Policy responses and statements

Name of organisation:

General Medical Council

Name of policy document:

Strategic proposals for student fitness to practise

Deadline for response:

25 October 2006

Background: The College was invited to participate in a period of informal feedback on areas of policy development in undergraduate medical education. The GMC launched 3 documents for early consideration on assessment and student fitness to practice. This follows a wide-ranging consultation on 'Strategic Options for Undergraduate Medical Education' which the College participated in last year. The consultation focused on national assessment, student registration and key principles in 'Tomorrow's Doctors'. The final report is now available on the GMC website.

The purpose of this informal stage of the consultation process was to give interested groups and people a chance to inform the GMC's policies and direction of travel. Towards the end of 2006, the GMC will publish a full account of this feedback with a view to initiating formal consultations in 2007.

In the current informal document on student fitness to practise, the GMC set out a number of ways in which local arrangements could be improved:

- Guidance on student fitness to practise
- Revising Tomorrow's Doctors to embed fitness to practise
- Reviewing QABME with a view to promoting effective student fitness to practise arrangements
- The development of mechanisms to share information between medical schools and the GMC

The GMC is also considering national procedures and looking into the policy implications of:

(a) The GMC advising medical schools on individual cases in local student fitness to practise procedures or
(b) The GMC acting as a backstop when the local procedures fail to protect patients, which could involve a UK-wide register of medical students.

COMMENTS ON
GENERAL MEDICAL COUNCIL
STRATEGIC PROPOSALS FOR STUDENT FITNESS TO PRACTISE

The Royal College of Physicians of Edinburgh is pleased to respond to the GMC on Strategic proposals for student fitness to practise.

The College has considered the evidence and options offered to address the important issue of student fitness to practise in the context of the continuing debate about doctors’ fitness to practise, and the likely changes following the Donaldson recommendations.

The College agrees that medical students must adhere to the ethical framework of the profession for the safety of patients and the reputation of medicine.  The College also accepts that leaving student fitness to practise procedures largely in the control of the 27 or so individual medical schools is unlikely to support consistency, despite the impact of GMC quality assurance procedures.  However, it is important that fitness to practise procedures both protect patients and support students and, as such, a more local approach may be more effective for most cases.

The College has considered the 5 options presented and agrees with the GMC’s reasons for rejecting:

• Option 1 – assessing FTP only at the point of provisional registration - this would be wasteful and miss opportunities for remedial action.

• Option 2 – routine GMC involvement in local medical school FTP procedures – this would bring organisational difficulties, be potentially wasteful and hard to evaluate.

• Option 3 – GMC led FTP procedures for students – would create a parallel system and may confuse students in terms of expectations.

The College agrees that Option 4 – GMC advising on individual cases as required - could bring benefit and would build on current informal practices, creating a partnership model between the GMC and the medical schools.

Option 5 – GMC as a fail safe option in serious cases would be a further development of Option 4 and therefore is worth further exploration.

For Options 4 and 5 to function effectively, all students would need to have a formal relationship with the GMC and registration becomes inevitable.  In discussion, Fellows and Collegiate Members have expressed some disquiet about overly oppressive regulatory controls over young undergraduates in their first years away from home.  However, the earlier introduction of clinical teaching in many courses makes it is imperative that student conduct, risk taking and competence is controlled and, when necessary, corrected.

On balance, therefore, the College can see a case for student registration with the regulator, although a working partnership with medical schools to deliver consistent and effective local FTP procedures supported by the GMC in the more serious cases would be preferable. Student registration should be at no cost to the students themselves.

The College would be interested in the views of the GMC on the potential inequity resulting from medical graduates from other EC member states and Switzerland seeking provisional registration without undergraduate scrutiny.

Copies of this response are available from:

Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.

Tel: 0131 225 7324    ext 608
Fax: 0131 220 3939

[23 October 2006]