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Student fitness to practise - myth busters

These myth busters dispel some common misconceptions about student fitness to practise.

Myth: If I tell my school about a health condition or concern I will be referred to student fitness to practise

This is not true.

Our guidance to medical schools makes it clear that a health condition does NOT mean there is a student fitness to practise concern (paragraph 14). Most students will continue their studies managing their health condition without their fitness to practise ever coming into it.

The only circumstances that might involve student fitness to practise are when a student is not showing insight into their condition, not seeking appropriate medical advice, or not complying with treatment. This becomes a student fitness to practise issue because the safety of the student or others around them, as well as confidence in the profession may be compromised.

See also: Your health - dos and don'ts from our guidance to medical students.

Myth: I shouldn’t tell my medical school about a health concern

This is not true.

We encourage students to tell their medical school if they have a health concern. This is because your school has a lot of mechanisms in place to support you, but they won’t know to do so unless you reach out to them.

Your medical school wants you to excel and will provide support to make sure this is the case. They can support you in lots of ways, for example:

  • use of their services: student support, university health services, occupational health, disability support, confidential counselling services.
  • putting adjustments in place for your studies or clinical placements. These include giving you helpful equipment, making changes to the facilities, and changes to the school’s provisions (e.g. extra time for assessments, enlarged writing, and placements in nearby locations).

Not only does telling your medical school about your health mean that your school can support you, it also shows you have insight into your condition and are being open and honest about your health.

See also: examples of reasonable adjustments in our guidance Gateways to the professions.

See also: our guidance for medical schools about Supporting medical students with mental health conditions.

Myth: If I do anything wrong, the school will call a student fitness to practise panel

This is not true.

Many concerns won’t cross the threshold for your school to initiate student fitness to practise procedures. This is defined in our guidance to medical schools, but in short your actions have to be serious enough for there to be concerns about patient safety or trust in the profession. If the concerns don’t cross that threshold, your school will manage them outside student fitness to practise proceedings. Some schools have a health and conduct committee, which sits below the fitness to practise process, to manage concerns that don’t cross that threshold. This lower level process is essentially supportive in nature.

Even if formal student fitness to practise procedures are initiated, your school has to complete an investigation first, where they decide whether referring you to a student fitness to practise panel is the best course of action. The investigators will only refer you if they think your fitness to practise might be impaired.

Investigations often end with no action, a warning, or an agreement with the student (‘undertaking’) and don’t reach a panel. In the 2015/16 academic year, more than two thirds of student fitness to practise investigations closed without reaching a panel.

If you are referred to a student fitness to practise panel, the panel will consider all the facts to decide what is an appropriate and proportionate action based on the concerns. Expulsion is an extremely rare outcome, only in the most serious circumstances.

See also: Table 2 in our guidance to medical schools for more details on where different outcomes are appropriate.

See also: a map of the full SFTP process (pdf).

Myth: Students often get expelled through student fitness to practise procedures

This is not true.

According to the data we received from medical schools, in 2015/16 there were only 10 cases where a medical student was expelled through formal student fitness to practise procedures.

To put this number into context, this is across 35 UK medical schools and over 40,000 medical students. It only represents 2% of the cases that schools reported as professionalism or student fitness to practise concerns.

This extreme action can only be taken in very serious circumstances, either when it is seen as the only way to protect patients, carers, relatives, colleagues or the public, or where a student’s behaviour is seen to be fundamentally incompatible with continuing on the course or becoming a doctor (paragraphs 143-144).

See also: table 2 in our guidance to medical schools for more details of where different outcomes (including expulsion) are appropriate.

Myth: If I do anything wrong, my school will tell the GMC and it will affect my registration

This is not true.

Medical schools send us information about ongoing and closed student fitness to practise cases and investigations when students are in their final year of study. This information helps our Registration team process the provisional registration applications of final year students who are about to graduate more quickly.

This means when you come to apply, we have the information we need and plenty of time to examine the details of the case. In the overwhelming majority of cases, applications with a declaration about fitness to practise will be granted provisional registration.

In 2016 13% of applications for provisional registration included declarations about fitness to practise issues. Only six applicants (0.08% of all applications) were refused provisional registration.

Medical schools also send us fully anonymised information on ongoing student fitness to practise cases each year. This allows us to see how well our guidance is being implemented and to distinguish any trends across medical schools.

See also: Our question on the fitness to practise declaration to the GMC.

Myth: The GMC makes all decisions about student fitness to practise for medical students

This is not true.

Any concerns about students, including those managed by student fitness to practise panels, are internal matters for the medical schools to manage.

We’ve issued advisory guidance with the Medical Schools Council on student fitness to practise, but it is up to the schools to integrate this into their local processes.

Decisions on student fitness to practise cases are taken by the medical school. Appeals to decisions can be made to the university or to external bodies, but not to us.

Our decision to register a graduate as a doctor is separate from any student fitness to practise decision, and also from the university decision to graduate a medical student.