Fitness to Practise
A medical student’s fitness to practise is judged by the same standards as those applied to registered doctors. As such, medical schools follow guidance and advice published by the General Medical Council (GMC) when considering medical students’ fitness to practise.
In accordance with GMC guidance, medical schools will not graduate students where fitness to practise concerns have been raised or are under consideration. Therefore, medical schools must have considered all fitness to practise concerns and reached a determination on them before they allow a student to graduate. By graduating a student with a recognised primary medical qualification, the medical school is declaring them fit to practise as a doctor.
The above is particularly important for final year medical students because, fitness to practise concerns raised about a student in the final year of study, might mean there may not be sufficient time to resolve the issue. GMC guidance makes it clear that it may be necessary to require a student to repeat all or part of a year, if appropriate.
What is fitness to practise for medical students?
In relation to a doctor’s fitness to practise, therefore also medical students, the GMC states:
To practise safely, doctors must be competent in what they do. They must establish and maintain effective relationships with patients, respect patients’ autonomy and act responsibly and appropriately if they or a colleague fall ill and their performance suffers.
But these attributes, while essential, are not enough. Doctors have a respected position in society and their work gives them privileged access to patients, some of whom may be very vulnerable. A doctor whose conduct has shown that they cannot justify the trust placed in them should not continue in unrestricted practice while that remains the case.
A medical student’s fitness to practise may be impaired by reason of:
- deficient professional performance
- a conviction or caution in the British Isles (or a conviction elsewhere for an offence which would be a criminal offence if committed in England or Wales)
- adverse physical or mental health
- not having the necessary knowledge of English
- a determination (decision) by a regulatory body responsible for regulation of a health or social care profession, either in the UK or overseas, to the effect that their fitness to practise as a member of the profession is impaired
Risk to patients, public or bringing the profession into disrepute
If a medical student’s behaviour suggests they may be a risk to patients or the public, or may bring the profession into disrepute, the school or university will launch a formal investigation.
If there is sufficient evidence to call into question a medical student’s fitness to practise, the school or university can deal with the issue without the need for a fitness to practise committee. For example, a warning, educational remediation, educational agreement or offer an undertaking might be more appropriate.
The outcomes of an investigation could also refer the case to a fitness to practise panel or committee.
Fitness to practise committee
The role of the fitness to practise committee is to make a decision on a student’s fitness to practise, based on the evidence of the investigation.
The committee or panel can find that:
- the student has sufficiently addressed any concerns relating to health or conduct and poses no risk to patients or the public, nor any risk to undermining the public’s trust in the medical profession;
- the student’s fitness to practise is not impaired, but the committee may issue the student with a warning if their behaviour has significantly departed from expected standards; or
- the student’s fitness to practise is impaired, in which case the committee will need to consider any mitigating or aggravating factors when deciding an appropriate outcome or sanction.
If the student’s fitness to practise is impaired the committee can:
- agree undertakings
- apply conditions
- suspend the student from the medical course
- expel the student from the medical course
It is a well established fact that legal representation can significantly improve positive outcomes in fitness to practise cases. This is particularly important for medical students because training providers must report the outcome of fitness to practise hearings to the GMC once a hearing has concluded. In addition, there is a duty on medical students to disclose any relevant outcomes to the GMC on application to begin registration. The GMC will use this information to assess an individual’s fitness to join the register.
Clearly, in relation to the above, a finding of impaired fitness to practise could have a lasting and significant implications for students and trainees.
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A brief overview of the Health and Care Professions Council’s fitness to practise investigation process and your opportunities to respond.