Becoming a doctor is not just about treating patients and having excellent clinical knowledge. You need to consider how you behave along with your academic performance.
Doctors must act in a professional way, and this relates to their behaviour outside work as well as when they are dealing with patients and their colleagues. The General Medical Council (GMC) takes an interest in doctors' behaviour if it calls their professionalism into question, so you should too.
This same standard of professionalism also applies to students. You're expected to make sure that your personal conduct doesn't bring your future professionalism – or profession – into disrepute, and this includes behaviour in your personal life. A medical student's behaviour should not jeopardise the public's trust in the medical profession.
How it relates to students
It can be difficult to adjust to life in medical school. Competition is strong and previously high-achievers may find themselves being regarded as 'just' an average student, rather than being at the top of their class.
Students can find themselves in academic difficulty, and this in itself may call their fitness to practice into question and raise concerns about their ability to continue in their chosen degree. But it's by no means the only reason students face disciplinary proceedings.
What can incur an FTP investigation?
The GMC and Medical Schools Council have produced guidance to help medical students and universities recognise what is expected from students, in terms of their performance at medical school and beyond.*
It's important to be familiar with this, as being in breach of it could lead to a university fitness to practise (FTP) investigation, and may make it difficult for a student to gain their provisional registration with the GMC when they graduate.
The GMC takes an interest in doctors' behaviour if it calls their professionalism into question, so you should too.
The guidance includes a non-exhaustive list of the types of behaviour which would call a student's fitness to practise into question. Not surprisingly this includes criminal convictions, ranging from drug and alcohol misuse and public disorder offences through to theft, financial fraud and aggressive or threatening behaviour.
Doctors have an obligation to inform the GMC if they have accepted a caution from the police or charged with or found guilty of a criminal offence, and this can lead to a full GMC investigation.
What students may not realise is that FTP investigations can also arise due to concerns about inappropriate attitude. These might include lack of commitment, poor time management, poor attendance, poor communication and failure to accept or follow advice given by their educators.
Investigations may also result from cheating in examinations and portfolios, forging signatures (such as that of a supervisor) and passing off other people's work as their own.
Implications of fitness to practise
These are all issues that could affect students on any university course. But they have greater implications for those studying medicine as they call into question the student's ability to be a practising doctor.
Importantly, some also call into question the student's honesty. Behaving in a dishonest way is taken very seriously by medical schools and by the GMC, and persistent dishonest behaviour is very likely to result in a student being removed from the course. It's possible to correct or account for academic failure and even attitude towards your studies, but habitual dishonesty is very difficult to overcome.
Remember that your behaviour, including your contributions to your studies, attendance and attitude, will be monitored. Any concerns will be flagged up and you may find that you are drawing attention to yourself for all the wrong reasons.
Hopefully any concerns will be drawn to the student's attention at the outset, giving them an opportunity to remediate their actions and reassure the medical school that their behaviour will improve.
If there are mitigating circumstances, the medical school and student support services should be aware and any absences reported straight away to the appropriate person. If the behaviour continues with no improvement, however, it's likely the student will be referred to the university's health and conduct committee, who will consider whether any action is needed.
If a student has health concerns, these would hopefully be dealt with sympathetically, but as a doctor and as a medical student you have an obligation to take your own health seriously, and seek and follow medical advice if needed. You can't use a health problem as an excuse for poor behaviour if you've not taken steps to address it appropriately. This may include seeing your own GP, hospital specialist or the university's Occupational Health physician.
Remember that your behaviour, including your contributions to your studies, attendance and attitude, will be monitored.
Where concerns continue, it's likely that an FTP investigation will follow, with a subsequent hearing. The medical school will gather evidence to support their case against the student, and this will include any recording of the inappropriate behaviour which has been made during their studies. This could include reports from tutors, educational supervisors and hospital staff as well as academic records, attendance registers and exam results.
Remember that any emails you have sent to or received from staff will be kept and used as evidence, as will written records of any telephone or face to face conversations. Because of this, it's important to be totally honest about your interactions and not to exacerbate concerns by trying to cover your tracks. Honesty is definitely the best policy.
Depending on the severity of the allegations, and your response to them, the tribunal may decide that the matter can be closed with no further action. But they could also offer a warning or even prevent you from continuing with your studies. Even where the medical school permits a student to continue and graduate, there is still the hurdle of acceptance onto the GMC's provisional register.
Students need to inform the GMC of any disciplinary proceedings or criminal convictions, and the GMC may pursue their own investigation before allowing a student to register, which can delay the start of their foundation training.
Fitness to practise investigations are stressful. It's important to get support from family, friends and your medical defence organisation. The MDU can help you in preparing for a hearing and responding to any allegations that have been made against you, as well as accompanying you to the hearing itself.
*This article was first published on 24 April 2016 and updated on 3 June 2016 to reflect new guidance for medical students from the GMC and Medical Schools Council.
Dr Kathryn Leask
Dr Kathryn Leask
BSc (Hons) MBChB (Hons) LLB MA MRCPCH FFFLM MRCPathME DMedEth
Kathryn has been a medico-legal adviser with the MDU since 2007 and is a team leader, trainer and mentor in the medical advisory department. Before joining the MDU, she worked in paediatrics gaining her MRCPCH in 2002 and did her specialty training in clinical genetics. She has an MA in Health Care Ethics and Law, a Bachelor of Law and a Professional Doctorate in Medical Ethics. She is also a fellow of the Faculty of Forensic and Legal Medicine and has previously been an examiner and deputy chief examiner for the faculty. Kathryn is currently a member of the faculty’s training and education subcommittee and a member of the Royal College of Pathologists (medical examiner).
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