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Defining the threshold of student fitness to practise
The below paragraphs are abridged from the full version of Medical students: professional values and fitness to practise. The complete guidance on thresholds is provided in the full version which is available on the GMC website or by pdf in the Publications section.
A student’s fitness to practise is called into question when their behaviour or health raises a serious or persistent cause for concern about their ability to continue on a medical course, or to practise as a doctor after graduation. This includes, but is not limited to, the possibility that they could put patients or the public at risk, and the need to maintain trust in the profession.
When considering the threshold, investigators and panellists at medical schools may want to consider the following questions:
Has a student’s behaviour harmed patients or put patients at risk of harm?
Harm or risk of harm may be demonstrated by an incident or a persistent series of incidents that cause concern to personal tutors and academic or clinical supervisors. A series of incidents could indicate persistent failings that are not being, or cannot be, safely managed through pastoral care or student support. Or it may be that care and support have been tried and have failed.
Has a student shown a deliberate or reckless disregard of professional and clinical responsibilities towards patients or colleagues?
An isolated lapse from high standards of conduct – such as a rude outburst – would not in itself suggest that the student’s fitness to ptactise is in question. But the sort of persistent misconduct, whether criminal or not, that indicates a lack of integrity on the part of the studenty, an unwillingness to behave ethically or responsibly, or a serious lack of insight into obvious professional concerns, would bring a student’s fitness to practise into question.
Is a student’s health or impairment compromising patient safety?
A fitness to practise procedure does not need to be initiated solely because a student is ill, even if the illness is serious. However, a student’s fitness to practise is brought into question if it appears that they have a serious medical condition and they do not appear to be following appropriate medical advice as necessary in order to minimise the risk to patients and colleagues.
Although unlikely given reasonable adjustments, an impairment or health condition may make it impossible for a student to meet the outcomes set by the GMC at the point of graduation. In these rare cases, it may be appropriate to consider the student through formal fitness to practise procedures.
Has a student abused a patient’s trust or violated a patient’s autonomy or other fundamental rights?
Conduct that shows that a student has acted without regard for a patient’s rights or feelings, or abused their professional position as a medical student, will usually give rise to questions about fitness to practise.
Has a student behaved dishonestly, fraudulently, or in a way designed to mislead or harm others?
The medical school should take action if a student’s behaviour is such that trust in the medical profession might be undermined. This might include plagiarism, cheating, dishonesty in reports and logbooks, forging the signature of a supervisor, or failing to comply with the regulations of the medical school, university, hospital or other organisation.