Cambridge University Reporter


REPORT

Joint Report of the Council and the General Board on procedures for dealing with questions of fitness to practise medicine of medical students

The COUNCIL and the GENERAL BOARD beg leave to report to the University as follows:

1. Graduation with a UK medical degree such as M.B., B.Chir. confers an automatic right to practise medicine. The General Medical Council has advised, and has agreed collectively with universities, that in order to protect patients there should be a means of preventing a student from continuing to study for such a degree if he or she is unfit to practise medicine. A heavy responsibility falls therefore on UK universities with medical schools to ensure that any conduct, behaviour, or other matters that could bear on a student's suitability or fitness to practise medicine or deal with patients that comes to light during the student's course must be properly handled by the university, which could not confine its responsibility to academic issues alone. Medical students in the University of Cambridge are informed of the special position of medical students through the Code of Conduct for Medical Students which reflects the guidance of the General Medical Council on standards of behaviour and principles of good medical practice. The Code of Conduct is published as an Appendix to this Report.

2. The regulations for the Faculty of Clinical Medicine (Statutes and Ordinances, p. 562) currently state the following:

3. Subject to the powers of the Council and of the General Board, the Faculty Board [of Clinical Medicine] shall maintain a register of students who are approved by the Director of Medical Education [previously the Clinical Dean], or by a deputy appointed by the Faculty Board for admission to courses leading to the degrees of Bachelor of Medicine and Bachelor of Surgery. The Faculty Board shall have the power, on the recommendation of the Director or the deputy for the Director, to remove from the register the name of any student, subject to consultation with his or her Tutor,

(a) if the Faculty Board are satisfied that the student is no longer a fit person to have the privilege of access to patients; or

(b) if the reports of the student's clinical teachers show that he or she has not been working to their satisfaction.

In recent times, the Clinical Dean, and now the Director of Medical Education, has been advised by a Fitness for Practice Committee of the Faculty Board. As a result of the introduction of clinical teaching for medical students during the first three years of the course, all medical students are now placed on the register at the beginning of their undergraduate course. The Committee membership therefore includes the Director of Medical and Veterinary Education and representatives of the Faculty of Biology and the Colleges.

3. In the light of national discussions on this subject, it became clear to the Faculty Board of Clinical Medicine that the current arrangements required review on the following grounds:

(a) To clarify the procedures to enact the provisions in place in the Ordinances, and
(b) to provide a mechanism for a student to appeal against the decision for removal from the register.

4. The Faculty Board of Clinical Medicine in consultation with the Faculty Board of Biology invited the current Fitness for Practice Committee to discuss the issues and they support unanimously the procedures proposed by the Committee. The Faculty Boards have recommended to the Council and the General Board that the regulations to govern these procedures set out in the Annex to this Report, which would relate to all cases, be adopted. However if prior to, or at any stage of the proceedings of a hearing regarding fitness for practice, it should become apparent that the student's alleged problems are caused by serious ill-health or disability, or that a breach of the University's discipline is concerned, the case would be investigated first under the procedures related to those particular issues.

5. The Faculty Boards have proposed that the procedures should be kept under review by a formally constituted Fitness for Medical Practice Committee which would replace the existing Fitness for Practice Committee and that any proposed changes of substance should be the subject of report to the University.

6. The Fitness for Medical Practice Committee would be a joint Committee of the Faculty Boards of Clinical Medicine and Biology and would submit reports as relevant also to the Medical Education Committee. The Faculty Boards have agreed to delegate to the Fitness for Medical Practice Committee full authority to manage the procedures on their behalf.

7. The Council and the General Board recognize the need for the University to have in place clear and detailed procedures to ensure that no student should continue to study for the M.B., B.Chir. Degree if he or she is unfit to practise medicine and have agreed to accept the proposals set out in this Report.

8. The Council have also agreed that it is necessary for the University to establish formal procedures to enable a medical student who has been removed from the Medical Student Register by the Fitness for Medical Practice Committee to appeal against the Committee's decision. They therefore propose the establishment of a Fitness for Medical Practice Appeal Tribunal which would consist of three members: a Chairman who would be drawn from a panel of legally qualified persons; and two persons drawn from a panel of Members of the Regent House. The Council would maintain the panels. Regulations to govern the rules of procedure of the Appeal Tribunal are set out in the Annex to this Report.

9. The Council and the General Board accordingly recommend:

I. That regulations to govern procedures for the consideration of a medical student's fitness to practise medicine as set out in the Annex to this Report be approved.

II. That the regulations for the Faculty of Biology (Statutes and Ordinances, p. 558) be amended by inserting the following new regulation:

Medical Students Register

The Faculty Board and the Faculty Board of Clinical Medicine shall maintain jointly through a Fitness for Medical Practice Committee a register of students who are deemed fit to practise medicine and consequently to be admitted as candidates for the Second Examination and the Final Examination for the degrees of Bachelor of Medicine and Bachelor of Surgery. A Fitness for Medical Practice Appeal Tribunal shall have the power on appeal from a student affected by a decision of the Fitness for Medical Practice Committee to confirm, quash, amend, or refer back to the Fitness for Medical Practice Committee the decision in question.

III. That the regulations for the Faculty of Clinical Medicine (Statutes and Ordinances, p. 562) be amended as follows:

Regulation 3.

By amending the regulation so as to read:

3. The Faculty Board and the Faculty Board of Biology shall maintain jointly through a Fitness for Medical Practice Committee a register of students who are deemed fit to practise medicine and consequently to be admitted as candidates for the Second Examination and the Final Examination for the degrees of Bachelor of Medicine and Bachelor of Surgery. A Fitness for Medical Practice Appeal Tribunal shall have the power on appeal from a student affected by a decision of the Fitness for Medical Practice Committee to confirm, quash, amend, or refer back to the Fitness for Medical Practice Committee the decision in question.

IV. That the New and Revised and New Curriculum Regulations for the degrees of Bachelor of Medicine and Bachelor of Surgery (Statutes and Ordinances, pp. 422 and 431, and Reporter, 2003-04, p. 1067) be amended as follows:

Regulation 3 (New and Revised and New Curriculum Regulations).

By adding a new sub-paragraph (m), (l) for New Curriculum Regulations, so as to read:

(m)the term Medical Students Register shall mean a register of students who are deemed fit to practise medicine. A student may be removed temporarily or permanently from the Register if he or she is deemed no longer a fit person to have the privilege of access to patients. Subject to the powers of the Council and of the General Board and of a Fitness for Medical Practice Appeal Tribunal, the Register shall be maintained by the Faculty Boards of Biology and Clinical Medicine through the Fitness for Medical Practice Committee.

Regulation 10 (New Regulations) and Regulation 11 (Revised and New Curriculum Regulations).

By attaching the following final sentence:

No student whose name does not appear on the Medical Students Register shall be a candidate for any subject of the Second M.B. Examination.

Regulation 14 (New Regulations) and Regulation 17 (Revised and New Curriculum Regulations).

By attaching to the end of this regulation the following sentence:

No student whose name does not appear on the Medical Students Register shall be a candidate for either Part of the Final M.B. Examination.

25 October 2004 ALISON RICHARD, Vice-ChancellorDAVID GOODJAMES MATHESON
 R. J. ANDERSONDAVID S. INGRAMMARTIN REES
 Z. BARANSKIIAN LESLIEG. A. REID
 RICHARD BARNESA.M. LONSDALEWES STREETING
 JOHN BOYDD. LOWTHERLIBA TAUB
 WILLIAM BROWND. W. B. MACDONALDJOAN M. WHITEHEAD
 GEMMA DONALDSON  

25 October 2004ALISON RICHARD, Vice-ChancellorH. A. CHASEMELVEENA MCKENDRICK
 JOHN BELLM. J. DAUNTONROGER PARKER
 TOM BLUNDELLR. FRIENDKEITH PETERS
 WILLIAM BROWNDREW LIVINGSTONS. J. YOUNG
 N. O. A. BULLOCKD. W. B. MACDONALD

ANNEX

Procedures to determine fitness for medical practice of pre-clinical and clinical medical students

1. The following regulations shall govern the procedures in the University to ensure that pre-clinical and clinical medical students are fit to practise medicine.

2. There shall be a Medical Students Register which shall be maintained by the Faculty Boards of Biology and Clinical Medicine through a Fitness for Medical Practice Committee constituted in accordance with Regulation 5.

3. Where there is a question concerning the fitness for practice, through serious ill health or inappropriate conduct, of a medical student, the Committee shall appoint a Fitness for Medical Practice Adjudication Board constituted in accordance with Regulation 12 to consider whether to remove the student's name from the Medical Students Register. The Adjudication Board shall make its recommendations to the Committee.

4. A medical student shall be entitled to appeal to a Fitness for Medical Practice Appeal Tribunal constituted in accordance with Regulation 15 against a decision of the Committee to remove her or him from the Medical Students Register.

Fitness for Medical Practice Committee, Fitness for Medical Practice Adjudication Board, and Fitness for Medical Practice Appeal Tribunal

Fitness for Medical Practice Committee

5. The Fitness for Medical Practice Committee shall consist of:

(a)the Director of Medical Education in the Faculty of Clinical Medicine;
(b)the Director of Medical and Veterinary Education in the Faculty of Biology;
(c)the Director of the Cambridge Graduate Course in Medicine;
(d)an officer in the Clinical School appointed by the Faculty Board of Clinical Medicine (who shall be Secretary);
(e)the University Occupational Health Physician (or a deputy);
(f)one member appointed by the Senior Tutors' Committee;
(g)four members appointed by the Faculty Board of Clinical Medicine, of whom two shall be practising GMC-registered medical practitioners and two shall be lay members, one of whom shall have experience as an NHS Trust Non-Executive Director;
(h)one member appointed by the Faculty Board of Biology.

6. Members in classes (f)-(h) shall be appointed in the Michaelmas Term to serve for three years from 1 January following their appointment.

7. The Chairman of the Committee shall be appointed from among the members of the Committee in classes (f), (g), or (h) by the Faculty Board of Clinical Medicine.

8. The duties of the Committee shall be

(a)to maintain on behalf of the Faculty Boards of Biology and of Clinical Medicine a register of medical students who are deemed fit to practise medicine, taking into account the students' health and conduct;
(b)to produce and keep under review a code of conduct to be observed by medical students;
(c)to appoint members of a Fitness for Medical Practice Panel and to maintain a list of such members;
(d)to appoint members from the Panel to serve on a Fitness for Medical Practice Adjudication Board, should it be necessary for such a Board to meet, to consider individual cases for removal from the Medical Students Register;
(e)to keep under review procedures for the Medical Students Register and to recommend changes in those procedures to the Faculty Boards of Biology and Clinical Medicine, who shall report such changes to the University.

9. The Committee shall meet at least once a year in the Michaelmas Term and whenever there is any business to consider. Five members shall constitute a quorum. The Committee shall submit the minutes of any meeting to the Faculty Boards of Biology and of Clinical Medicine and to the Medical Education Committee.

Fitness for Medical Practice Panel

10. The Committee shall appoint at least ten members of the Regent House to the Fitness for Medical Practice Panel, which shall include but not be limited to members of the Faculties of Biology and Clinical Medicine and persons who are medically qualified, and shall publish annually in the Reporter a list of members of the Panel.

11. Members of the Committee shall not be eligible to serve on the Panel.

Fitness for Medical Practice Adjudication Board

12. A Fitness for Medical Practice Adjudication Board shall comprise three members appointed by the Fitness for Medical Practice Committee to consider individual cases for removal from the Medical Students Register and to recommend to the Committee whether a medical student should remain on the Register. The three members shall be chosen from the Fitness for Medical Practice Panel and shall include:

(a)in the chair, one person selected by lot from the Panel;
(b)one medically qualified person nominated by the Committee;
(c)one person nominated by the medical student, this person to be a medically qualified member of the Faculty of Clinical Medicine.

13. No member of an Adjudication Board shall have had any involvement or interest in the case or be a current teacher of the medical student.

14. The Secretary of the medical student's Faculty Board,1 or a nominated deputy, shall serve as Secretary to the Adjudication Board.

Fitness for Medical Practice Appeal Tribunal

15. The Council shall maintain two panels, panel (a) and panel (b) from which members of a Fitness for Medical Practice Appeal Tribunal shall be appointed as follows:

panel (a): persons who are legally qualified or who have had experience of acting in a judicial capacity, not being members of the Council;

panel (b): members of the Regent House not being members of the Fitness for Medical Practice Panel or of the Faculties of Biology or Clinical Medicine.

The Council shall appoint in the Michaelmas Term each year such number of persons as they shall see fit to serve as members of each panel for one year from 1 January following their appointment.

16. A Fitness for Medical Practice Appeal Tribunal shall be appointed to consider any appeal by a medical student against a decision of the Fitness for Medical Practice Committee, and shall confirm, quash, amend, or refer back to the Committee the decision made. An Appeal Tribunal shall consist of three members:

(a)one drawn by lot from panel (a), who shall be Chairman;
(b)two drawn by lot from panel (b).

17. No member of a Tribunal shall have had any involvement or interest in the case or be a current teacher of the medical student.

18. The Registrary or a person nominated by the Registrary shall act as Clerk of the Tribunal.

Rules of Procedures

1. The consideration of whether or not a medical student is fit to practise medicine must take place strictly in accordance with the following process which shall consist of three stages, preliminary, investigation, and adjudication.

2. If, at any stage:

 (a)it should become apparent or it is suspected that the medical student's alleged problems are caused by ill health or disability, these procedures shall be suspended and the Committee's procedures for dealing with serious ill health which are set out below shall be invoked;
or(b)the Chairman of any of the bodies involved considers that the medical student may have committed an offence against the discipline of the University, the Chairman shall suspend proceedings and refer the circumstances for consideration to the University Advocate under Statute B, VI. In such instances, the body or bodies shall not resume discussion of the case until either the Advocate has ruled that he or she shall not institute proceedings against the medical student under the general regulations for discipline, or, if proceedings are taken, until the University Courts have ruled finally on the matter.

Status of the student during proceedings

3. On receipt of an expression of concern made under Regulation 7 below, and during the proceedings, the Chairman of the Fitness for Medical Practice Committee, following consultation with the relevant NHS Hospital Trust officer or lead general practitioner if appropriate, shall have the authority to decide whether a medical student, who is the subject of an expression of concern, shall:

(a)continue her or his studies without limitation;
(b)continue her or his studies under specified limitations and conditions;
(c)be prohibited from entering specified clinical facilities as a medical student;
(d)be provisionally suspended from the Medical Students Register and therefore from the clinical components of the courses.

4. The Chairman may, during the proceedings, review and change a decision regarding a medical student's status.

5. If the medical student is dissatisfied with the decision of the Chairman, the student may request an adjudication by the full Committee. Pending any such adjudication the Chairman's decision shall remain in force.

6. In the event that the Chairman has any involvement or interest in the case arising other than by way of these rules of procedure, the Chairman shall stand down from the Committee while the case is being considered and shall appoint another member of the Committee as Chairman in her or his place; references to the Chairman in these rules of procedure shall be deemed to be a reference to that other member of the Committee.

Preliminary stages

7. Any expression of concern that a medical student may not be fit to practise medicine shall be made in writing to the Secretary of the Committee; it shall show clearly the author's name and address, and be signed. Anonymous allegations shall not be considered.

8. The Secretary shall inform the Chairman of the Committee of the receipt of any written and signed expression of concern and shall ascertain whether the student has any disability which would affect the procedures to be followed and which would require appropriate steps to be taken to ensure the student is not disadvantaged.

9. Not more than three months after the expression of concern was first made under Regulation 7 above, the Chairman shall determine whether the matter can and should be dealt with informally or whether investigation as set out in Regulations 13-17 below should proceed, and whether any action under Regulation 3 above should be taken. Before the expiry of the three-month period, the Chairman may, having initially determined that the matter should be dealt with informally, subsequently determine that investigation as set out in Regulations 13-17 below should proceed and that action under Regulation 3 above should be taken.

10. If, after appropriate consultation, the Chairman judges that there is a prima facie case of an offence against the discipline of the University, action shall be taken as under Regulation 2(b) above.

11. The Chairman shall determine whether a report should be submitted to the Police.

12. If the University Advocate institutes proceedings against the medical student under Statute B, VI, any subsequent judgement of the University Courts may be considered as evidence within the procedures set out in Regulations 13-36 below. If the University Courts find that a charge is proven against the student then that finding shall be conclusive evidence within the procedures set out in Regulations 13-36 below that the student in question has committed the offence against the discipline of the University with which he or she was charged.

Investigation

13. When an investigation is initiated, the Secretary of the Committee shall write to the medical student concerned and to the Senior Tutor of the student's College and her or his Tutor, stating that an investigation of the student's fitness for practice is going to take place. The letter to the student shall state the nature of the expression of concern made under Regulation 7 above and the grounds for launching the investigation.

14. The Chairman shall refer the case to an Investigator, chosen from a list of members of the Regent House appointed by the Committee, who has had no previous involvement in this case. The Investigator shall interview the medical student concerned, the maker of the allegation, and any other relevant persons. Notes of these interviews shall be taken and a written report prepared and submitted by the Investigator to the Chairman.

15. During any interview with the Investigator, the medical student may be accompanied by a member of the University or other representative chosen by the student.

16. If the Chairman concludes from the Investigator's written report that there may be a serious issue to be determined concerning the medical student's fitness for medical practice, the Chairman shall refer the matter for adjudication in accordance with Regulations 18-28 below. The Secretary of the Committee shall inform the student and the Student's Senior Tutor and Tutor of the Chairman's conclusion and of the adjudication process.

17. If the Chairman, after consultation with other Committee members if the Chairman so desires, concludes that there is no issue to be addressed, a determination that no further action be taken shall be submitted to the Secretary of the Committee in writing. The Secretary shall inform the student and the student's Senior Tutor and Tutor of the decision. The Chairman's letter to the Secretary shall be submitted to the next full meeting of the Committee.

Adjudication

18. An Adjudication Board of three members, appointed in accordance with Regulations 12-14 of the regulations for the Fitness for Medical Practice Committee, Fitness for Medical Practice Adjudication Board, and Fitness for Medical Practice Appeal Tribunal, shall consider the Investigator's report and shall adjudicate upon the case on behalf of the Committee.

19. The medical student shall be required to attend the meeting of the Board in person. The student and her or his Tutor shall be informed of the details of the meeting in writing, not less than seven days in advance. The letter to the student shall be sent to the student's College and Cambridge residential addresses.

20. If the medical student has good cause to object to the membership of the Board, he or she shall inform the Chairman of the Committee in writing of the details in advance of the meeting of the Board. The Chairman shall consider whether to advise the Committee that the member(s) should be replaced and shall inform the medical student accordingly.

21. If the medical student fails to attend the meeting without reasonable explanation, the Board may consider the case in the student's absence. The Board shall have discretion to decide what constitutes a 'reasonable explanation'.

22. Members of the University who may have information relevant to the case may be invited by the Board or the medical student to attend the meeting to give evidence. The Board may also call upon other persons (whether or not current members of the University) to provide advice and give evidence on specific aspects of the case in writing or in person.

23. The medical student may choose to be accompanied by any of the following: a 'friend' nominated by the student (for example, a relative or student representative); a College representative nominated by the student; a legal representative (at the student's own expense).

24. The medical student's Tutor (or a deputy appointed by the Tutor), if not nominated by the student under Regulation 23, shall be entitled to be present.

25. The meeting shall be held in public unless the medical student requests that it be held in private (in which case the Chairman of the Board shall normally rule that the hearing shall be in private), or unless the Chairman considers that a private hearing would be in the best interests of any person involved, for the whole or a part of the meeting.

26. The Board shall determine its own procedure for the conduct of the meeting. The procedure shall normally include the following:

(i)Prior to the meeting, the Secretary of the Board, in addition to the procedures set out in Regulations 19 and 20 above, shall provide the medical student with copies of all documents circulated to members of the Board and shall inform the student of the procedure to be followed.
(ii)The Chairman of the Board shall introduce by name and explain the functions of the members of the Board, the officers, and any others present. The Chairman shall explain the powers of the Board.
(iii)The Chairman of the Board shall invite the Investigator (or his or her nominee) to make an opening statement and shall then invite Board members to ask questions.
(iv)The Chairman of the Board shall invite the medical student to make a statement and shall then invite Board members to question the student.
(v)The Chairman of the Board shall invite, any 'friend', College representative, and/or legal representative accompanying the student pursuant to Regulation 23 to make a statement. The Chairman shall then invite Board members to ask questions.
(vi)The Chairman of the Board shall invite any other persons called upon to attend the meeting to make a brief statement and shall then invite Board members to ask questions.
(vii)At each stage, the Chairman of the Board shall have discretion to allow reciprocal questioning by all parties.
(viii)When the Chairman of the Board is satisfied that the Board has completed its questioning and the medical student and other persons present have had a full opportunity to convey information to the Board, the student and other persons not on the Board shall withdraw. The Secretary of the Board shall remain.
(ix)The Board shall then discuss the case. If for any reason the Board requires further clarification of any aspect of the case from either the medical student or other persons they shall all be invited back into the meeting while the questioning takes place and shall leave the meeting again when the Chairman of the Board so determines.
(x)The Board shall make its recommendations to the Fitness for Medical Practice Committee.
(xi)The reasons for the recommendation shall be regarded as confidential between the Committee, the medical student, the Senior Tutor of the medical student's College and her or his Tutor, and the relevant regulatory bodies.

The outcome of the Adjudication

27. The Board, following consideration of the case, may:

(i)declare that the medical student is fit for medical practice and recommend to the Committee that he or she may continue on the course with no conditions (a category (i) recommendation);
(ii)declare that there are grounds for concern as to the fitness of the medical student for medical practice and recommend to the Committee that he or she may continue her or his course of study for the Second or Final M.B. Examinations only on specified conditions: this may include recommending to the Committee that the student be temporarily suspended from the Medical Students Register (a category (ii) recommendation);
(iii)declare that the medical student is unfit for medical practice and recommend to the Committee that the medical student be removed from the Medical Students Register and that the General Medical Council be informed of this action. A recommendation to the Committee to remove a medical student from the Medical Students Register shall only be made where the Board unanimously determines that it has been established beyond reasonable doubt that the student is not fit to practise and that removal from the Medical Students Register is the appropriate and proportionate response (a category (iii) recommendation).

28. The Committee shall make a decision based on the recommendations of the Board and the Secretary of the Committee shall communicate in writing the decision of the Committee to the medical student, to the Senior Tutor of the student's College and her or his Tutor, and to the relevant Faculty Board. No member of the Committee who has had any involvement or interest in the case shall be present when the Committee consider the Board's recommendations or make a decision.

Appeal

29. A medical student shall have the right of appeal to a Fitness for Medical Practice Appeal Tribunal against a decision of the Committee implementing a category (ii) recommendation or a category (iii) recommendation.

30. A medical student may appeal in writing within twenty-eight days of the notification of the result of the decision to the Secretary to the Committee stating the grounds on which the appeal is made. On receipt of the appeal letter, the Secretary will inform the Registrary who shall appoint a Tribunal to hear the appeal. The medical student shall not be entitled to rely during the hearing, without the permission of the Tribunal, on any grounds other than those in the appeal letter.

31. During the consideration of the appeal, the decision of the Committee shall remain in force.

32. A Tribunal hearing shall be arranged as soon as possible in accordance with the following procedures:

(i)The medical student may choose to be accompanied by any of the following: a 'friend' nominated by the student (for example, a relative or student representative); a College representative nominated by the student; a legal representative (at the student's own expense). The medical student's Tutor (or a deputy appointed by the Tutor), if not nominated by the student, shall be entitled to be present.
(ii)The meeting shall be held in public unless the medical student requests that it be held in private (in which case the Chairman of the Tribunal shall normally rule that the hearing shall be in private) or unless the Chairman of the Tribunal considers that a private hearing would be in the best interests of any person involved, for the whole or a part of the meeting.
(iii)The Adjudication Board's case shall be presented by the Chairman of the Board, or a person appointed by her or him.

33. The Tribunal shall consider their decision in private. The Clerk of the Tribunal shall be present throughout the hearing and throughout consideration by the Tribunal of its decision.

34. The Tribunal may confirm, quash, amend, or refer back to the Committee the decision of the Committee.

35. The Tribunal shall not confirm a decision implementing a category (iii) recommendation unless they are unanimously satisfied beyond reasonable doubt that the case is proved and that the circumstances of the case require this decision to be taken.

36. As soon as possible, normally within seven working days, the Clerk of the Tribunal shall write to inform the medical student of the decision and the reasons for the decision and inform other parties including: the Chairman of the Committee and the Secretary; the Director of Medical Education and, as appropriate, the Director of Medical and Veterinary Education; the Senior Tutor of the student's College and her or his Tutor.

Procedures for dealing with a medical student's serious ill-health or disability which is likely to affect fitness to practise medicine

1. Medical students have a responsibility to report any illness or disability likely to affect their fitness to practise medicine to their Tutor or Director of Studies and, as appropriate, to the Director of Medical Education or Director of Medical and Veterinary Education.

2. The following procedures shall be followed for medical students whose health is considered to make them unfit for medical practice.

(a)The student's Tutor or Director of Studies shall liaise with the Director of Medical Education or Director of Medical and Veterinary Education who shall ensure that the medical student is appropriately referred for treatment.
(b)Where the nature of the illness or disability suggests an immediate concern for the safety of patients or others, the Director of Medical Education or Director of Medical and Veterinary Education shall inform the Chairman of the Fitness for Medical Practice Committee who shall determine the status of the student using the procedures set out in Regulations 3-5 of the rules of procedure above.
(c)Where there is concern for the medical student's present or future fitness for practice by reason of ill-health or disability, the Director of Medical Education or Director of Medical and Veterinary Education shall request a review by the University Occupational Health Service and/or the NHS Trust Occupational Health Service and/or other appropriate medical experts.
(d)Upon receipt of reports from the Occupational Health Services and/or other appropriate medical experts, the Director of Medical Education or Director of Medical and Veterinary Education may invite the student to undertake to comply with such arrangements for the management and supervision of her or his condition as the Director may consider appropriate having regard to any recommendations contained in such reports. If the Director considers that the medical student would not be able to give such an undertaking, or could not be relied on to comply with such an undertaking, or has subsequently failed to comply with an undertaking which he or she has given, or that the condition of the medical student is such that it would not be appropriate to proceed by way of undertaking, the Director shall refer the matter to the Committee.
(e)Upon referral by a Director, the Committee shall appoint a sub-committee of three of its members to make findings as to the medical student's fitness for practice based on her or his health or disability and recommendations thereon to the Committee.
(f)A copy of the reports from the Occupational Health Services and/or other appropriate medical experts requested by the Director shall be provided to the medical student and to the sub-committee. The student shall be entitled to provide to the sub-committee a copy of any report of any other specialist who has examined her or him (provided that, unless the sub-committee decides otherwise, the number of specialists whose reports may be provided by the medical student to the sub-committee must not exceed the number of specialists requested by the Director to provide a report).
(g)A hearing shall subsequently take place before the sub-committee, at which the medical student shall be entitled to make representations. The hearing shall be in private, unless the medical student requests otherwise. Subject to these conditions, the sub-committee shall determine its own procedure for the conduct of the hearing.
(h)The sub-committee, following consideration of the case, may make declarations in the same terms as those set out in Regulation 27 of the rules of procedure above.
(i)The Committee shall make a decision based on the recommendations of the sub-committee and the Secretary of the Committee shall communicate in writing the decision of the Committee to the medical student, to the Senior Tutor of the Student's College and her or his Tutor, and to the relevant Faculty Board.
(j)A medical student shall have the right to appeal against a decision of the Committee in accordance, mutatis mutandis, with Regulations 29-36 of the rules of procedure above.
(k)No member of the Committee who has had any involvement or interest in the case shall take part in the procedures set out above.

APPENDIX

Medical student code of conduct

As a medical student, you will be studying to obtain a University degree that automatically allows you to work in the medical profession. During your studies, you will be working within this professional environment and the General Medical Council expects you to behave in a manner appropriate to your future role. As a member of the University, you are subject to the statutory provisions of University Discipline set out in Statutes and Ordinances.

Medical Students are also required to confirm their acceptance of the University's Medical Student Code of Conduct and of the rules to be observed by Medical Students by signing the Medical Students Register Agreement form; inclusion on the Register is a pre-requisite for patient contact which begins in the first year of medical studies.

Students whose health or conduct may lead them to be a risk to patients will be removed from the Medical Student Register and will not be permitted to enter the Final M.B. Examinations for the award of the M.B., B.Chir. Degree and provisional registration with the GMC.

Medical Student Code of Conduct

* Do not abuse drugs and alcohol.

Do not abuse drugs and alcohol: abuse of alcohol and other mind-altering substances can lead to behaviour that may put patients at risk - problems associated with such abuse, such as violent and aggressive behaviour when intoxicated, may put your career at risk.

* Respect others.

Treat patients politely and considerately, respect patients' privacy and dignity, and respect the right of patients to refuse to participate in teaching: lack of respect for patients, colleagues, and other health care workers, especially that based upon gender, ethnic, or racial prejudice, is not compatible with a future career as a caring medical practitioner.

* Take care of your appearance.

Your appearance, personal hygiene, and demeanour should always be modest and reasonably conventional; you must wear an identification badge and show your face so that you can be recognized by patients, teachers, and other staff. Head dress routinely worn as part of religious observance must not cover the face: showing your face also makes it easier for patients who are hard of hearing to hear you and/or lip-read, an important part of communication is by using facial expression. The appearance of a student or medical practitioner should not be such as to potentially affect a patient's trust in that person's medical judgement or standing.

* Abide by the law.

Do not break the law in any way, never threaten violence, act violently towards others, or act dishonestly: one criminal conviction could jeopardize your career prospects in medicine.

* Be open and honest.

Report potentially serious problems to your College Tutor at an early stage; they will be able to give support and advice: concealment of, for example, involvement in a drunken brawl that may lead to prosecution is likely to be viewed as an even greater offence than the incident itself.

Do not cheat in examinations: cheating, at any level, destroys trust and those who cheat may also lie and be unfit for medical practice.

* Seek help at an early stage when any problem arises.

Seek help early when the likelihood of successful treatment is much greater and patients will not be put at risk: Medicine is a demanding profession and, at times, all medical students are subject to stress and consequent anxiety; minor emotional problems and psychiatric conditions such as depression and eating disorders are not uncommon.

Report physical illness, including infectivity for such conditions as hepatitis B and HIV, to your College Tutor at an early stage: the GMC requires doctors to take responsibility for their own health in the interests of public safety - a practitioner must be physically able to attend to a patient who suddenly collapses and be able to initiate appropriate measures for initial life support.

Confidential Sources of Help and Advice
Student's College:University:External:

Tutors

Director of Studies

Chaplains - local place of worship

Supervisors

Nurse

Student Mentors

Counselling Service:
tel. (3)32865
E-mail: counsel@hermes
General Practitioner: University or family
National University Counselling Services: www.studentcounselling.org
Clinical Dean/DOME, Dr D. F. Wood
tel. (3)36732
E-mail: clinical.dean@medschl.cam.ac.uk
Samaritans: 4 Emmanuel Road, Cambridge
tel. 364 455 or 0345 909 090
http//:www.samaritans.org.uk (national site)
DOMVE, Dr D. MacDonald:
tel.(3)33176
E-mail: dwm1000@cam.ac.uk
Centre 33 Information and Counselling Service:
33 Clarendon Street, Cambridge - tel. 316 448
Occupational Health Service:
tel. (3)36594
E-mail: ab431@cam.ac.uk
Drinksense: 4a Gonville Place, Cambridge -
tel. 302 850
Alcohol Concern: www.alcoholconcern.org.uk ;
Don't Do Drunk: www.dontdodrunk.com
CUSU Welfare Officer:
tel. (3)33313
Down Your Drink NHS online alcohol reduction programme: www.downyourdrink.org/
Drinkline telephone helpline: 0800 917 8282
Student Samaritan Linkline:
17 St Edwards Passage - tel. (7)67575
Drug and Alcohol Service: Mill House, Brookfields Hospital, 351 Mill Road
tel. (3)32 301

1 Pre-clinical students are assigned to the Faculty of Biology and clinical students to the Faculty of Clinical Medicine.