Professional behaviour and fitness to practise

How should medical schools deal with low-level professionalism concerns?

Identifying low-level concerns

  1. Medical students must meet all the outcomes for undergraduate medical education, including behaving according to ethical and legal principles. Medical schools are required to have formal processes in place for assessing these requirements. Any system for identifying, raising and monitoring low-level professionalism concerns should work in conjunction with existing systems for assessment.
  2. Students who experience difficulties with their health may display unprofessional behaviour that raises concern. It is important for medical schools to have a system to identify students who display such behaviour, since this may be an early indicator of more-significant misconduct or health issues.
  3. Low-level professionalism concerns may be identified and raised by a number of sources, such as personal tutors, staff on placement or other students (see paragraph 57). For example, some medical schools have a card or points system for flagging unprofessional behaviour and such systems have the advantage that they can also be used to recognise and promote exemplary professional behaviour.
  4. Having a formal process for reporting and monitoring low-level professionalism concerns – such as lateness, not handing in work on time and missing lectures – will allow medical schools to identify any unprofessional behaviour and to address it before it leads to more-significant fitness to practise issues.
  5. It’s important for medical schools to give clear guidance to staff on their process for reporting any concerns about students and to make sure this guidance is clearly available to anyone who may wish to use it.
  6. Medical schools should also tell students how they will identify and monitor unprofessional behaviour, and what its consequences will be. Medical schools should be open and transparent with students and give clear and consistent advice.

Taking action on low-level concerns

  1. There should be clear processes for dealing with and making decisions about persistent low-level concerns. Many medical schools have a group or committee to address persistent low-level concerns and make decisions about whether a student has reached the threshold of their fitness to practise being impaired. In other schools, a senior staff member, such as the dean or year tutor, is responsible for doing this.
  2. Whatever method medical schools use, they should define a set of rules governing how the process will be handled and make these available for students.
  3. It is not practical to define a particular number of low-level concerns that mean a student’s behaviour has reached the threshold for a referral to fitness to practise procedures. Medical schools must consider students’ behaviour on a case-by-case basis. Medical schools must be consistent in their assessment of whether a student has reached the threshold for referral to fitness to practise procedures, taking into consideration the student’s previous behaviour and any patterns of persistent misconduct.
  4. As a rule, a medical school should consider whether the student’s behaviour indicates they may be a risk to patients or the public, or may undermine public trust in the medical profession, when it decides whether the student has met the threshold for referral to fitness to practise procedures.
  5. Whatever outcome or action the committee or individual decides to take in relation to a low-level concern, it must be clearly justified and explained to the student. In addition, the implications of repeating the behaviour should be detailed for the student in writing. Medical schools should keep a record of all the decisions they make in relation to low-level concerns so they can follow up on persistent instances of poor behaviour.
  6. In some circumstances, a student’s behaviour or pattern of behaviour may depart significantly from the expected standards of professionalism outlined in Achieving good medical practice: guidance for medical students, but not reach the threshold for referral to fitness to practise procedures. In these circumstances, as well as monitoring future behaviour, it may be appropriate to issue a warning to the student without referring their case to a student fitness to practise panel or committee (see Table 2).