Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets
About this guidace The Geeral Medical Coucil (GMC) ad the Medical Schools Coucil (MSC) have published this documet to give high-level guidace about maagig processes for professioalism cocers ad fitess to practise i medical schools ad uiversities. You should read it together with Achievig good medical practice: guidace for medical studets, which outlies the stadards of professioal behaviour expected of medical studets. You may also fid it helpful to read Supportig medical studets with metal health coditios ad Gateways to the professios, which give guidace o how schools ca support studets with metal health coditios ad disabilities. You ca read these ad other guidace documets, alog with additioal resources to support the use of this guidace i practice, o the GMC website. Published 27 May 2016. Comes ito effect 1 September 2016. Geeral Medical Coucil ad Medical Schools Coucil 01
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets Cotets Page What does this guidace cover? 4 Usig this guidace 6 How ca medical studets use this guidace? 7 The GMC s role i promotig professioalism ad fitess to practise 8 Cosiderig equality ad diversity issues 10 Fitess to practise throughout udergraduate educatio 12 Fitess to practise at graduatio 14 How fitess to practise affects GMC provisioal registratio 14 Whe should studets be give pastoral care ad studet support? 16 Workig together ad sharig iformatio 17 Cosiderig health ad disability issues 19 Referrig a studet to occupatioal health 21 Makig adjustmets to accommodate a studet s eeds 24 Trasfer of iformatio as studets move to F1 26 How should medical schools deal with cocers they receive about a studet s health or behaviour? 28 How should medical schools deal with low-level professioalism cocers? 30 Idetifyig low-level cocers 30 Takig actio o low-level cocers 31 02 Geeral Medical Coucil ad Medical Schools Coucil
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets Page Medical studet fitess to practise 33 What do we mea by studet fitess to practise? 33 The threshold of studet fitess to practise 34 Cosiderig fitess to practise o the grouds of health 38 Reasos for impaired fitess to practise i medical studets 39 Table 1 Reasos for impaired fitess to practise i medical studets 42 Referrig a studet to fitess to practise procedures 47 What is the role of the ivestigator? 47 What are the possible outcomes of a ivestigatio? 50 Fitess to practise committee or pael 54 What are the outcomes of a fitess to practise committee or pael? 58 Table 2 Outcomes of a ivestigatio or fitess to practise committee or pael 66 Reviewig a studet s fitess to practise followig a sactio 70 Timescales for fitess to practise procedures 70 Expellig studets o health grouds 71 Cofidetiality ad disclosure 74 Appeals committees ad paels 76 Exteral complaits 78 Appedix 79 Diagram: a example illustratio of the process for maagig professioalism cocers ad fitess to practise issues i relatio to medical studets 80 Geeral Medical Coucil ad Medical Schools Coucil 03
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets What does this guidace cover? The GMC ad the MSC, referred to as we ad us i this documet, have produced this guidace. It is aimed at medical school ad uiversity staff, ad at placemet provider orgaisatios, who idetify, maage ad support studets whose professioalism or fitess to practise is a cause for cocer. This guidace will also be useful for ayoe ivolved i fitess to practise ivestigatios ad hearigs, ad for those ivolved i makig decisios about studet fitess to practise. Medical studets are workig towards joiig the medical professio. Their studies will put them i cotact with patiets ad members of the public, who may ofte be vulerable. Because of this, we expect medical studets to display stadards of professioal behaviour that are differet from those expected of other studets ot traiig to joi a regulated professio. Meetig these stadards is a requiremet for graduatio with a primary medical qualificatio. This guidace oly applies to medical studets. Oce a doctor is registered their fitess to practise is moitored by the GMC. 04 Geeral Medical Coucil ad Medical Schools Coucil
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets Medical schools are resposible for givig their studets opportuities to lear, uderstad ad practise the stadards we expect of them. To support this, we have produced Achievig good medical practice: guidace for medical studets a guidace documet for studets that outlies the stadards of professioal behaviour expected of them. Medical schools are remided that fitess to practise should be just part of how they make sure their studets become excellet professioals. Educatio ad traiig o professioalism are also importat. Whe a medical studet s coduct or health becomes a cause for cocer, it is essetial that they get the appropriate support ad guidace to cotiue their studies. But some cocers ca t be remedied with support, so medical schools ad uiversities must have a process i place to idetify ad deal with studets whose coduct or health is such that their fitess to practise may be impaired. Geeral Medical Coucil ad Medical Schools Coucil 05
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets Usig this guidace I this guidace, we use the terms you must ad you should i the followig ways. You must is used for a overridig priciple. You should is used whe we give a explaatio of how you ca meet a overridig priciple. You should is also used where the priciple will ot apply i all situatios or circumstaces, or where there are factors outside your cotrol that affect whether or how you ca follow this guidace. This guidace aims to give medical schools ad uiversities a cosistet framework for addressig health ad behaviour cocers i medical studets. Medical schools ad uiversities will also have their ow local procedures that are appropriate for their size ad goverace structure, ad they must follow these procedures. Local procedures ad practices should reflect the iformatio give i this guidace. Ay deviatio from the medical school or uiversity s ow procedures or this guidace should be justifiable ad the reasos for ay deviatio documeted. 06 Geeral Medical Coucil ad Medical Schools Coucil
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets I relatio to the GMC s statutory role, this guidace is advisory rather tha madatory. However, GMC quality assurace reports o medical schools may recommed that they comply with this guidace or may commed a istitutio for good practice. Also, give that the GMC has to be satisfied that graduates applyig for registratio with a licece to practise are fit to practise, it would be surprisig if a medical school thought it sesible to disregard this guidace. How ca medical studets use this guidace? Although this guidace is maily aimed at medical schools ad uiversities, medical studets may also fid it useful. It ca help them to uderstad how medical schools ad uiversities deal with professioalism cocers ad fitess to practise issues. Studets should also look at their ow medical school or uiversity processes for guidace o local procedures ad practices. Medical schools ad other stakeholders icludig medical studets were cosulted as part of the developmet of this guidace, ad medical schools gave valuable iput to the pre-cosultatio developmet of this guidace. Geeral Medical Coucil ad Medical Schools Coucil 07
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets The GMC s role i promotig professioalism ad fitess to practise 1 The GMC helps to protect patiets ad improve medical educatio ad practice i the UK by settig stadards for studets ad doctors. The Medical Act 1983 (as ameded) makes it clear that public protectio is the overarchig objective of the GMC ad that this ivolves: protectig, promotig ad maitaiig the health, safety ad wellbeig of the public promotig ad maitaiig public cofidece i the medical professio promotig ad maitaiig proper professioal stadards ad coduct for members of that professio. 2 The stadards of professioal behaviour expected of registered doctors are set out i Good medical practice * ad the stadards of professioal behaviour expected of medical studets are outlied i Achievig good medical practice: guidace for medical studets. 3 There are differeces betwee the stadards expected of medical studets ad those expected of registered doctors. But medical studets are the doctors of tomorrow ad, as such, there are may similarities betwee the behaviour expected of them at medical school ad that expected of registered doctors. * You ca read Good medical practice at www.gmc-uk.org/gmp. You ca read Achievig good medical practice: guidace for medical studets at www.gmc-uk.org/studetftp. 08 Geeral Medical Coucil ad Medical Schools Coucil
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets 4 This guidace aligs with the requiremets of Good medical practice ad, wherever possible, the GMC s test of fitess to practise for doctors who apply to joi the register ad its fitess to practise procedures for registered doctors. 5 Awareess ad educatio are key to makig sure, from the begiig of their courses, all medical studets are familiar with the stadards of professioal ad persoal behaviour expected of them ad the values that uderpi these stadards. Medical schools should also uderstad that studets who come to study i the UK from overseas might eed additioal support to uderstad some of the cultural aspects of workig ad studyig i the UK. 6 As well as it beig importat for studets to behave i a way that demostrates professioal values, it s equally importat for medical schools to actively promote a ope ad trasparet culture that embeds these values. Geeral Medical Coucil ad Medical Schools Coucil 09
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets Cosiderig equality ad diversity issues 7 Medical schools procedures for maagig cocers about professioalism ad fitess to practise should clearly explai how they make sure their processes are fair. Procedures should outlie schools resposibilities uder the Equality Act 2010 * ad should make sure they do t ufairly discrimiate o the basis of lifestyle, culture, or social or ecoomic status. This icludes characteristics protected by legislatio, that apply to further ad higher educatio establishmets: age disability geder reassigmet race pregacy ad materity religio or belief sex sexual orietatio. * The Equality Act 2010 does ot apply to Norther Irelad. You ca fid more iformatio about the equality legislatio i Norther Irelad o the Equality Commissio for Norther Irelad s website at www.equalityi.org. 10 Geeral Medical Coucil ad Medical Schools Coucil
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets 8 I additio, medical schools should be midful of their resposibility to provide reasoable adjustmets ad support for studets who eed them to access learig. You ca fid more iformatio i the GMC guidace about prevetig uecessary barriers for disabled studets studyig medicie, Gateways to the professios. * 9 Staff members who have sigificat roles i the studet fitess to practise process, such as ivestigators, paellists or committee members ad other relevat decisio makers, must uderstad ad receive traiig i the legal requiremets ad good practice of equality ad diversity specific to their role. * You ca read Gateways to the professios at www.gmc-uk.org/educatio/ udergraduate/gateways_guidace.asp. Geeral Medical Coucil ad Medical Schools Coucil 11
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets Fitess to practise throughout udergraduate educatio 10 Uder the terms of the Medical Act 1983, a registered doctor s fitess to practise may be impaired by reaso of: miscoduct deficiet professioal performace a covictio or cautio i the British Isles (or a covictio elsewhere for a offece which would be a crimial offece if committed i Eglad or Wales) adverse physical or metal health ot havig the ecessary kowledge of Eglish a determiatio (decisio) by a regulatory body resposible for regulatio of a health or social care professio, either i the UK or overseas, to the effect that their fitess to practise as a member of the professio is impaired. 11 The GMC uses these reasos for impairmet whe it applies the test of fitess to practise to registered doctors ad those applyig for registratio. Medical schools may also wish to refer to these reasos for impairmet whe they make decisios about a studet s fitess to practise. 12 Geeral Medical Coucil ad Medical Schools Coucil
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets 12 Medical schools ad uiversities should be aware that fitess to practise cocers ca ivolve issues that fit ito more tha oe category. Where there are multiple issues (for example, health ad miscoduct), the medical school must cosider all matters ad must take accout of the cumulative effect of all impairig factors. It s importat to make sure the studet is give appropriate support ad, where a health coditio is ivolved, the opportuity to seek appropriate treatmet. 13 Deficiet professioal performace, i the cotext of medical studets, refers to usatisfactory academic competece ad progressio. As such, this is ulikely to be a reaso for impairmet of fitess to practise i medical studets, ad will be dealt with by the uiversity or medical school s academic procedures. 14 Adverse physical or metal health aloe is ot usually sufficiet to coclude impairmet. It is a studet s failure to seek the appropriate help or egage i the process to maage ay coditio that may call ito questio their fitess to practise. 15 Not havig the ecessary kowledge of Eglish should also ot ormally be a issue for studets workig towards a primary medical qualificatio i the UK, because medical schools require proof of Eglish laguage skills at the poit of etry to the course. Studets will also be subject to ogoig assessmet of their laguage ad commuicatio skills to meet the outcomes of udergraduate medical educatio. Geeral Medical Coucil ad Medical Schools Coucil 13
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets Fitess to practise at graduatio 16 Medical schools must ot graduate studets where fitess to practise cocers have bee raised or are uder cosideratio. Therefore, medical schools must have cosidered all fitess to practise cocers ad reached a determiatio o them before they allow a studet to graduate. By graduatig a studet with a recogised primary medical qualificatio, the medical school is declarig them fit to practise as a doctor. How fitess to practise affects GMC provisioal registratio 17 Medical graduates who wish to work i the UK must apply to the GMC for provisioal registratio ad aswer questios about their health, coduct ad ay crimial record, which will help the GMC decide if they meet the requiremets for registratio. The GMC has a statutory duty to register oly those doctors whose fitess to practise is ot impaired. The GMC must reach this decisio ad caot simply accept a decisio made by aother authority. If there are ay cocers, the GMC will assess these ad will decide whether to grat provisioal registratio. 18 The law does t let the GMC make a coditioal grat of registratio, or register a doctor ad cosider their fitess to practise afterwards. At the time of applicatio, a doctor is either fit to practise or ot fit to practise. 19 Medical schools should tell studets that the GMC is resposible for decisios about registratio, ad that this icludes a separate test of fitess to practise. They should highlight this i admissios procedures, studet hadbooks ad i fitess to practise guidace ad procedures. 14 Geeral Medical Coucil ad Medical Schools Coucil
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets 20 Medical schools must make clear to studets that the GMC will cosider ay issue that calls their fitess to practise ito questio whe they come to apply for provisioal registratio. I exceptioal circumstaces, this may iclude icidets that happeed before they etered medical school as well as icidets that occur durig their udergraduate years. 21 Medical schools should make studets aware, before they apply for provisioal registratio, of the requiremets i the GMC s declaratio of fitess to practise. * Ay discipliary or fitess to practise actio take by a medical school or uiversity for example, ay issue cosidered by a formal pael, committee or hearig should be declared to the GMC, irrespective of the outcome. Medical schools should remid studets that if they have ay cocers about what they should declare to the GMC, they should speak to their medical school i the first istace. 22 If there is a cocer that a studet may be refused registratio, the GMC may be able to give advice o the possible outcomes of a applicatio based o the disclosed facts of the case. It is importat to ote that this would ot bid the GMC to a particular decisio at the poit of registratio. If studets, medical school or uiversity staff, or ay other perso have cocers, they should seek advice as early as possible. * You ca fid out more about the declaratio of fitess to practise at www.gmc-uk.org/doctors/registratio_applicatios/declaratio_of_ftp.asp. Geeral Medical Coucil ad Medical Schools Coucil 15
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets Whe should studets be give pastoral care ad studet support? 23 Givig support to studets is pivotal i helpig to prevet issues of behaviour or health becomig more serious ad a greater cause for cocer. Studets may be affected by may issues durig their time at medical school, icludig health, fiacial ad family or other social issues. Medical schools should be aware that overseas medical studets may have particular support eeds due to their ufamiliarity with their ew home ad work eviromet. Whe cocers arise, medical schools should give their studets access to appropriate support to help maage these issues. 24 It s importat that support is made available to studets who are goig through formal fitess to practise procedures. Writte procedures should also iclude the requiremet to give support to studets from the outset of the process. 25 Medical schools should give their studets clear iformatio about the rage ad type of support services available. Staff should be aware of the details of what support is available ad direct studets to a appropriate service if ecessary. 16 Geeral Medical Coucil ad Medical Schools Coucil
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets 26 Support services may iclude: studet health services (icludig metal health) disability support services occupatioal health services cofidetial cousellig services support services through the studet uio this may iclude peer support, ad fiacial, housig ad legal help or advocacy persoal tutors. Medical schools may also wish to sigpost studets to medical defece orgaisatios who ca support studets through fitess to practise processes. Workig together ad sharig iformatio 27 Medical schools should foster a ope, trasparet ad supportive eviromet ad ecourage studets to discuss problems opely with appropriate staff. There should be amed or dedicated staff i the faculty so that studets kow whom they ca go to for advice ad support, i additio to their ow persoal tutor. Staff ad studets should work together to address ay issues, wherever possible. Geeral Medical Coucil ad Medical Schools Coucil 17
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets 28 There may be circumstaces where iformatio will eed to be shared with relevat staff so they ca provide support but this should be doe with the studet s coset. Staff should make clear to studets that iformatio may be shared without their coset i limited circumstaces if there is a potetial risk to colleagues, patiets or the studet themselves. 29 I such circumstaces, disclosure of iformatio should be limited to that which is relevat to the issue ad should oly be shared with those who have a legitimate eed to kow. This duty to share iformatio i limited circumstaces applies to medical school ad uiversity staff, ad to idepedet practitioers who provide support services. 30 Medical schools should make sure they regularly review the support a studet is gettig. They should moitor whether the support is helpig to address the issues the studet has, ad fid out what else, if aythig, eeds to be doe. 31 It is very importat for the wellbeig of studets that pastoral care ad academic progress are kept separate where possible. Staff ivolved i makig decisios o a studet s academic progressio should ot provide pastoral care. 32 The GMC ad the MSC have joitly produced guidace for medical schools ad medical studets o Supportig medical studets with metal health coditios. * The guidace also sets out some geeral priciples medical schools ca use to support studets with physical health issues. * You ca read Supportig medical studets with metal health coditios at www.gmc-uk.org/metalhealth. 18 Geeral Medical Coucil ad Medical Schools Coucil
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets Cosiderig health ad disability issues 33 I most cases, health coditios ad disabilities do ot affect a medical studet s fitess to practise, as log as the studet: demostrates appropriate isight seeks appropriate medical advice complies with treatmet. 34 Medical schools must make adjustmets, where possible, to allow a studet to fulfil the core competecies of their course ad eable them to study ad work safely i a cliical eviromet. * 35 All studets should register with a local geeral practitioer (GP), who will be able to offer them idepedet support ad cotiuity of care while they are at medical school. Educatioal supervisors, who are ivolved i teachig a studet, should ot also be ivolved i providig their healthcare or occupatioal health assessmets. 36 A GP or medical doctor who treats a studet should ot also be ivolved i occupatioal health assessmets of fitess to practise, because this is a coflict of iterest with their role as a therapeutic advocate. Similarly, occupatioal physicias are cotractually obliged to give idepedet assessmets of fitess to practise, so ca t also provide medical treatmet services. * You ca fid more detail o how medical schools ca make reasoable adjustmets, as well as examples of adjustmets other medical schools have made, i the GMC s Gateways to the professios guidace, available at www.gmc-uk.org/educatio/udergraduate/gateways_guidace.asp. Geeral Medical Coucil ad Medical Schools Coucil 19
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets 37 Studets with health coditios i particular, those with metal health coditios are ofte idetified as havig problems because they display uprofessioal behaviour that is out of character, such as poor attedace or failure to egage with their studies. Medical schools should give their staff traiig to help them idetify, at a early stage, studets whose behaviour idicates a uderlyig health issue. 38 Medical schools ca use low-level cocers processes to idetify ad support studets with health coditios. They ca also use their fitess to practise procedures where makig adjustmets ad providig support have bee tried without success. The fitess to practise process ca help studets by makig sure they access the support that will eable them to complete their course. 39 Whe a studet has a medical problem, it s importat to cosider their fitess to study whether they are well eough to participate ad egage i their programme. The Higher Educatio Occupatioal Physicias group publishes fitess to trai stadards for medical studets o its website. * * To view the stadards, go to www.heops.org.uk/guide.php. 20 Geeral Medical Coucil ad Medical Schools Coucil
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets Referrig a studet to occupatioal health 40 Medical schools should refer studets who have bee diagosed with a medical coditio to the uiversity s occupatioal health provider so they ca get a appropriate assessmet. If it would be helpful ad the studet cosets to it, the studet s treatig specialist ca give the medical school their opiio o whether the studet should remai o the course. This advice is likely to be alog the lies of oe of the followig. Medically fit to remai o the course This may iclude recommedatios about ay reasoable adjustmets (followig cosultatio with the disability support office) ad may also suggest the optio of regular reviews through the occupatioal health service. The eed for a iterruptio from the course This is usually recommeded where a studet eeds to take time out to access appropriate treatmet or if they eed a period of stability. Ay retur to the course should be depedet upo a further review through the occupatioal health service to cofirm the studet s medical fitess. If the medical school does ot cosider such a review appropriate, they should give a clear, documeted explaatio as to why. Geeral Medical Coucil ad Medical Schools Coucil 21
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets Referral to a idepedet specialist for further advice This may be recommeded by a occupatioal health physicia i a limited umber of complex cases (ofte ivolvig metal health coditios). Such a referral would be made with the studet s iformed coset. The idepedet specialist will produce a report, which they will sed to the occupatioal health service. The occupatioal health service will discuss the report with the studet, before sedig further iformatio ad advice to the medical school. 41 Studets should be able to self-refer to the occupatioal health service if they have cocers that a medical coditio may affect their academic performace or fitess to practise. The occupatioal health service should reassure the studet that ay iformatio it receives durig such a cosultatio is cofidetial ad will oly be shared with the studet s iformed coset, uless the occupatioal health practitioer cosiders that the studet is a potetial risk to others or themselves. The occupatioal health service should ecourage the studet to coset to share their occupatioal health report with their medical school. 42 Followig a occupatioal health assessmet, ay subsequet report from the occupatioal health service should address: the issue of the studet s medical fitess to study or practise ay ecessary adjustmets or support eeded 22 Geeral Medical Coucil ad Medical Schools Coucil
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets the eed for reviews ay expectatios of the studet for example, compliace with medicatio. 43 The treatig doctor has the same duty of cofidetiality to studets as to ay patiet. If the studet does t coset to the disclosure of iformatio about them, the doctor ca oly disclose it if either it is required by law or they judge disclosure to be i the public iterest. 44 I some cases, the occupatioal health physicia may ask the studet to give coset for the disclosure of medical iformatio to let them provide appropriate care ad ogoig support. For example, if a studet returs to their course after a period of ill health, it may be helpful for the studet, the disability support office, the occupatioal health physicia ad the treatig specialist to discuss what steps they might take to miimise future problems. 45 I some cases, medical schools may eed to moitor the extet to which a studet is complyig with a treatmet programme to make sure they are fit to study or practise. The occupatioal health service is i a ideal positio to do this, i cosultatio with the treatig specialist. * For more iformatio, see the GMC s guidace Cofidetiality, available at www.gmc-uk.org/cofidetiality. Geeral Medical Coucil ad Medical Schools Coucil 23
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets Makig adjustmets to accommodate a studet s eeds 46 Medical schools must make reasoable adjustmets for studets with a disability to allow them to achieve the outcomes for graduates required by the GMC. Although adjustmets ca t be made to the outcomes themselves, reasoable adjustmets ca be made to learig ad assessmet methods. I all cases, ay reasoable adjustmets should be subject to regular review. You ca fid further iformatio i the GMC s guidace, Gateways to the professios. 47 If a studet is receivig ogoig support for a health coditio, it may be appropriate to arrage their placemets i locatios where they ca receive cotiuity of care with the same healthcare professioals. 48 Medical schools should make clear to studets that i some circumstaces equivalet adjustmets might ot be available whe they eter postgraduate educatio. Medical schools may fid it helpful to ask local postgraduate educatio providers what reasoable adjustmets they are able to make. This will help medical schools to give studets better iformatio about what reasoable adjustmets may be realistic i the workplace, which will help studets to make iformed decisios about their progressio through medical educatio. 24 Geeral Medical Coucil ad Medical Schools Coucil
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets 49 I rare circumstaces, a chroic or progressive health coditio may mea it is t possible for a studet to meet all the outcomes required by the GMC for graduatio. Also, i a small umber of cases, a health coditio may mea a studet s fitess to practise is impaired. 50 If a studet ca t demostrate the ecessary competecies ad all optios for support ad adjustmets have bee explored without success, it may be ecessary to begi formal fitess to practise procedures. Medical schools must cotiue to support studets throughout this process. Geeral Medical Coucil ad Medical Schools Coucil 25
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets Trasfer of iformatio as studets move to F1 51 The trasfer of iformatio (TOI) process is desiged to support medical studets durig their trasitio from medical school to employmet as a doctor i traiig, i the first year of the Foudatio Programme (F1). It is separate from the process of applyig for registratio with the GMC. 52 It allows medical studets to idetify areas where they may eed more support oce they eter F1, i relatio to: health ad wellbeig educatioal progress professioal performace. 53 Studets complete the TOI forms ad the medical school sigs them off. Medical schools ca add extra iformatio where appropriate. 54 Medical studets must iclude o the TOI form details of ay fitess to practise or discipliary cases that resulted i a writte warig or sactio. This is to protect patiet safety by makig sure cocers ca be tracked from medical school to postgraduate educatio ad traiig ad to make sure studets ca cotiue to be supported i relatio to their developmet as a professioal. 26 Geeral Medical Coucil ad Medical Schools Coucil
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets 55 It is importat to ote that the TOI process does ot replace the eed to report ay fitess to practise issues to the GMC or to flag health ad disability matters to employers. 56 You ca fid more iformatio i the MSC s guidace o the process for applicats. * * You ca read Natioal Trasfer of Iformatio: Process ad guidace for medical studets, graduates, ad Foudatio Programme applicats, medical schools ad foudatio schools at www.foudatioprogramme.hs.uk/pages/ home/trasfer-of-iformatio-process. Geeral Medical Coucil ad Medical Schools Coucil 27
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets How should medical schools deal with cocers they receive about a studet s health or behaviour? 57 Allegatios about a studet s health or behaviour may come from a umber of sources, icludig: members of medical school or uiversity staff staff who work i placemet provider orgaisatios occupatioal health physicias fellow studets the circumstaces by which this iformatio comes to light should be carefully examied the police self-referral perhaps declaratio of a crimial matter members of the public aoymous complaits, through a raisig cocers policy or through the media. 58 Medical schools ad uiversities should make sure their procedures have sufficiet flexibility to receive allegatios from a umber of sources. They should also make sure procedures clearly defie how cases are evaluated. 28 Geeral Medical Coucil ad Medical Schools Coucil
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets 59 Medical schools should also cosider how they will deal with aoymous complaits ad how they ca gather evidece i these circumstaces. Aoymous complaits ca limit a medical school s ability to take actio, as it will be more difficult to ivestigate ad gather evidece. It may be appropriate to deal with such complaits uder the medical school or uiversity s aoymous complait or raisig cocers policy. 60 I some situatios, such as where there is a allegatio of plagiarism, it may be appropriate to cosider the case uder both academic ad fitess to practise procedures. I these circumstaces, medical schools should coduct the academic process first ad coclude it before begiig the fitess to practise process. This will avoid the studet facig simultaeous discipliary procedures for the same allegatio. 61 Medical schools procedures o dealig with cocers should also make clear how ad whe they commuicate allegatios to the studet. Medical schools must give allegatios to the studet i writig before begiig ay ivestigatio. They should also give the studet iformatio about the fitess to practise process ad the support available to them durig it. Geeral Medical Coucil ad Medical Schools Coucil 29
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets How should medical schools deal with low-level professioalism cocers? Idetifyig low-level cocers 62 Medical studets must meet all the outcomes for udergraduate medical educatio, icludig behavig accordig to ethical ad legal priciples. Medical schools are required to have formal processes i place for assessig these requiremets. Ay system for idetifyig, raisig ad moitorig low-level professioalism cocers should work i cojuctio with existig systems for assessmet. 63 Studets who experiece difficulties with their health may display uprofessioal behaviour that raises cocer. It is importat for medical schools to have a system to idetify studets who display such behaviour, sice this may be a early idicator of more-sigificat miscoduct or health issues. 64 Low-level professioalism cocers may be idetified ad raised by a umber of sources, such as persoal tutors, staff o placemet or other studets (see paragraph 57). For example, some medical schools have a card or poits system for flaggig uprofessioal behaviour ad such systems have the advatage that they ca also be used to recogise ad promote exemplary professioal behaviour. 65 Havig a formal process for reportig ad moitorig low-level professioalism cocers such as lateess, ot hadig i work o time ad missig lectures will allow medical schools to idetify ay uprofessioal behaviour ad to address it before it leads to more-sigificat fitess to practise issues. 30 Geeral Medical Coucil ad Medical Schools Coucil
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets 66 It s importat for medical schools to give clear guidace to staff o their process for reportig ay cocers about studets ad to make sure this guidace is clearly available to ayoe who may wish to use it. 67 Medical schools should also tell studets how they will idetify ad moitor uprofessioal behaviour, ad what its cosequeces will be. Medical schools should be ope ad trasparet with studets ad give clear ad cosistet advice. Takig actio o low-level cocers 68 There should be clear processes for dealig with ad makig decisios about persistet low-level cocers. May medical schools have a group or committee to address persistet low-level cocers ad make decisios about whether a studet has reached the threshold of their fitess to practise beig impaired. I other schools, a seior staff member, such as the dea or year tutor, is resposible for doig this. 69 Whatever method medical schools use, they should defie a set of rules goverig how the process will be hadled ad make these available for studets. Geeral Medical Coucil ad Medical Schools Coucil 31
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets 70 It is ot practical to defie a particular umber of low-level cocers that mea a studet s behaviour has reached the threshold for a referral to fitess to practise procedures. Medical schools must cosider studets behaviour o a case-by-case basis. Medical schools must be cosistet i their assessmet of whether a studet has reached the threshold for referral to fitess to practise procedures, takig ito cosideratio the studet s previous behaviour ad ay patters of persistet miscoduct. 71 As a rule, a medical school should cosider whether the studet s behaviour idicates they may be a risk to patiets or the public, or may udermie public trust i the medical professio, whe it decides whether the studet has met the threshold for referral to fitess to practise procedures. 72 Whatever outcome or actio the committee or idividual decides to take i relatio to a low-level cocer, it must be clearly justified ad explaied to the studet. I additio, the implicatios of repeatig the behaviour should be detailed for the studet i writig. Medical schools should keep a record of all the decisios they make i relatio to low-level cocers so they ca follow up o persistet istaces of poor behaviour. 73 I some circumstaces, a studet s behaviour or patter of behaviour may depart sigificatly from the expected stadards of professioalism outlied i Achievig good medical practice: guidace for medical studets, but ot reach the threshold for referral to fitess to practise procedures. I these circumstaces, as well as moitorig future behaviour, it may be appropriate to issue a warig to the studet without referrig their case to a studet fitess to practise pael or committee (see table 2). 32 Geeral Medical Coucil ad Medical Schools Coucil
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets Medical studet fitess to practise What do we mea by studet fitess to practise? 74 I relatio to a doctor s fitess to practise the GMC states: To practise safely, doctors must be competet i what they do. They must establish ad maitai effective relatioships with patiets, respect patiets autoomy ad act resposibly ad appropriately if they or a colleague fall ill ad their performace suffers. But these attributes, while essetial, are ot eough. Doctors have a respected positio i society ad their work gives them privileged access to patiets, some of whom may be very vulerable. A doctor whose coduct has show that they caot justify the trust placed i them should ot cotiue i urestricted practice while that remais the case. The meaig of fitess to practise, GMC policy statemet, 2014. * 75 This statemet explais what fitess to practise is for a registered doctor. But it is also relevat to medical studets. Studets are also i a privileged positio, ad have access to patiets who may be vulerable. Medical schools should ot let a studet cotiue their medical studies urestricted, or let them graduate from medical school, if their coduct suggests they may be a risk to patiets or the public. 76 Studets are i a learig eviromet at the start of their professioal career. Whe a medical school cosiders the fitess to practise of a studet, it is appropriate to reflect o the severity of the behaviour, the maturity of the studet ad the year of study, as well as the likelihood of repeat behaviour ad how well the studet will respod to support. * You ca read the full policy statemet at www.gmc-uk.org/the_meaig_of_ fitess_to_practise.pdf_25416562.pdf. Geeral Medical Coucil ad Medical Schools Coucil 33
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets 77 Expectatios of studets are likely to chage over the course of their studies. For example, misdemeaours i the early years of study, whe a studet has greater scope to demostrate remediatio, may have less of a impact o a studet tha misdemeaours i the later years of their course whe there is less time before they must meet the requiremets for graduatio. 78 Medical schools should be aware that whe cocers are raised about a studet i the fial year of study, there may ot be sufficiet time to resolve them. If a cocer about a studet s fitess to practise is raised close to the date of graduatio, the the medical school should cosider the amout of time the studet will have to demostrate remediatio. It may be ecessary to require a studet to repeat all or part of a year, if appropriate. But i cases where there is a outstadig, justifiable cocer over a studet s fitess to practise, the medical school must ot graduate the studet. The threshold of studet fitess to practise 79 I decidig whether to refer studets to fitess to practise procedures, medical schools should cosider how a studet s behaviour or health might affect patiet ad public safety, or the public s trust i the medical professio. Ivestigators ad paellists must cosider, o a case-by-case basis, whether a studet s behaviour or health has crossed the fitess to practise threshold. 34 Geeral Medical Coucil ad Medical Schools Coucil
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets 80 The followig questios ca help whe cosiderig this threshold. Medical schools should be midful that this advice is oly illustrative of the sort of cocers about behaviour or health that could call a studet s fitess to practise ito questio ad the outcome i all cases will deped o the particular circumstaces. Has a studet s behaviour deviated from the guidace set out i Achievig good medical practice: guidace for medical studets or a medical school s ow code of coduct? Ad might it, as a result, have harmed patiets or put patiets, colleagues or themselves at risk of harm? A icidet or a series of icidets that cause cocers to persoal tutors ad academic or cliical supervisors ca be evidece of harm or risk of harm. A series of icidets ca suggest persistet failigs that are ot beig, or caot be, safely maaged through pastoral care or studet support. For example, a persistet failure to egage with studies, follow istructios ad heed educatioal advice. Has a studet show a deliberate or reckless disregard for professioal or cliical resposibilities towards patiets, teachers or colleagues? A isolated lapse i coduct, such as a rude outburst, may ot itself suggest that the studet is ot fit to practise. But persistet miscoduct, which idicates a lack of itegrity o the part of the studet, a uwilligess to behave resposibly or ethically, or a serious lack of isight ito obvious professioal cocers, would brig a studet s fitess to practise ito questio. Geeral Medical Coucil ad Medical Schools Coucil 35
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets Persistet miscoduct, such as beig disruptive i teachig sessios, showig challegig behaviour towards cliical teachers, failig to accept criticism ad repeatedly ot respodig to commuicatios, may also be grouds for cosiderig a studet has reached the threshold of impairmet. Have attempts to improve a studet s behaviour or health failed ad does the medical school idetify a remaiig uacceptable risk to patiet safety or public cofidece i the professio? If a medical school has tried to give a studet support or educatioal remediatio to address some, or all, of the issues that are causig cocer, but these measures have failed, it s likely that the studet s fitess to practise will be called ito questio. For example, the studet may have bee give a warig for previous miscoduct ad bee told that a repeat of the behaviour would idicate impairmet of fitess to practise ad formal proceedigs. Has a studet abused a patiet s trust or violated a patiet s autoomy or other fudametal rights? Behaviour that shows a studet has acted without regard for a patiet s rights or feeligs, or has abused their positio as a medical studet, will usually give rise to questios about fitess to practise. For example, if a studet deliberately misleads patiets by ot displayig their studet idetity badge to obtai coset to carry out a examiatio. 36 Geeral Medical Coucil ad Medical Schools Coucil
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets Has a studet behaved dishoestly, frauduletly or i a way desiged to mislead or harm others? Deliberate dishoesty or fraudulet behaviour will call ito questio a studet s fitess to practise, especially if there is a patter of this kid of behaviour. Examples may iclude plagiarism, cheatig, dishoesty i reports ad logbooks or forgig the sigature of a supervisor. Might the studet s behaviour udermie public cofidece i doctors geerally if the medical school did ot take actio? The medical school should take actio if a studet s behaviour might udermie trust i the medical professio. The priciple of public trust i the professio applies to doctors: Patiets must be able to trust doctors with their lives ad health, so doctors must make sure that their coduct justifies their patiets trust i them ad the public s trust i the professio Good medical practice, paragraph 65. Geeral Medical Coucil ad Medical Schools Coucil 37
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets Studets are traiig to joi the professio ad therefore the same priciple applies. I relatio to studets some factors medical schools could cosider might iclude, for example: misuse of social media receivig a crimial cautio * or covictio failig to comply with the regulatios of the medical school, uiversity, hospital or other orgaisatio dishoest ad fraudulet behaviour. Is a studet s health or disability compromisig patiet safety? Medical schools do t eed to start fitess to practise procedures just because a studet is ill, eve if the illess is serious. But they might eed to if the studet is ot followig medical advice to miimise the risk to themselves ad colleagues. Or if the studet does ot have isight ito the impact of their coditio ad how it might compromise patiet safety. * Due to differeces i Scottish law, for studets based i medical schools i Scotlad: receivig a cautio caot lead to studet fitess to practise procedures or be a reaso for a studet s fitess to practise beig foud to be impaired. This oly applies to stu dets based i medical schools i Scotlad, ad ot to Scottish studets based i medical schools i Eglad, Wales or Norther Irelad. 38 Geeral Medical Coucil ad Medical Schools Coucil
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets Cosiderig fitess to practise o the grouds of health 81 Medical schools should cosider fitess to practise procedures for a studet with a health coditio (icludig addictio) i the followig circumstaces. Where there are sigificat cocers about the studet s fitess to practise or about patiet safety. For example, if a studet s ill health appears to be ucotrolled or where there is evidece that the studet is ot followig treatmet or advice. Where there is a sigificat risk of relapse or loss of isight, which may be characteristic of a coditio, for example addictio or certai metal health coditios. If the studet fails to comply with measures ad adjustmets set by occupatioal health or others that are desiged to eable them to complete the course. If a health coditio cotiues to impact o the studet s ability to egage with the course after adjustmets have bee made. Where there are sigificat miscoduct issues liked with a health coditio. For example, where a studet is covicted of a misuse of drugs offece. Geeral Medical Coucil ad Medical Schools Coucil 39
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets 82 Medical schools should cosider the followig factors to decide if itervetio is eeded. Whether there is risk to patiets (ow or i the future), staff, fellow studets or to public cofidece i the professio. Whether the studet has isight ito their coditio. Whether the studet is seekig appropriate treatmet, followig the advice of the people treatig them, ad adjustig their studies or activities appropriately. Reasos for impaired fitess to practise i medical studets 83 Table 1 gives examples of the sorts of behaviour that might idicate a studet s fitess to practise is impaired. The examples vary i seriousess. I some cases, the behaviour itself might idicate a eed to refer the studet directly ito fitess to practise procedures. Other examples are less serious o their ow, but if they happe repeatedly or i combiatio, or if there are aggravatig factors, there may also be grouds for referral to a fitess to practise ivestigatio. 84 To put these examples of behaviour i cotext, we ve orgaised the table accordig to the published reasos for impairmet for fully or provisioally registered doctors ad applicats for registratio. These examples are ot iteded to be a exhaustive list. Medical schools should cosider each case idividually i light of the specific circumstaces the case presets. 40 Geeral Medical Coucil ad Medical Schools Coucil
Professioal behaviour ad fitess to practise: guidace for medical schools ad their studets 85 Studets must meet the outcomes of udergraduate medical educatio to graduate with a medical degree. There is some overlap betwee the expected professioal behaviour of studets ad the assessed outcomes of medical educatio i relatio to professioalism. Therefore, medical schools may have a formal meas of assessig some of the behaviour outlied i this table. Geeral Medical Coucil ad Medical Schools Coucil 41