17Providers have an important role in supporting students to achieve fitness to practice, in ensuring that students understand why the professional standards are important and what this means for them.
18As well as giving students information about what they need to disclose when they apply, providers should, at an early stage, bring to students’ attention the expected standards of behaviour, and the consequences of breaching those standards. This can be set out in codes of conduct, student charters and the relevant professional body’s guidance. Students should be made aware of these early in their studies, regularly during the programme, and before practical placements.
19Providers should make sure that course structures incorporate opportunities for students to work through examples of fitness to practise issues, for example through role play, so that they are well equipped for practical placements.
20Students are expected to behave professionally and competently at all times. But students who fall short of the expected standards of professionalism and competence early in their studies are more likely to have the chance to improve their behaviour than those nearing the end. Some professional qualifications involve different levels of study, for example undergraduate and postgraduate levels. It is the responsibility of the provider to teach, train, mentor and support students towards the standards that apply at each level. The exception to this would be a student who is already registered as a member of a profession and is studying towards a further qualification in that field. Those students would be expected to maintain professional standards from the beginning of their course.
Health and disability issues
21Sometimes fitness to practise concerns are related to the student’s mental or physical health, or to a disability.
22Providers should be aware of their duties under the Equality Act 2010 to make reasonable adjustments for disabled students in relation to a provision, criterion or practice other than a competence standard. A competence standard is defined in the Equality Act as “an academic, medical or other standard applied for the purpose of determining whether a person has a particular level of competence or ability”[2].
23Providers have a responsibility to ensure that students are properly supported during practical placements. Providers should agree with the student before the placement starts what information can be shared with the placement to make sure that support is in place.
24If the matter leading to the fitness to practise concern may be related to a student’s disability, the provider should consider whether the student requires additional support, and whether it should make reasonable adjustments to the way in which it is assessing the student. This might include agreeing and arranging additional support for the student in their practical placement setting. Providers should consider each case individually.
25Providers should consider what evidence, if any, it requires from the student so that it can properly assess their fitness to practise and support them in their studies. This might include medical evidence and/or occupational health referral. Providers should support students in obtaining this evidence, for example, by directing them to the appropriate expert and paying for the report where this is proportionate.
26Most regulators now provide extensive guidance about health and disability issues, which may be relevant to the provider/student relationship. For example, the General Medical Council (GMC) and Medical Schools Council (MSC) publish professional behaviour and fitness to practise guidance, which says:
“In most cases, health conditions and disabilities do not affect a medical student’s fitness to practise, as long as the student:
- demonstrates appropriate insight;
- seeks appropriate medical advice; and
- complies with treatment.
Medical schools must make adjustments, where possible, to allow a student to fulfil the core competencies of their course and enable them to study and work safely in a clinical environment.”[3]
27A provider may be able to make adjustments to a student's learning and working environment to make it possible for that student to meet competence standards. The GMC's “Welcomed and valued” guidance [4] provides practical suggestions to medical schools to make their courses more accessible to students.
Examples of reasonable adjustments
Providers must make reasonable adjustments to the learning environment and to its assessment methods. (There is no requirement to make adjustments to competence standards.)
- Changes to the physical environment to improve access to facilities.
- Providing or allowing students to use assistive tools (such as a visual display stethoscope) or technology (such as dictation software).
- Adjustments to teaching and learning, including providing information in a variety of formats.
- Adjustments to examinations and practical assessments, such as extra time or provision of a scribe.
- Additional training time when a student’s health means they can’t meet learning objectives in time.
- Flexible training – extending the programme to allow reduced working hours on placement so that a student with a disability can balance work and rest, while still meeting the minimum placement hours required.
28Providers have an anticipatory duty to make reasonable adjustments for disabled students. The provider should work with disabled students and disabled people’s organisations when considering how best to remove barriers to learning. When students think that they might need additional support it is important for them to tell the provider. Although students don’t have to tell providers about a disability, providers should make sure that there is a supportive environment that encourages them to; and that students understand the need for insight into their condition. Providers should explain to students that they need to tell the provider if there is anything that might affect their ability to study or fulfil competence and for which they might need additional support, even if they don’t want to give details of what it is.
CASE STUDY 1: Health and disability
A trainee teacher has anxiety and depression. The provider meets with the trainee to discuss what it can do to support them during their studies and while they are on placement in schools and a support plan is agreed.
The trainee has an anxiety attack at the school where they are on placement and the school sends them home. The provider meets with the student to discuss what has happened and to see whether there are any fitness to practise concerns about the student’s health. The student says that their counsellor is helping them develop strategies for managing their anxiety. The provider agrees some additional support with the student and the school, and the student continues with their studies.
CASE STUDY 2: Health and disability
A third-year dentistry student has dyslexia. The provider agrees a range of support measures including additional time in assessments, study mentoring, library assistance and advance copies of lecture materials.
The student is accused of stealing money from another student’s bag. The provider takes action under its disciplinary procedures and explains to the student that it also has concerns about the student’s fitness for practice. The student denies stealing the money and blames another student.
At the disciplinary hearing the student admits that they stole the money. The disciplinary panel tells the student to write a letter of apology and to pay the money back. It refers the student under the provider’s fitness to practise process.
The provider’s fitness to practise panel considers the conclusions of the disciplinary panel and hears from the student, who says they were under a lot of pressure because of their dyslexia. The panel decides that the student's fitness to practise is impaired because they have behaved dishonestly, and then lied about it. It decides that the disciplinary offence was not linked to the student’s dyslexia.
GMC and MSC guidance on considering health and disability issues[5]
Guidance published by the GMC and MSC says “Students with health conditions – in particular, those with mental health conditions – are often identified as having problems because they display unprofessional behaviour that is out of character, such as poor attendance or failure to engage with their studies. Medical schools should give their staff training to help them identify, at an early stage, students whose behaviour indicates an underlying health issue.
Medical schools can use low-level concerns processes to identify and support students with health conditions. They can also use their fitness to practise procedures where making adjustments and providing support have been tried without success. The fitness to practise process can help students by making sure they access the support that will enable them to complete their course.
When a student has a medical problem, it’s important to consider their fitness to study – whether they are well enough to participate and engage in their programme.”
