As the lead for student Fitness to Practise at the University of Manchester, one of the best pieces of advice I can offer is to use your defence organisation. If you're referred to an FTP committee, get help from the MDU – immediately!
The MDU has a lot to offer students facing an FTP committee, but we continue to see students who fail to take advantage of this crucial benefit of their membership. Yet the MDU can do so much to help.
Preparation for a committee meeting
A medico-legal adviser can help you prepare a written submission and help you get across the message you want to give to the committee. They can give good advice about how to prepare for the meeting – is it best to fight the case to the death and deny everything, or should you demonstrate an acceptance and a determination to turn over a new leaf and do better? I am not suggesting you should own up to something you haven't done!
An adviser can also help you collect correctly formatted testimonials and prevent howlers. Examples I've seen have included a student with a serious alcohol problem who submitted a single testimonial – from his pub landlord. Or another who had received a prison sentence for fraud and who submitted a testimonial on her own behalf, saying she was a totally honest person.
A number of students submit testimonials from their relatives. These are always favourable, but they lack the objectivity that's needed. For this, they need to be written by a professional involved in your education. This could be a clinical supervisor, or at least someone who has been fully informed about the reasons for your referral to FTP.
Support at the FTP committee meeting
On the day of the meeting, a representative from your medical defence organisation can be invaluable. The knowledge that you're accompanied by someone familiar with these meetings can be very reassuring, and whilst the representative can't answer questions put to you, there's still much useful advice that can be given. It's also helpful to be accompanied by someone who can speak up if the meeting is being incorrectly or unfairly handled.
If you are suffering from appendicitis, should you wait until it has perforated and you're at death's door from peritonitis and septicaemia, or should you get help a bit sooner?
Seek help immediately upon learning you are to be referred to an FTP committee. We often encounter students who only contact the MDU at a very late stage, sometimes only a few days before the meeting, which gives the advisers very little chance to assist.
The need for evidence
Always supply evidence in support of an explanation for your difficulties. If, for example, you had to spend time with your uncle who was having a triple coronary artery bypass and who was counting on your help and support, get a medical report from the hospital to verify this.
Could you have done better? Do you have insight?
Insight can mean many things. It can include the ability to step back from the situation and consider it objectively; a recognition of what went wrong; an acceptance of your responsibilities at the time in question; an appreciation of what could and should have been done differently, or an understanding of how to act differently in the future to avoid a reoccurrence of similar problems.
Avoid deflecting the blame
If you have done something wrong, avoid blaming others. Accept responsibility for your own actions. I recall a student who uploaded a piece of work written by another and pretended it was his own. Instead of accepting responsibility, he produced an obscure publication suggesting that plagiarism is common – in other words, 'everyone does it so don't blame me!'
You may find it hard to accept criticism from colleagues if your behaviour is being scrutinised, particularly if you don't believe you're in the wrong. But don't take it out on the messenger.
Ensure you co-operate fully with investigations and medical assessments, and don't fight battles with staff who are trying to help. It's better to engage with the process, move on and keep your views to yourself, while maybe making a few notes for your future memoirs.
Be 100% honest
Whatever you've done (or not done) make sure you are totally honest in any statement you produce, and when answering questions at an FTP committee. Being honest means more than simply answering questions truthfully. It would be dishonest to allow a Committee to gain a false impression of a situation, even if you didn't actually lie to do so.
Your medical school might not allow you to be accompanied by a lawyer
Even though an FTP Committee has the power to affect your human rights by ending your career, it is a curious fact that some medical schools will not allow a student to be accompanied by a lawyer at an FTP Committee.
But the medical school cannot stop you getting help and advice from the MDU, who tend to send along medico-legal advisers.
Know what to expect
It will help to have a basic outline of the FTP committee meeting process. A medical school representative (who is not a member of the committee) will be at the meeting to explain to the committee the school's concerns about you. You are there to respond to those concerns.
The committee is neutral. It is not on anyone's side. The committee must not include anyone with whom you have had significant personal contact (like a tutor, academic adviser, supervisor, or someone who has made decisions about you or complained about you).
The job of the committee, having read the papers and having put questions to the school representative and to you, is to understand the case, to arrive at conclusions about the facts of the case, and to make a decision about the outcome.
Whatever you've done – or not done – make sure you are totally honest.
The next hurdle – GMC provisional registration
The MDU will also be well aware of what the GMC will be looking for at the time of provisional registration application. This can be vital. The numbers are small, but each year the GMC refuses provisional registration to a graduating student who was found to be fit to practise by a university committee, which may have avoided ending a career because of procedural reasons.
The GMC has the luxury of being able to focus purely on the question of whether the individual is fit to practise, without worrying about a university's procedures and regulations. The MDU has a lot of experience dealing with the GMC and their input can be crucial at this stage – not just in anticipating difficulties, but advising on issues like what the GMC is likely to accept as remediation in the event that provisional registration is refused.
The vast majority of students who attend an FTP committee are allowed to continue, possibly after receiving warnings or various other sanctions. Expulsion is rare, and is seen as an absolute last resort, in cases where a student's behaviour has been fundamentally incompatible with continuing with a medical career. The three most serious problems are dishonesty, failing to respond to warnings, and refusing to co-operate with assessment or treatment of a health problem.
Input from a defence organisation can have a huge impact. We repeatedly see students who, for whatever reason, have failed to respond to advice from the medical school but listen to a defence organisation and can then demonstrate that change has occurred. Going to an FTP committee without an appropriate legal representative puts a student at a real disadvantage.
The MDU's medico-legal advisers are there to help you. Use them.
Has the MDU helped you through a difficult time? Why not let others learn from your experience?
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Professor Tim David
MB ChB PhD MD FRCP FRCPCH DCH
Professor Tim David
MB ChB PhD MD FRCP FRCPCH DCH
A Bristol graduate, Professor Tim David moved to Manchester in 1978 and was appointed as chair in child health and paediatrics in 1991. With a special interest in medical regulation, he worked for the GMC helping to develop performance assessment, and was chair of the University of Manchester FTP committee between 2007-2018.
See more by Professor Tim David