Sunday, 19 February 2012

Are medical schools abusing 'fitness to practice'?

In 2005 the GMC introduced guidance on 'Professional values and fitness to practice' for medical students. Some have said the notion that a student could be 'fit to practice' is they aren't licensed until after graduation. But the case has been made that medical students are placed in a position of trust with regards to patients and public as students so they should be held to higher standards than other students.

However, a conversation on Twitter today suggests that some medical students feel that medical schools are abusing their responsibility to ensure students 'fitness to practice' by threatening to carry out FTP procedures for what students perceive as minor misdemeanours  such as missing a day on placement.

You can find the fitness to practice guidance of many medical schools online. They specify serious and severe health and professional issues, but often have a line which says 'and any other matter which may call into question a student's fitness to practice'. This ambiguity is retained in a lot of professional guidance because it is impossible to specify every single circumstance that may mean that concerns would be justified, but it may be that this alarms students as they feel that the guidance then leaves too much leeway to the medical school and potential for abuse as suggested.

So do you think that medical schools are becoming unnecessarily disciplinarian? If so what is driving them to do this? Or are standards slipping? Were higher standards expected of medical students 'in your day'?

UPDATE: Thanks to @jomciver for this link to a very helpful blog post from senior staff in Birmingham medical school on what Fitness to Practice means (and what it doesn't)  and how they are trying to make the process clearer.


  1. I feel as if it's definitely more threat than action with our med school. However, they placed a lot of emphasis on us reading this article, I believe it's fear of the media that influences the increase in discipline:

    1. Thanks @medstudent :) What was the reaction of students to reading this article? Did they feel it was fuss over nothing? Did your medical school suggest that students engaging in activities like this might be subject to FTP procedures?

      Your point about how the media (and wider community) perceives medical student's behaviour is a good one. Is it good that people know what students get up to? Or is something that should be kept behind closed doors? And is it possible to keep stuff like this out of the public view now?

    2. A lot of my colleagues read it in the first few week of the term of first year and thought that it was the end for their hopes to participate in 'normal' student activities eg. no excessive drinking, no photos on facebook that might suggest drunkenness etc. We had several lectures on the topic of FTP and specifically online behaviour and they made it very clear that any sort of 'inappropriate' behaviour would not be tolerated, and the FTP tribunal as the ultimate threat.
      However since then that fear has completely vanished - most students thinking that realistically, there aren't many people who'd leave their online accounts open to the public and trusting that the friends they do have online won't send their (possibly incriminating) pictures out to the media.

      It's difficult to say whether these things should be kept from being reported to the public in the media. They are often so exaggerated, making huge sweeping assumptions about the behaviour of entire years of students/medical schools. These ultimately must affect the doctor-patient trust and university reputation in a bad and unnecessary way.
      If anything, I think transparency to the public about med student behaviour in the latter/more clinical years of the course is different. These students are in the hospitals, regularly interacting with and carrying out procedures on patients. If a scandal of great proportion were to emerge involving older students, attempting to conceal it could be risky, causing an even great breach of public trust if uncovered.

    3. I think that the Imperial story is not in the Daily Mail because it is telling a story that could be about any university student but because it shows what some consider to be a pervasive culture amongst medical students. As you say it isn't all medical students in all medical schools and it might't even be all 'rugby boys' in Imperial.
      I guess that if your medical school is directing you to read this then they are saying that they do not want a culture like this in your medical school. Is that enough to change a culture? That's a topic that could generate many more blog posts. Here is one paper about how one medical school went about trying to change it's culture and 'informal curriculum'

  2. Slightly off topic but Bristol are certainly making an effort to 'teach' professionalism, something I'm not really sure is possible. Of course you can educate people about the boundaries of professionalism but as you correctly say, often these boundaries are rather ambiguous, and I don't think this sort of education necessarily makes students more professional.

    Professionalism is something that is be part of your personality and your personality naturally develops during your time at medical school and as you get older.

    In my opinion there is a clear distinction between the behaviour expected of an 18 year old 1st year student and a 22+yr old final year and I do worry that trying to police this will have a negative influence rather than a positive one.

    1. Teaching professionalism? I think that there are a few levels to being professional. We can follow the 'rules'- and we learn the rules because they are overt through guidance or because we pick them up from being around other professionals. Next, we can decide if we can internalise those rules and see how they make sense to us. We may end up rejecting some of them because they don't fit with our own values but we'll be prepared to justify that to others. And finally, there is an awareness that our rules and the rules of the profession are not shared universally. We come across situations where are values are in conflict with others and we have to decide how to make sense of that.

      Professionalism is 'ethics in action'. You learn it by doing, but we all need help.

  3. I read the Daily Mail article. It was unnecessarily mean and snide. I was glad to see that the majority of the commenters called them on this.

    In the US (as you know), med students are four years older than in the UK. They have already had their four years of experimentation. Binge drinking on undergraduate campuses is very common in the US. It’s unfair of the Mail to single out teenaged med students and imply people should be worried about their doctors. It was nice to see from the comments that the public is more intelligent than the journalist.

    UK med students are probably living away from home for the first time in their lives – a major transition. It’s a time to discover who you are and who you want to be. Whatever happened to the wisdom that we learn from our mistakes?

    In the US, doctors and lawyers are often considered together when discussing professions. The undergraduate behavior of lawyers is understood as age-appropriate. It doesn’t even keep lawyers from becoming President (“but I didn’t inhale.”)

    This issue reminds me of your previous post on how doctors should act “at all times” (in their private lives) to uphold Good Medical Practice. Do I see a theme here?


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