The dilemma

A medical student got in touch with us having been contacted by her medical school about a potential breach of COVID-19 restrictions. The student explained that she had hosted a BBQ in her back garden for six friends, including two that she also lived with in the house. They were also students but they weren’t studying medicine. The student admitted that she was aware that the current restrictions meant that people should not be meeting up with anyone from outside their own household, either indoors or in a private garden.

When asked by the medical school, the medical student was worried about repercussions so initially denied any wrongdoing and said the event had never happened. She was then made aware that one of the people who’d been at the BBQ had taken some photos of the seven of them and had put this on social media, with clear reference to the date. These photos had been brought to the medical school’s attention. The medical student therefore had to admit that the BBQ had taken place. 

The medical student now very much regretted what she had done and was very worried about what might happen next. She was upset that she was the only student who had got into trouble for this. She had been asked to provide her comments as part of a university fitness to practise (FTP) investigation.

What leads to university FTP investigations?

As future doctors, it’s important that your behaviour does not bring the profession into disrepute. One way medical schools can investigate a student’s behaviour is by a FTP investigation which may lead to a panel hearing. FTP investigations can look into a student’s conduct while they are on the course but also their behaviour in their personal life, if it is felt to be necessary and appropriate. 

Students on other courses, which do not lead to professional qualifications, are less likely to face disciplinary action and their actions are much less likely to be under scrutiny. Being a doctor is a trusted and respected position to hold and, therefore, the expectations placed on medical students are much higher than those for other students. These expectations continue once a student qualifies. 

In this case, the medical school would be concerned that the student had acted outside current government guidelines and in a way that could put the public at risk. This would be especially concerning if she was attending hospital wards or clinics, meaning she could put vulnerable patients as well as fellow students and hospital staff at risk.

In addition to this, the student had initially been dishonest when first questioned about her actions and only admitted what had happened when she realised there was compelling evidence. Patients and the public must be able to trust those working in medical practice and although these events occurred outside the student’s professional life, being dishonest could call her suitability to being a doctor into question.

Concerns about dishonesty are often the most difficult for students and doctors to deal with and it can be difficult to convince both medical school FTP panels, the GMC and Medical Practitioners Tribunal Service (MPTS) panels that they are not inherently dishonest. This is in contrast to a clinical concern, which can often be remediated by additional training or even an error of judgment in one’s personal life.

The implications of a FTP hearing

Outcomes of FTP panel hearings can vary from a finding of no case to answer and, therefore, no sanction to a warning or even suspension or dismissal from the course.

Where a student has been subject to a FTP investigation, they will need to declare this to the GMC when they complete their application for pre-registration. The medical school will also have to inform the GMC that the student has been the subject of an investigation. This in turn may result in a GMC investigation and the potential to delay pre-registration and the start of a newly qualified doctor’s FY1 post.

MDU advice and support

The medical student called the MDU advice line for help. The student was advised by a MDU medico-legal adviser to write a reflective account of what had happened. A statement for a FTP investigation needs to be open, honest and factually correct. This avoids any further allegations of dishonesty. The student was advised to consider her actions and why these had been inappropriate and to provide an apology.

In preparation for writing the statement, the student was advised to read through the GMC’s guidance for doctors, including:

• Good medical practice
• Achieving good medical practice – this guidance specifically refers to professionalism and the key areas of concern and actions that will undermine the trust patients have in doctors and the public has in the medical profession.

Due to the initial dishonesty that the student had displayed, the case was referred to a FTP panel hearing. The hearing was held remotely, because of the pandemic, rather than in person as would normally be the case. The MDU adviser gave the student specific advice on how to prepare for a remote hearing and also joined the meeting remotely on video.

The student accepted the allegations and apologised for the initial dishonesty and inappropriate behaviour. She gave a good account of herself. She also satisfied the panel that she had learned from this experience and that it was unlikely to be repeated. The student had a clear understanding of not only why her personal behaviour was important but, more so, the paramount importance of being an honest person and how concerns about a doctor’s probity can undermine a patient’s confidence and trust.

The panel explained that due to the dishonesty, she would receive a final written warning. The panel also made it clear the student’s proactive reflection of her own behaviour and sincere apology had been critical to her continuation on the course.

The student was reminded that she would need to inform the GMC of the investigation. The student was strongly advised to ensure that her professionalism was not called into question again. The panel also asked for regular updates on the student’s progress from her supervisors during the remainder of the course.

Seeking support when you need it

The pandemic is taking its toll on university students across the board but medical students, due to the nature of their course and the fact that they are working in clinical areas, have been particularly affected. This is in addition to the impact that the restrictions have had generally on our lives. It’s obviously important to comply with the rules to help keep everyone safe and to protect the NHS, however, you also need to look after your own physical and mental health and keep an eye on your friends and fellow students to make sure they’re coping too. We may all be in the same storm but we are not all in the same boat and how we react and respond in these unprecedented times we are living in will vary for everyone.

Some medical students have had to go back to university due to the need to attend clinical or practical activities. Even those who had planned to live with others during the academic year may have found that they are living alone as their friends on other courses have decided to work remotely from home. In this situation, it may be appropriate to form a support bubble with another household so that you are able to visit them. Check the rules in your local area online for up to date information on support bubbles.

Universities have support and student welfare services available if you are struggling and you should speak to your educational or clinical supervisors. If you are concerned about your physical or mental health, seek advice from your GP. Sometimes it is difficult to be objective about your own health. It is important to follow advice and seek help if concerns are raised about your health, for example, by a tutor or someone who you are working with on the wards.

Finally, if you do face difficulties with your fitness to practise during your time at medical school, seek advice from us early. That way, you'll be guided through the process from the start and we can help you best represent yourself.

This is a fictional case based on calls and cases dealt with by our advisory team.