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The threshold of student fitness to practise

  1. 79. In deciding whether to refer students to fitness to practise procedures, medical schools should consider how a student’s behaviour or health might affect patient and public safety, or the public’s trust in the medical profession. Investigators and panellists must consider, on a case-by-case basis, whether a student’s behaviour or health has crossed the fitness to practise threshold.
  2. 80. The following questions can help when considering this threshold. Medical schools should be mindful that this advice is only illustrative of the sort of concerns about behaviour or health that could call a student’s fitness to practise into question and the outcome in all cases will depend on the particular circumstances.

Question 1: Deviation in behaviour

Has a student’s behaviour deviated from the guidance set out in Achieving good medical practice: guidance for medical students or a medical school’s own code of conduct? And might it, as a result, have harmed patients or put patients, colleagues or themselves at risk of harm?

An incident or a series of incidents that cause concerns to personal tutors and academic or clinical supervisors can be evidence of harm or risk of harm. A series of incidents can suggest persistent failings that are not being, or cannot be, safely managed through pastoral care or student support. For example, a persistent failure to engage with studies, follow instructions and heed educational advice.

Question 2: Disregard for responsibilities

Has a student shown a deliberate or reckless disregard for professional or clinical responsibilities towards patients, teachers or colleagues?

An isolated lapse in conduct, such as a rude outburst, may not itself suggest that the student is not fit to practise. But persistent misconduct, which indicates a lack of integrity on the part of the student, an unwillingness to behave responsibly or ethically, or a serious lack of insight into obvious professional concerns, would bring a student’s fitness to practise into question.

Persistent misconduct, such as being disruptive in teaching sessions, showing challenging behaviour towards clinical teachers, failing to accept criticism and repeatedly not responding to communications, may also be grounds for considering a student has reached the threshold of impairment.

Question 3: Student remains a risk despite support

Have attempts to improve a student’s behaviour or health failed and does the medical school identify a remaining unacceptable risk to patient safety or public confidence in the profession?

If a medical school has tried to give a student support or educational remediation to address some, or all, of the issues that are causing concern, but these measures have failed, it’s likely that the student’s fitness to practise will be called into question. For example, the student may have been given a warning for previous misconduct and been told that a repeat of the behaviour would indicate impairment of fitness to practise and formal proceedings.

Question 4: Abuse of trust or violation of rights

Has a student abused a patient’s trust or violated a patient’s autonomy or other fundamental rights?

Behaviour that shows a student has acted without regard for a patient’s rights or feelings, or has abused their position as a medical student, will usually give rise to questions about fitness to practise. For example, if a student deliberately misleads patients by not displaying their student identity badge to obtain consent to carry out an examination.

Question 5: Dishonest or fraudulent behaviour

Has a student behaved dishonestly, fraudulently or in a way designed to mislead or harm others?

Deliberate dishonesty or fraudulent behaviour will call into question a student’s fitness to practise, especially if there is a pattern of this kind of behaviour. Examples may include plagiarism, cheating, dishonesty in reports and logbooks or forging the signature of a supervisor.

Question 6: Behaviour that undermines public confidence

Might the student’s behaviour undermine public confidence in doctors generally if the medical school did not take action?

The medical school should take action if a student’s behaviour might undermine trust in the medical profession.

The principle of public trust in the profession applies to doctors: patients must be able to trust doctors with their lives and health, so doctors must make sure that their conduct justifies their patients’ trust in them and the public’s trust in the profession (Good medical practice, paragraph 65).

Students are training to join the profession and therefore the same principle applies. In relation to students some factors medical schools could consider might include, for example:

  • misuse of social media
  • receiving a criminal caution or conviction
  • failing to comply with the regulations of the medical school, university, hospital or other organisation
  • dishonest and fraudulent behaviour.

Question 7: Student health or disability compromises patient safety

Is a student’s health or disability compromising patient safety?

Medical schools don’t need to start fitness to practise procedures just because a student is ill, even if the illness is serious. But they might need to if the student is not following medical advice to minimise the risk to themselves and colleagues. Or if the student does not have insight into the impact of their condition and how it might compromise patient safety.