this regard are framed by respective SMC.

The office bearers of the organization planning to provide the CME are expected to apply for
accreditation to their respective SMC.

Besides, the topic and duration of presentation, the complete schedule and transcripts of the
event, including faculty names, designations, qualifications and their country of residence,


3 Website of the Karnataka Medical Council: http://www.karnatakamedicalcouncil.com/News.aspx.

4 Ibid.

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are to accompany the application. Credit hours shall be determined on the basis of
composition of faculty, content of the program and participants’ feedback.

Accredited professional bodies, such as the Indian Medical Association, which arrange CME
programmes regularly, have to inform the SMC of the date and time of the event in advance,
so that the SMC can assign an observer.

Upon validation of the organization and event credentials, the SMC issues a certificate of
accreditation. The providing organization has to make prior arrangements for publicity to
reach out to the target group of participants/delegates. It must not award certificates to the
attending participants/delegates until the last day, i.e. after completion of the CME
programme. Also, it has to ensure that the list of delegates and their feedback are sent to the
accrediting SMC. A distinct list of delegates belonging to the various SMCs should be sub-
mitted to the accrediting SMC.

6. AWARD OF CME CREDITS

In India, didactic live lectures are the primary and generally accepted mode of accredited
CME. Apart from live lectures, publication of medical text books or chapters in textbooks
and/or research articles in national/ international indexed journals are the other modes of
accumulating CME credits by doctors. Different SMCs in India showed highly varying
criteria for CME credit hours; e.g. Chhattisgarh Medical Council5, Madhya Pradesh Medical
Council6 and Himachal Pradesh Medical Council7 award two credit hours for a half- day event
as compared with one credit hour by the Tamil Nadu Medical Council8. Noting the lack of
parity in award of credit hours, the Medical Council of India issued the following guidelines
for award of credits on 29/08/2013:

For a conference/ workshop of accredited CME programme of minimum 8 hours duration per
day:

3 credit hours/ day/ speaker


5 Chhattisgarh Medical Council. Rules for Continuing Medical Education (CME),
http://www.cgmedicalcouncil.org/pdf/rules_cme.pdf .
6 Madhya Pradesh Medical Council. CME guideline. Rules for Continuing Medical Education (CME),
http://www. mpmedicalcouncil.net/CME%20Guide%20Line% 202011.pdf.
7 Himachal Pradesh Medical Council. Guidelines for CME accreditation,
http://hpsmc.org/cme%20guidlines.pdf.
8 Tamil Nadu Medical Council. Guidelines for CME programme for getting accreditation,

http://www.tnmedicalcouncil.org/cmeguid line.pdf.

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2 credit hours/ day/ participant

Any conference/ workshop of duration less than 4 hours shall not be considered for CME
accreditation.

For published medical text book/ chapter of medical textbook/ research papers in national and
international indexed journals, the following credits are awarded:

Publication of Medical Text CME Credit

book 4
1st Author

Co- Author(s) 2

Publication of Chapter in CME Credit

Medical Text book

1st Author 2

Co-Author(s) 1

Publication of research CME Credit

articles in journals

1st Author 2

Co-Author(s) 1

Different SMCs award variable credit points for conducting a CME
programme/workshop/conference, publication of medical textbooks or papers, and for
attending/presenting at conferences. Other criteria for awarding CME credit points include
subscription to journals, postgraduate courses for doctors, guest lectures, attendance at a
guest lecture by foreign faculty, and online module certification.

7. MODE OF CME

In India, usually the Continuing Education programme is implemented through:

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1. Seminars/Symposium

2. Workshops

3. Short-term courses (online- audio/video)

4. Educational Programmes which are carried out for the development of Human

Resource for Health like Scientists Exchange Programme and Training of Junior

Medical Scientists etc.

These programmes are administered through the Zonal or State branches of National
Academy of Medical Sciences (NAMS), Zonal conveners/State Liaison Officers, medical
institutions as well as national professional associations. A committee named ‘CME
Programme Committee’ has been set up to guide and monitor the progress made through such
CME programmes on a regular basis.

That apart, all medical teachers in MCI recognised institutions and national institutions where
teaching programmes are undertaken will get 4 credit hours per year. All doctors undergoing
post graduate courses from recognised/ reputed institutions in India or abroad are awarded 4
credit hours per year during the duration of the course.

8. GUIDELINES FOR CME SCHEME IN INDIA AND
PROCEDURAL FORMALITIES

On the basis of the meetings held during 1983 and 1987, following recommendations relating
to CME were made9-

v Making Continuing Education compulsory for all medical and health professionals

v Each medical professional society must develop appropriate CME Programmes and

establish a Committee/ Cell for the same

v The societies should develop programmes in multi-disciplinary manner and it should

be problem based

v Each society must give significance to various national health programmes

v The National Academy of Medical Sciences (NAMS) should be the national co-
ordinating body for CME10


9 National Academy of Medical Sciences (India), http://www.nams-india.in/webpages/cmeguide.html accessed
16 October 2018.
10 Government of India, Ministry of Health and Family Welfare recognized National Academy of Medical
Sciences as the Co-ordinating nodal agency for Continuing Medical Education programmes for both
professionals as well as paraprofessionals.

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v CME and health education should be recognized as an important component of health
sciences which must be consistent with the objectives of the National Health Policy

The Central Government, after consulting the Ministry of Health & Family Welfare had
decided in 1985 to take help of the services of Indian Physicians settled in USA in CME and
Patient Care in India. Thus, two Scheme were planned namely Continuing Medical Education
Scheme and Equipment Donation Scheme.11

The Medical Council of India was named the nodal agency for collaborating these Schemes
and a CME cell was set up in the Council office in December, 1985 for the said purposes. In
1993, it was decided by the Central Government that Indian doctors from UK and Canada
should also be involved in the process of CME in India by collaborating with the Association
of Indian doctors in USA, UK and Canada.12 During 1985-86, the initial number of 4 CME
programmes were held which have now increased to 100 to 150 programmes per year. The
topics on which programmes are to be held are finalised by respective Medical Councils and
it depends upon the request of such programmes and the availability of faculties for the topic.

On completion of the CME programme, a brief summary/report (both hard copy as well as
soft copy) along with the list of delegates and their registration numbers is to be sent to the
SMC.

§ Responsibility of the Hosting Institutions13
v Finalise the dates and broad topics for the programmes after consulting with
the faculty
v Make necessary arrangements for the programme
v Send invitations to Indian faculty members and others officials
v Make arrangements for the stay of the NRI/foreign /Indian faculty and their
internal travel
v Send the finalised brochure of CME programme to the Council for the purpose
of distributing it to all medical institutions at least 3 months prior to the
scheduled date of the programme.


11 Guidelines for CME Scheme, Medical Council of India,
https://www.mciindia.org/ActivitiWebClient/aboutus/guidelinesforCMEScheme, accessed on 10 July 2018.
12 Ibid.
13 Ibid.

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v After the programme is held, a detailed report of the programme to be sent to
the Council along with suggestions

v Publish the programme proceedings and distribute copies to all medical
institutions in India and to the Medical Council

v For reimbursing the expenses towards hospitality of the visiting foreign
faculty and publication of programme proceedings, send bills for the same

§ Responsibility of the Foreign Faculty14

v Bear their own travel expenses from USA/UK/Canada to India and back

v Identify maximum five faculty members with experience in the corresponding
discipline to participate in the programme

v For assessment, complete list of the visiting faculty members with their
Curriculum Vitae to be sent to the Council

v Finalizing the dates and topic of the programme after consulting with the local
faculty leader

v Send the report regarding the programme, including their suggestions if any

§ Responsibilities of the Council15

v Selecting of topics and venues for the programmes

v Resolving of issues arising between the institution and the faculty, if any

v Sending official invitations to the foreign faculty

v Announcements to various medical Institutions

v Collecting the detailed report of the programmes from the institution hosting
CME programme

v Issuing certificates of participation to the visiting foreign faculty

§ Financial Assistance16

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14 Ibid.
15 Ibid.

The Council can provide financial assistance of maximum of 1 lakh INR to the
hosting institution to accommodate his boarding, lodging and internal travel expenses
and for publication of programme proceedings when an NRI faculty from
USA/UK/Canada participates.

Although, if the institution is requesting financial assistance only for publication of
programme proceedings and not for accommodating any NRI faculty, then the
Council can provide only a maximum of 40,000 INR. However, the participation of
NRI faculty from USA/UK/Canada is essential, for availing the said financial
assistance.

§ Procedure for submission of requests

The application for requesting financial assistance to conduct CME Programmes can
be obtained from the Office of the Secretary, NAMS or can be downloaded online.

Completed application forms must be submitted three months in advance of the
proposed scientific activity and it should be accompanied by the following
documents:

v Objectives of CME programme
v List of faculty speakers with addresses
v Detailed scientific programme of minimum 8 hours of CME activity
v A questionnaire designed to evaluate the immediate results of the CME

programme
v Estimate of expenditure
v Section II D to clearly indicate that the Scientific Report, audited income and

expenditure statement and Utilization Certificate will be sent to the Academy
within one month of conduct of CME programme.

The application must be forwarded through the Convener of the concerned Zone and
should carry the official stamp of the Organising Secretary and Head of the
Institution. The proposal is technically reviewed by a Fellow who is a subject expert.
Any modifications or alterations suggested are to be incorporated in the revised
proposal.



16 Ibid.

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A stamped receipt in advance may be sent to enable the Academy to send a crossed
cheque for the first instalment of the grant in time. The grant will be utilised for the
purpose for which it is sanctioned.

§ Additional requirements17
v The programme should promote learning in important areas related to
medicine and basic sciences through practical demonstrations, workshops or
lectures and seminars.
v Registration of applicants other than post-graduate students should be
encouraged.
v The organizers of the CME Programmes are required to raise funds through
local resources to the extent of at least 15-20% of the estimated expenditure.
v All announcements made in connection with the programme should highlight
the sponsorship of the National Academy of Medical Sciences for the CME
programmes. Copies of all announcements, invitations, etc. should be sent to
the Academy.
v If the grant or any part thereof is proposed to be utilized for purpose other than
for which it is sanctioned, prior approval of the Academy shall be obtained
which may be given only in exceptional circumstances on very special
grounds.
v In case the grant is not utilized for the purpose for which it is sanctioned by
the scheduled date of the programme, the grantee shall refund the unspent
amount of the grant forthwith, unless prior approval of the Academy has been
obtained for the same.
v Within one month after the completion of the CME Programme, a detailed
Scientific Report should be submitted in duplicate to the Academy.

While compiling the scientific reports, it should be ensured that a brief synopsis of the
subjects covered in the workshop/seminar is given. It should not be merely the
reproduction of the detailed programme, which has already been submitted by the
organizer along with the application. Further, whichever topic has been dealt with, it
should be briefly described e.g. if it is a lecture on some topic, a brief synopsis of the


17 Ibid.

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lecture should be given. Similarly, if it is a practical/clinical demonstration, then a
brief description of the technique used to demonstrate a particular disease/function
along with the result be given. All attempts should be made to frame the report in such
a way that a subsequent reference on a particular subject can be facilitated and may
serve as guideline in future.18

9. CME THROUGH E-LEARNING IN INDIA

The Maharashtra Medical Council has produced an extensive policy document for seeking
accreditation. In addition to accrediting live events and courses, the MC of Maharashtra also
provides accreditation for free online medical education (e-learning). However, the
Maharashtra Medical Council is one of the very few state MCs which offers the service for e-
learning.

Few online platforms in India that digitally provide medical educational courses and
individual lectures to help medical practitioners as well as aspirants and paramedic staff to
continue their education on distant learning mode are Medvarsity and Omnicuris.

These online education platforms provide full-fledged courses as well individual lectures,
which are prepared by senior medical professionals and healthcare experts in specific fields.
These platforms combine the training methods where online lectures are provided along with
internships in the hospitals.

§ Can E-learning Replace Traditional Methods?19

Traditional medical education like print-based materials and live events such as
conferences and symposia are popular forms of education. Although, e-learning has
become an increasingly popular form of education and many medical organizations in
the United States and Europe now recognize and accredit this format.

Studies have shown that e-learning is as, or more, effective than traditional learning
methods, it cannot replace face-to-face or peer-to-peer learning, and the healthcare
professionals must also learn through direct patient contact and consultation.

family Physicians’,
18 Ibid.
19 Chayan Datta, ‘The rise of e-learning and the opportunities for Indian
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3893955/ accessed on 10 July 2018.

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Therefore, e-learning complements rather than replaces other forms of education and
provides an additional choice for healthcare professionals. It should be borne in mind
that not everyone likes or can attend a conference and some professionals probably
prefer print to electronic formats. Effective CME programmes should be based around
“blended learning” where the healthcare professionals can participate in a variety of
formats.

§ The Rise of E-learning in CME20

The availability of e-learning and its acceptance among healthcare professionals can
be explained easily while addressing recent technological advances. More people own
personal computers and they are extensively used in healthcare within developed
countries. Newly qualified healthcare professionals of the new Internet generation
have grown up in a technological environment and they are comfortable with
electronic forms of education and communication. E-learning has a “just-in-time”
advantage over traditional forms of education. Medical professionals may choose the
time and place to undertake their education and react to changes within their day-to-
day medical practice, so not much waste of time as the programmes are time-flexible.
E-learning also offers customized learning packages which allow the individual to
tailor their learning. Most importantly, e-learning provides an effective mechanism for
an outcomes-based approach to learning where an individual may report the results of
their learning, and the quality and effectiveness of the learning programmes can be
assessed.

§ Access for Healthcare Professionals in India21

Any healthcare professional in India may use the website myCME.com by completing
a simple registration process. This once-only, free registration gives various
advantages to the medical practitioner like-

v It contains every exam in the database.
v Access to information produced by, or in partnership with, internationally

renowned academic institutions such as Johns Hopkins University, Boston
University and Albert Einstein University.

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20 Ibid.

21 https://www.mycme.com/.

v Option to sign up for email editorial updates.

v An “Exam History” page which allows the user to track what they have

learned.

Exams are assigned a number of recommended credits and learning hours. Within the
UK, the RCGP states that one credit is equivalent to 1 hour of learning. For healthcare
professionals within India, the number of credits and learning hours on myCME.com
can be used as a guide for the amount of time they may spend interacting with the
exam portal. The number of exams taken should be limited only by the individual's
needs and desire to learn, not by reaching a set target of credits.

Every exam follows a similar structure with an overview page, the materials, a
multiple choice test based on the materials and a post-test evaluation. Importantly,
every successful exam is awarded a certificate of learning, which outlines the number
of credits and the date of participation.

10. CREDIT HOURS

The Medical Council of India awards credit hours for continued medical education (CME). A
minimum of 150 credit hours per 5 years is required to renew medical registration.22 Various
state medical councils are also coming up with the guidelines for credit hours. For example,
the AP Medical Council has come up with a regulation of earning minimum 30 credit hours
per 5 years for renewal of registration23.

§ Advantages

The concept of credit hours being implemented in India has the following advantages
for the profession and medical professionals as well-

v Since the Continuing Medical Education meets are recognised by Medical

Council, the doctors get credits for the meets they attend

v The whole event is supervised by an observer from medical council

v Quantification of scientific work done by doctors is possible


22 Anupama Sukhlecha, Continued medical education credit hours: Are they being awarded too liberally?,
NCBI, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3669584/.
23 Sulogna Mehta, Now 30 CME credit hours must for docs' registration renewal, TOI,
https://timesofindia.indiatimes.com/city/visakhapatnam/Now-30-CME-credit-hours-must-for-docs-registration-
renewal/articleshow/51819548.cms.



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v Researchers get points for presentations and publications
v There involves credit in teaching too
v Organizers and resource persons of scientific meets are also given credits
v Subscription to journals published by medical societies also gives credit
v It will encourage a scientific culture in the nation

§ Disadvantages

The concept of credit hours being associated with CME has been introduced in our
country very recently. However, it has not been welcomed warmly from the very
beginning due to number of issues like-

v There is lack of proper system in place
v Most doctors oppose the initiative stating that there is no mandatory CME for

other professionals like lawyers and engineers then why for medical practitioners
v In the era of internet when all information is available at the click of a button,

why would a busy practitioners waste his time and money to attend conferences
v Some doctors also believe that nothing extra would be learnt by just sitting in a

dark room with slide presentations
v Credit is not given to interactions or active involvement in scientific meets
v All publications get equal credits overlooking the impact factor of journals
v All teachers get equal credit points overlooking the quality and quantity of classes

taken

11. LOOPHOLES

According to a WHO’s study, Promoting Rational Use of Medicines in 2002, Continuing
Medical Education opportunities are limited in developing countries like India when
compared to the developed countries like United States. The studies state that the reason for
the same could be lack of legal or other incentives. However, the Medical Council of India
MCI has made it mandatory for doctors to complete 30 hours of CME every five years in
order to renew their license through CME by attending workshops and seminars, which are
organised by various healthcare institutions in India.

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The major challenge in the field of CME is that Medical Council of India does not recognize
online medical education content.24 So, if a medical practitioner did a course on
endocrinology, he cannot practise as an endocrinologist but can assist a diabetes doctor.
There is critical difference between formal educations that the MCI governs versus what we
provide as an add-on education support.

Informal evidences suggest that access to high quality CME is difficult for most healthcare
professionals in India and the need to attend regional conferences and courses can be
problematic. Access to e-learning and other forms of distance-learning are best suited to offer
considerable opportunities for many healthcare professionals.

Also the provision of good quality education is very well achievable, but maintaining a
vigorous mandatory CME system requires significant changes and investment to be made at
national and local levels. Developing a consistent policy for accreditation of traditional CME
and e-learning will enable a greater availability of good quality education and allow mutual
recognition of CME credits between states in India.

12. CME in disciplinary proceedings against Doctors

Medical negligence complaints against doctors are increasing on a daily basis. India’s doctor
to population ratio stands at .62:1000 which is way below the WHO standard of 1:1000. For
reference, the doctor population ratio in Germany stands at 4.125, Australia at 3.374, France
at 3.227, Russia at 3.306 & US at 2.554. Brazil & China are at 1.8 &1.49 respectively. Even
Pakistan has a better doctor population ratio at .806 as compared to India.25

Under these circumstances, harsh disciplinary action of directing removal of names from the
Register or suspension from the rolls of the Council on account of medical negligence would
have a negative social impact. The General Medical Council of UK, suggests that remedial
action taken by a doctor on facing concerns about his professional performance can be one of


24 Priyanka V Gupta, ‘Online Medical Institution gaining momentum in India’, ETHealthWorld (25 July 2017),
nhttps://health.economictimes.indiatimes.com/news/hospitals/online-medical-education-gaining-momentum-in-

india/59738564.

25 https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/less-than-one-doctor-for-1000-
population-in-india-government-to-lok-sabha/articleshow/59697608.cms.

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the factors that can be taken into account for deciding whether his fitness to practice is
impaired.26
It is in this context, that the author feels that the Councils deciding disciplinary proceedings
against doctors may also consider doctors found to be negligent in their area of specialisation
to undergo CME training of specified hours depending on the extent of their negligence. Such
directives cannot be made in isolation, but should be made in conjunction with Council’s
statutory power to reprimand a medical professional or to suspend his licence. Such
directions would vastly improve the standard of patient care and thus serve the object of
disciplinary proceedings.


26 Para 38, Sanctions guidance, General Medical Council; Medical Practitioners Tribunal Service.

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