Myth Busting: Professionalism and Fitness to Practise
What is professionalism?
Professionalism can actually be a really difficult concept to describe, but it is fundamental to all we do as doctors and medical students. The Royal College of Physicians define it as ‘a set of values, behaviours and relationships that underpin the trust the public has in doctors.’ The General Medical Council expects that both doctors and medical students behave in a way that justifies that trust, and has produced guidance for medical schools to make sure that professionalism as a concept is well covered in the medical course.
It may be useful for medical students to refer to the GMC’s policy document ‘Achieving good medical practise: guidance for medical students'. In this booklet, the GMC outlines four domains which underpin your journey as a medical student:
- Knowledge, skills and performance
- Safety and quality
- Communication, partnership and teamwork
- Maintaining trust
Expectations of behaviour are grouped to one of these domains. For example, domain three includes guidance on the importance of maintaining patient confidentiality, and working collaboratively as part of a team.
What is the Professionalism and Academic Competency Committee (PACC)?
This is a committee in the School of Medicine which has oversight of the professionalism curriculum in the school. It provides guidance to other school committees and module leads about the coverage of professionalism as a concept, and its assessment.
PACC also oversees the process of reporting and investigating professionalism concerns about a student, to ensure that the process is fair. Where recommendations have been made in order to facilitate professionalism remediation of a student, PACC oversees this process too.
The committee was set up in response to a review of a number of recent cases of students who had been brought to a fitness to practice process because of concerns about their professionalism. On several occasions, it became apparent that a pattern of ‘low level concerns’ had been emerging earlier on in the course. If these concerns had been adequately addressed at the earlier stage, it was likely that the student wouldn’t have had to have gone through the fitness to practise investigation. The General Medical Council has also stipulated that schools have a process for monitoring low level concerns – as evidence from postgraduate education suggests that doctors who have professionalism problems may have had concerns raised about them as a student, which were not adequately addressed.
Read more about the work of PACC
What is a ‘low level concern’?
This could be described as a lapse in professional behaviour, which on its own may not be a true reflection of an individual’s professionalism, but if viewed as part of an emerging trend, is important to consider.
For example, a member of the administrative team may report that a student has been rude to them. The student may then apologise and reflect on why they were perceived to be rude, and how they can attempt to not appear rude in a similar situation.
An isolated incident of a student’s alleged rude behaviour would not usually be taken to mean that a student is unprofessional with their person interactions. However, if in the next attachment a different member of the multiprofessional team reports that the same student was rude to them, this would be more concerning, and could indicate genuine concerns.
What is an ‘intervention form’?
This is the main means by which the PACC are informed about a potential low level concern. Any alleged lapse in professional behaviour can be reported to the PACC on this form. The form can be completed by anyone – a fellow student, member of university or trust staff, member of a GP practice or member of the public. The allegation on the form is then investigated by the lead for professionalism, or their nominated deputy.
Read more about the 'request for intervention' form
How is this different to a ‘support form?’
Support forms can also be raised by anyone - and should be raised as a means of suggesting that a student may benefit from welfare support. For example, a clinical educator may have noticed that a student appears more withdrawn than usual in a teaching session. Support forms are reviewed by members of the welfare team and are not seen by the professionalism team unless the welfare team are concerned about a professionalism issue.
Read more about the 'request for support' form
How is PACC different to fitness to practise panel?
PACC is designed to monitor low level concerns. The fitness to practise process gets invoked if there was demonstration of a severe lack of professionalism. The GMC also has guidance on this. For example, if an intervention form was raised because a student had been arrested and charged with dealing class A drugs, this would be immediately referred for a fitness to practise investigation, rather than to the PACC.
In its role in monitoring low level concerns, it is possible that PACC may refer a student for investigation by the fitness to practice process. For example, a pattern of non-attendance may have emerged through the process of low level concern monitoring. If the student then fails to engage with the remediation process, and persists in non-attendance despite having received a warning, they may be referred to the fitness to practise process. This would always be the exception to the rule, and all options for primary remediation would be explored before referral to the fitness to practise process.
What kinds of issues result in fitness to practise proceedings?
The General Medical Council have outlined common reasons that lead to medical students being investigated in a fitness to practise hearing. These include:
- Criminal conviction or caution
- Drug or alcohol misuse
- Aggressive, violent or threatening behaviour
- Persistent inappropriate attitudes or behaviour
- Cheating or plagiarism
- Unprofessional attitudes or behaviour
- Health concerns – Lack of insight in how impacting on their duty of care
Read more about fitness to practise
I have struggled with mental health issues; do I need to worry that a fitness to practise hearing could be convened about me?
NO. The General Medical Council is very clear on the fact that having a mental illness does not preclude you from practicing as a doctor. As long as you are engaging with appropriate medical treatments and occupational health assessments, fitness to practise should not be a concern. There would only be cause for fitness to practise investigation where an individual has no insight into their illness or where they are failing to engage in treatment (as this could put patients or colleagues at risk).
What about celebrating excellent professionalism?
The school is very aware that discussions about professionalism can be focused around fitness to practise and a lack of professionalism, when actually the vast majority of students demonstrate excellent professional behaviour and would never come close to a fitness to practise panel.
As well as investigating and monitoring reports of poor professionalism, the PACC will also receive reports of students who have demonstrated exemplary professional behaviour. When this occurs, students will be notified and congratulated. Where appropriate, there will also be the opportunity for students to be celebrated with specific mention of their exemplary professionalism at the end of each academic year.