Professional behaviour and fitness to practise

Considering health and disability issues

  1. In most cases, health conditions and disabilities do not affect a medical student’s fitness to practise, as long as the student:
    • demonstrates appropriate insight
    • seeks appropriate medical advice
    • complies with treatment.
  2. Medical schools must make adjustments, where possible, to allow a student to fulfil the core competencies of their course and enable them to study and work safely in a clinical environment.*
  3. All students should register with a local general practitioner (GP), who will be able to offer them independent support and continuity of care while they are at medical school. Educational supervisors, who are involved in teaching a student, should not also be involved in providing their healthcare or occupational health assessments.
  4. A GP or medical doctor who treats a student should not also be involved in occupational health assessments of fitness to practise, because this is a conflict of interest with their role as a therapeutic advocate. Similarly, occupational physicians are contractually obliged to give independent assessments of fitness to practise, so can’t also provide medical treatment services.
  5. Students with health conditions – in particular, those with mental health conditions – are often identified as having problems because they display unprofessional behaviour that is out of character, such as poor attendance or failure to engage with their studies. Medical schools should give their staff training to help them identify, at an early stage, students whose behaviour indicates an underlying health issue.
  6. Medical schools can use low-level concerns processes to identify and support students with health conditions. They can also use their fitness to practise procedures where making adjustments and providing support have been tried without success. The fitness to practise process can help students by making sure they access the support that will enable them to complete their course.
  7. When a student has a medical problem, it’s important to consider their fitness to study – whether they are well enough to participate and engage in their programme. The Higher Education Occupational Physicians group publishes fitness to train standards for medical students on its website.

Referring a student to occupational health

  1. Medical schools should refer students who have been diagnosed with a medical condition to the university’s occupational health provider so they can get an appropriate assessment. If it would be helpful and the student consents to it, the student’s treating specialist can give the medical school their opinion on whether the student should remain on the course. This advice is likely to be along the lines of one of the following.

    Medically fit to remain on the course

    This may include recommendations about any reasonable adjustments (following consultation with the disability support office) and may also suggest the option of regular reviews through the occupational health service.

    The need for an interruption from the course

    This is usually recommended where a student needs to take time out to access appropriate treatment or if they need a period of stability. Any return to the course should be dependent upon a further review through the occupational health service to confirm the student’s medical fitness. If the medical school does not consider such a review appropriate, they should give a clear, documented explanation as to why.

    Referral to an independent specialist for further advice

    This may be recommended by an occupational health physician in a limited number of complex cases (often involving mental health conditions). Such a referral would be made with the student’s informed consent. The independent specialist will produce a report, which they will send to the occupational health service. The occupational health service will discuss the report with the student, before sending further information and advice to the medical school.

  2. Students should be able to self-refer to the occupational health service if they have concerns that a medical condition may affect their academic performance or fitness to practise. The occupational health service should reassure the student that any information it receives during such a consultation is confidential and will only be shared with the student’s informed consent, unless the occupational health practitioner considers that the student is a potential risk to others or themselves. The occupational health service should encourage the student to consent to share their occupational health report with their medical school.
  3. Following an occupational health assessment, any subsequent report from the occupational health service should address:
    • the issue of the student’s medical fitness to study or practise
    • any necessary adjustments or support needed
    • the need for reviews
    • any expectations of the student – for example, compliance with medication.
  4. The treating doctor has the same duty of confidentiality to students as to any patient.** If the student doesn’t consent to the disclosure of information about them, the doctor can only disclose it if either it is required by law or they judge disclosure to be in the public interest.
  5. In some cases, the occupational health physician may ask the student to give consent for the disclosure of medical information to let them provide appropriate care and ongoing support. For example, if a student returns to their course after a period of ill health, it may be helpful for the student, the disability support office, the occupational health physician and the treating specialist to discuss what steps they might take to minimise future problems.
  6. In some cases, medical schools may need to monitor the extent to which a student is complying with a treatment programme to make sure they are fit to study or practise. The occupational health service is in an ideal position to do this, in consultation with the treating specialist.

Making adjustments to accommodate a student's needs

  1. Medical schools must make reasonable adjustments for students with a disability to allow them to achieve the outcomes for graduates required by the GMC. Although adjustments can’t be made to the outcomes themselves, reasonable adjustments can be made to learning and assessment methods. In all cases, any reasonable adjustments should be subject to regular review. You can find further information in the GMC’s guidance, Welcomed and valued.
  2. If a student is receiving ongoing support for a health condition, it may be appropriate to arrange their placements in locations where they can receive continuity of care with the same healthcare professionals.
  3. Medical schools should make clear to students that in some circumstances equivalent adjustments might not be available when they enter postgraduate education. Medical schools may find it helpful to ask local postgraduate education providers what reasonable adjustments they are able to make. This will help medical schools to give students better information about what reasonable adjustments may be realistic in the workplace, which will help students to make informed decisions about their progression through medical education.
  4. In rare circumstances, a chronic or progressive health condition may mean it isn’t possible for a student to meet all the outcomes required by the GMC for graduation. Also, in a small number of cases, a health condition may mean a student’s fitness to practise is impaired.
  5. If a student can’t demonstrate the necessary competencies and all options for support and adjustments have been explored without success, it may be necessary to begin formal fitness to practise procedures. Medical schools must continue to support students throughout this process.

* You can find more detail on how medical schools can make reasonable adjustments, as well as examples of adjustments other medical schools have made, in our Welcomed and valued guidance. 

** For more information, see the GMC’s guidance Confidentiality, available at www.gmc-uk.org/confidentiality.