Achieving good medical practice: guidance for medical students

Annex: Professionalism and fitness to practise processes in medical schools and universities

Health concerns and insight or management of these concerns

  • Failure to seek appropriate treatment or advice from an independent and appropriately qualified healthcare professional
  • Failure to follow the requirement to tell your medical school or university if you have a serious health condition
  • Refusal to follow medical advice or care plans, or to comply with arrangements for monitoring and reviews
  • Failure to comply with reasonable adjustments to ensure patient safety
  • Failure to recognise limits and abilities or lack of insight into health concerns
  • Failure to be immunised against common serious communicable diseases (unless contraindicated)

You can read Professional behaviour and fitness to practise: guidance for medical schools and their students.

  1. This annex sets out basic information on fitness to practise processes in medical schools and universities. You can find more information in our guidance, Professional behaviour and fitness to practise: guidance for medical schools and their students.
  2. Medical schools have a duty to graduate with a primary medical qualification only those students who are fit to practise medicine. This requirement is set by the GMC, which is responsible for the quality assurance of all medical education and training in the UK. Because of this requirement, your medical school will have ways to monitor students' behaviour and have a fitness to practise or professionalism process to deal with students who display unprofessional behaviour.
  3. We provide high-level guidance to medical schools on running these processes, but the processes themselves do vary between medical schools. This is because each medical school is unique in its size and structure and because of other factors, such as its relationship to its parent university. However, we have set out a broad framework for schools to follow.

Monitoring low-level concerns

  1. Low-level concerns are things like missing teaching sessions, failing to hand in work on time or failing to respond to communications from the medical school. Medical schools will monitor the behaviour of their students in relation to these types of concern. One instance of this type of behaviour may not be enough to trigger a fitness to practise process - but if a student persistently exhibits these types of behaviour, the medical school will want to look at the concerns in more detail.
  2. Some medical schools have a committee to look at instances of this type of behaviour, while in other schools an individual may be responsible for this process. This is an opportunity to discuss with the student why they have acted in this way and to identify any underlying issues that indicate the student needs additional support, such as a health issue.
  3. These committees will also be able to advise students about the steps they need to take to avoid getting into further trouble in relation to their professional performance and can support students to help them do this.
  4. These committees can sometimes issue a warning to say that a student must improve their behaviour or face further action.

A formal fitness to practise investigation

  1. If a student does something more seriously unprofessional or exhibits persistent low-level unprofessional behaviour, including in relation to the management of their health, this could potentially mean their fitness to practise medicine is impaired. Their medical school will begin a process to investigate this behaviour. The investigation may conclude with no further action, a warning or referral to a fitness to practise panel or committee.

What is a fitness to practise panel or committee?

  1. A fitness to practise panel or committee is an impartial group of individuals that considers whether a student is fit to practise for the purposes of continuing their studies or for the purposes of graduation. Medical schools prepare evidence for the panel or committee to consider - students can also submit any evidence they feel is relevant.
  2. The medical school and student then present their evidence to the panel or committee, which makes a decision based on it. A panel or committee will seek to establish the facts of the case - they make their decision based on the balance of probabilities that the alleged incident occurred. They will then decide whether the student's fitness to practise medicine is impaired and make a decision on what, if any, sanction should be applied.
  3. The panel or committee will set out its decision in writing and explain the reasons for it. This decision letter will also give the student information on how they can appeal the decision of the panel or committee.

What support will I get during a fitness to practise investigation?

  1. Your medical school and university will support you during fitness to practise investigations and hearings. You can also contact external organisations such as the BMA or a medical defence organisation, which can also provide support and guidance.
  2. You can find further guidance on student fitness to practise procedures in our guidance Professional behaviour and fitness to practise: guidance for medical schools and their students.

Some of the factors fitness to practise panels and committees consider

Patterns of behaviour

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If you keep behaving in an unprofessional way, it can suggest you are not learning from your mistakes and can be evidence of an unprofessional attitude. This may also be considered in relation to your health - for example, if you show a pattern of not asking for help with a medical condition.

Insight

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This means you understand that what you have done is unprofessional and why it is unprofessional. Establishing whether you have insight is one of the key things panels and committees look at. Things like apologising for your behaviour and being open and honest about past mistakes to third parties can help demonstrate insight.

Remediation

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This is the process where you take steps to show you have corrected your behaviour and are now fit to practise. Some examples of remediation might include:

  • writing reflective essays on past unprofessional behaviour
  • engaging with support provided by your medical school
  • being able to demonstrate a significant period of good behaviour
  • engaging with activities such as random drug and alcohol screening that can be used to show a change in behaviour.

Mitigating factors

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These are things that may help to explain the reasons for poor behaviour. For example, you may have experienced bereavement and this might have affected your behaviour. You should note that although mitigating factors might explain your behaviour, they might not necessarily reduce its impact or seriousness.

Aggravating factors

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These are things that make an offence worse. For example, if you repeat behaviour you have previously received a warning for.

Your year of study

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It is expected that you mature while you're at medical school and learn about professionalism as you progress through your course. Therefore, some examples of behaviour could be considered minor misconduct if displayed when you are a new student, but would be taken more seriously if you were about to graduate. In addition, if you are nearing graduation you may not have time to show that you have remediated and this can make it hard for your medical school to allow you to graduate.