Students
Fitness to Practice Mechanism

1. Health and professional conduct can both affect a student’s FTP.  Under this set of FTP procedures, the professional behavior expected of medical students as set out in the document “Medical students: professional values and fitness to practise” published by the General Medical Council (“GMC”) is generally acknowledged and followed.
2. For a concern over health, the FTP mechanism becomes valid when the case under investigation has implications on the safety of patients or co-workers, notwithstanding that there is currently no complaint about a student’s professional behavior or competence.
3. Upon any person referring a concern in respect of a student’s FTP to the Dean, which the Dean upon initial review considers to be a legitimate concern that calls for consideration by the FTP Enquiry Committee, the Dean shall convene the FTP Enquiry Committee and refer the case to it.
4. The FTP Enquiry Committee’s roles are:
   • to decide if there is enough evidence to prove that the student’s professional conduct or health is called for question, or his/ her FTP becomes a concern, upon consideration of the balance between:
     • patient and public safety
     • rights of the student concerned
     • needs to maintain trust in the profession
   • to investigate and assess the category/ scope of and level at which a student’s FTP being investigated is impaired on the basis of the following aspects: (quoting from the GMC guidelines):
     • Has the student’s behaviour harmed patients or put patients at risk of harm?
     • Has the student shown a deliberate or reckless disregard of professional and clinical responsibilities towards patients or colleagues?
     • Is the student’s health or impairment compromising patient safety?
     • Has the student abused a patient’s trust or violated a patient’s autonomy or other fundamental rights?
     • Has the student behaved dishonestly, fraudulently, or in a way designed to mislead or harm others?
5. The FTP Enquiry Committee can initiate actions to investigate into the case, e.g. by asking for professional reports or calling witnesses.  All aspects of the investigation and decisions should be well documented and treated under strict confidentiality.  In addition, the independence and privacy of the student concerned should be fully respected.  The FTP Enquiry Committee has the final discretion over the disclosure of the case information if the conditions are justified enough to exempt the case information (in particular, the decisions) from the provision of confidentiality.  In any case, the student concerned should be informed in advance should the FTP Enquiry Committee decide that his/ her case information (in particular the decisions) shall be released to a third party.
6. A formal hearing to deliberate on the case concerned would be called upon if deemed necessary.  The proceedings should be transparent and fair.  The FTP Enquiry Committee should take note of the following in the course of hearings:
   • make sure the composition of membership in the FTP Enquiry Committee is unbiased, with no conflicts of interest
   • ensure that the student concerned is well aware of the his rights to make representations or calling for the presence of his/ her solicitor; he or she should also comprehend the entire proceedings
   • set up appropriate procedures of calling for a hearing, including how it may proceed in the absence of the student
   • ensure that there is proper disclosure of information and equal opportunity to present evidence, which may include providing the student with a complete copy of the information presented to the Committee
   • make sure that decisions and recommendations are consistent, and that reasons for the decisions are explained
   • make sure that written records are kept properly
7. After evaluating the case, the FTP Enquiry Committee can refer the student to receive remedial measures, including counseling, to rectify the behaviour/ concern in question.  For cases on medical ground, the FTP Enquiry Committee can recommend treatment plan, arrange reasonable adjustment and/ or offer support to the student concerned where appropriate.  Regular monitoring and proper supervision will be arranged for the student so that his/ her FTP can be evaluated either regularly or after a certain period whichever is regarded as appropriate by the FTP Enquiry Committee.
8. If the FTP Enquiry Committee deems appropriate, a complaint could be made to the University’s Disciplinary Committee (“UDC”) by any of its members or the Dean against the student pursuant to Statute XXXI.  In this respect, the required procedural and timing requirements should be observed.
9. For students who are, owing to health reasons, proven to have failed to meet the expected standard of behavior/ competency, the Faculty shall consult the Director of the University Health Service and may seek advice from a medical board of three medical practitioners, one of whom shall be the Director of the University Health Service, and one of whom may be nominated by the student.  The recommendation of the University’s Medical Board will be forwarded to the FTP Enquiry Committee for consideration.
10. The Faculty Internship Committee will deal with matters relating to medical interns.  Should a problem over an intern is reported, including offences convicted by the Court, professional misbehavior/ incompetency and/ or health/ impairment, the Faculty Internship Committee, in liaison with the Chief of Service of the Division to which the intern is attached, make recommendations on the case, e.g. providing counseling/ monitoring, proposing remedial measures.  The case may be reported to the Central Internship Committee if deemed necessary.  The FTP Enquiry Committee shall be convened to discuss on cases where the FTP is in question.
11. At the point when an intern whose FTP is of concern to the Faculty, the Dean, in consultation with the FTP Enquiry Committee, will have the discretion to communicate with the Medical Council of Hong Kong over the potential risks of the intern concerned should he/she enter into medical practice upon completion of the internship training.  Referrals to the Medical Council of Hong Kong should be made at least 14 days after the decision of the FTP Enquiry Committee/ the Dean of Faculty.  In case an Appeal Board is called for by the Chairperson of the Faculty Board, the case should not be passed to the Medical Council of Hong Kong until a final decision is reached by the Appeal Board.
12. The decision of the FTP Enquiry Committee and the Faculty should be properly and clearly conveyed to the student in writing, specifying the reasons and outcomes.  It should also be reported to the Faculty Board.  During the investigation and/ or review process, the FTP Enquiry Committee should consider if it is necessary to recommend that the student’s studies be suspended for the benefit of the student’s own self, patients, teachers and other students.  Due explanation should be given to the student under investigation as to the cause of the suspension and its expected duration.

To prevent any conflicts of interest and ensure objectivity/ fairness, members of the FTP Enquiry Committee should not have direct relationships with the student concerned (e.g. personal tutor, mentor) and any person having such direct relationship shall not be a member of the FTP Enquiry Committee for that particular case.  The student representative(s) concerned should not directly know the fellow student being investigated.

The membership of the FTP Enquiry Committee shall comprise:

1. The Dean or delegate as Chairperson;
2. Three staff members nominated by the Dean, from any Department/ Unit/ Curricular module excluding that/ those reporting the alleged misconduct; and
3. One student representative from a pool of representatives as nominated by the Medical Society.

A teacher/ staff member from the Department/ Unit/ curricular module relevant to the occurrence or impact of the alleged misconduct will be invited to appear before the FTP Enquiry Committee.

Where a solicitor is called for by the graduate/ intern whose FTP is in question, the FTP Enquiry Committee has the discretion to nominate a legal advisor to sit in the Committee.

Once a FTP concern has been addressed as stipulated in the FTP procedures, a decision/ recommendation is made by the FTP Enquiry Committee.  If the student concerned finds it not agreeable with the decision/ recommendation of the FTP Enquiry Committee, he/ she can launch a formal appeal directly to the FTP Appeal Board.

The FTP Appeal Board is also part of the internal mechanism within the Medical Faculty to deal with requests from students appealing against the decision/ recommendation of the FTP Enquiry Committee.  It serves as a review body to revisit the case concerned and is formed on a case-by-case basis by the Board of the Faculty.

Upon careful review and substantiation, the Appeal Board can uphold or subvert the recommendation/ decision of the FTP Enquiry Committee.

The membership of the Appeal Board, with its power and authority, should be appointed and delegated directly by the Chairperson of the Board of the Faculty.

1. The student concerned should be notified of the fact that he/ she has the right to appeal against the decision/ recommendation of the FTP Enquiry Committee and the formal appeal procedures.  He/she is required to commence his/ her appeal by sending to the Chairperson of the Faculty Board a notice in writing stating the grounds of the appeal, and, if it is proposed to present any additional evidence, the nature of any such new evidence, within 14 working days after the decision of the FTP Enquiry Committee.  An Appeal Board at the Faculty level is to be established and directly appointed by the Chairperson of the Faculty Board, where appropriate.
2. If an appeal is commenced, the decision of the FTP Enquiry Committee shall be suspended pending the outcome of the appeal.

To prevent any conflicts of interest and ensure objectivity/ fairness, members of the FTP Appeal Board should not have direct relationships with the student concerned (e.g. personal tutor, mentor) and any person having such direct relationship shall not be a member of the FTP Enquiry Committee for that particular case.

The membership of the FTP Appeal Board shall comprise:

1. The Chairperson of the Board of the Faculty or delegate as Chairperson; and
2. At least two staff members nominated by the Chairperson of the Board of the Faculty:
   
   • one from the Medical Faculty either from any Department/ Unit/ Curricular module excluding that/ those reporting the alleged misconduct or from the medical profession; and
   • one outside the Medical Faculty, from a cognate discipline/ Faculty/ institution

Where a solicitor is called for by the graduate/ intern whose FTP is in question, the FTP Enquiry Committee has the discretion to nominate a legal advisor to sit in the Appeal Board.

Examples of areas of fitness-to-practice concerns

• Examples from the Medical Practitioners Tribunal Service and General Medical Council
• Examples from the Medical Council of Hong Kong