Medical school fitness to practise: the challenge of competing interests and responsibilities

UK medical schools are required by the regulator, the General Medical Council (GMC), to only graduate students who are fit to practise.1 The responsibility for this is divested to medical schools who sit within the framework of higher education institutions (HEIs). This contrasts with qualified doctors whose fitness to practise is considered within the Medical Practitioner Tribunal Service (MPTS) which, while separate from the GMC, sits under its auspices and governance. Other countries have equivalent systems around regulating and maintaining professional standards, as do other professional groups, such as nursing. While at its core, fitness to practise is intended as a supportive and developmental process, there are cases of students not being fit to practise who are consequently prevented from progressing with their studies.2 Sitting at the complex intersection of healthcare and higher education, medical schools are presented with an inherent dichotomy.3 In holding responsibility for educating and supporting their students to become doctors, alongside potentially preventing them from doing so through their responsibility to graduate only those who are fit to practise, competing interests may arise.4 We have heard this described as akin to being “poacher and gamekeeper.” As a senior undergraduate medical educator with substantial experience in fitness to practise and a head of a UK medical school, we are …