Many UK medical students begin university as teenagers, go through five or six years of training and then come out the other end as doctors. Medical school is notoriously difficult and many will have to resit examinations of some sort. What is less widely known is that an increasing number of students go through “fitness to practise”procedures. Abbreviated to “FTP” (or “F2P” by the more trendy medical schools), fitness to practise is a much-feared buzz-phrase. Once it became widely adopted, lectures were able to casually drop into their talks that being late could potentially be a “fitness to practise issue”. University staff were able to mention off-hand that students not checking their email regularly enough could be casting doubts on their “fitness to practise” as doctors. Medics in older years would tell first-year students that not attending certain social events in welcome week (the re-branded freshers’ week) could constitute a “fitness to practise issue”. Such is the gravity these words are imbued with that some would believe these lies.
Which is why a booklet designed to point out what medical students shouldn’t do, when they should be punished and even when they should be ejected from the course is to be welcomed. Unintuitive though it may be, the body responsible for banning doctors from practising medicine ominously issuing guidelines on undergraduate behaviour is good news for medical students. The reason is simply that before there were no guidelines. The various medical schools have one pretty good incentive to fall in line with the General Medical Council (GMC) as their Quality Assurance of Basic Medical Education (QABME) cycles decide whether or not they can aware medical degrees. In the GMC’s own words, “Also, given that the GMC has to be satisfied that graduates applying for registration are fit to practise, it would be surprising if a medical school thought it sensible to disregard this guidance.”
Completion of the medical degree in the UK leads to provisional registration with the GMC, followed by full registration one year later, and therefore recourse to proceedings which can lead to being “struck off” the medical register. It is very important that doctors remain publically accountable, in fact the British Medical Assocation (BMA) lobbied for the established of the GMC in the first place when the Medical Act of 1858 went through Parliament. This was to battle the quackery du jour, as at that time “doctor” was not a protected title, and so anyone could use this title.
With medical schools now more directly accountable to the GMC it is now easier for the student body to lobby on issues. Whereas previously local issues were local issues, and any students complaining about unfair fitness to practise procedures could potentially be subject to unfair fitness to practise procedures, now any discussions can be made centrally. The Student Fitness to Practise Working Group to develop this guidance was founded as a collaboration between the GMC and what is now the Medical Schools Council (MSC), the in which the Deans of all the UK medical schools make plans. This body co-opts one elected member of the BMA’s Medical Student Committee (also the MSC), who has the tough job of keeping an eye on what’s being said on behalf of medical students everywhere.
Fortunately, there are no big nasty surprises within this document. The key issue which is raised is just how “off-work” medical students are when they’re in their own time and outside of a clinical environment. The best predictor of future behaviour is past behaviour, it would clearly be unsafe to leave patients in the care of a doctor who had a criminal conviction for physical violence, who cheated in exams, who falsified research or who was too ill themselves to treat others. The controversial issue comes in the form of a disparity in the examples of concern between “Alcohol consumption which affects clinical work or the work environment” and “Dealing, possessing or misusing drugs even if there are no legal proceedings”. The government’s chief advisor on drugs Sir David Nutt found in the famous 2007 Lancet paper
to no great surprise that many illegal drugs are less harmful than alcohol. Interpreted literally, these rules would mean that a first-year students experimenting with drugs once in her first term at university would automatically be a fitness to practise concern, but an alcoholic who managed to hold it together through finals would not be.
Historically, there have been great discrepancies between proceedings in different medical schools. What would be seen as a jolly prank at one institution would be seen as definitive proof that a young person was unsuitable to ever be a doctor at another. These discrepancies were sufficient to spur the GMC into action. Standardised procedures define the roles of the investigator, the fitness to practise panel and appeals process. The investigator decides whether or not there is sufficicent evidence to determine if a student’s fitness to practise is impaired on the balance of probabilities. This civil standard of proof means it is quite likely that students who are being investigated in the first place will make it to the full fitness to practise panel. The standard of proof in the fitness to practise hearing itself is also on the balance of probabilities, in the line with how doctors are now tried.
The only requirement for the composition of the fitness to practise panel is that it must contain one GMC-registered doctor. I suppose a medical school would find it difficult to argue that one doctor by themselves makes a panel. Recommendations are that the panel includes someone from outside the medical school, someone with legal knowledge and a student representative who does not know the student being investigated. Appeals themselves are less rigidly defined. There’s no new real advice for medical students to be garnered from this new document apart from the obvious: don’t do anything silly.