Fitness to Practice



As a medical student, you are expected to behave appropriately in your academic, professional, and personal lives. Medical students are expected to behave in a way that makes sure that the general public can trust medical professionals. Behaving poorly may impact your ability register with the General Medical Council (GMC). You should read the policy along with other GMC guidance as relevant.

Fitness to practise can also be about your health, if your health could put patients’ safety or trust at risk.

Process for Current Students

First steps

Fitness to Practise issues are raised to Dean of Medicine in the first instance. Referrals may be from anyone concerned including academic, NHS, Student Services, or Student Conduct staff.

If your case involves University disciplinary procedures then it will be decided which procedures will be used. The Dean may make a risk assessment for cases that are being pursued through disciplinary or criminal procedures. If relevant, you may be suspended from studies or placements.

The Dean will work out whether your case should go to a Fitness to Practise hearing or not. They may consult with other staff when making this decision. They will also consider the context around your academic performance, alongside any previous discipline cases and welfare issues.

The Dean may take one or multiple actions:

  • Dismiss the concerns
  • Make a risk assessment
  • Refer on to the personal tutor, School Progress Committee, or University supports
  • Regularly review the case
  • Record the concerns
  • Formal warning
  • Agree steps with the student
  • Bring about an investigation

A warning is held on file at the Medical School indefinitely. You must tell future medical schools and the GMC when you register about any warnings you have received. You can challenge a warning through a Fitness to Practice panel, but the panel may decide to give you a stronger penalty,


A member of staff from the School unconnected with you and your case will be the investigator. They will write a report on the allegations and evidence, and share it with the Dean. As part of this investigation, they will look at all the evidence, interview people including the student in the case, and arrange witnesses for the panel.

After the investigation, the Dean may decide to; not continue with a hearing and take one of the actions in the list above; redo the investigation with a different investigator; carry on with the hearing based on the report.

Fitness to Practise Panel

The Standard Panel

The Dean will choose the panel, consisting of a Chair and 3 other members who may or may not be from the University. At least one panel member should be registered with the GMC. The Panel will be gender balanced, and no one will have had any previous involvement in the case or with you. A Sabbatical Officer may be selected to sit on the panel.

The Chair will be a senior academic from another Medical School, or an academic clinician who holds an honorary role at the University of St Andrews. There will be a secretary who will take notes, but will not be a full or voting panel member. The panel may also have a legal adviser where relevant.

The Panel Hearing

You’ll be given at least 10 working days’ notice of the hearing, and you’ll be given all the documents you need, including the investigator’s report.

You have the right to present your case in person, and you can bring either a supporter and/or a representative with you:

  • A supporter can reassure you and give you general help, but not be your representative. This person must be a member of staff from the University or Students’ Association, or another St Andrews student.
  • You can also bring a representative from within or outside the University and may include legal representation. This person can also speak for you on your behalf if you give your consent. If you wish to have a legal representative with you, you’ll need to inform the Secretary so that the Panel can organise their own legal advice.

7 working days before the hearing you need to email the Secretary with:

  • any evidence you want the Panel to consider,
  • names of witnesses,
  • names of which supporter and representative you will bring with you.

You can request an extension if you need more time to get your evidence together, but the Chair has the right to refuse.

As far as possible, the Panel will meet at a time that suits you. The Chair will try to reschedule if both you and your representative are unavailable, though they can carry on with the hearing if you and/or your representative fail to appear for the second time.

How the Hearing will work

The Hearing will not be recorded, but the Secretary will take notes. The Hearing may happen in person or online.

The Chair will introduce everyone, explain how the Hearing will work, and explain the case to date including any evidence. You or your representative will then be able to make a statement about your side of the story, and add any information you did not provide in the written documents.

The School Investigator will make an opening statement and add any information not provided in the written documents.

You can question the Investigator at each stage, by asking the Chair if you may ask a question. Likewise, Panel members can ask you questions by asking the Chair if they may do so.

Others invited to the Panel will be asked to make statements and invited to ask questions as relevant.

The Investigator will make a closing statement, and then you/your representative will be able to do the same. You will then leave and the Panel will discuss your case and decide on outcomes. The Panel may need to pause to consider additional evidence or seek more information about anything that was unclear. They will try to come to a unanimous decision on outcomes of the hearing, but if this is not possible the Chair will have the deciding vote.

Decisions will be made based on the balance of probabilities. This means that the Panel will be asking themselves “is it more likely than not that this student’s fitness to practise is severely impaired based on the evidence available?” rather than “is this true without a doubt?” They will also weigh up any mitigating circumstances when coming to their decision.


You will receive your outcome letter within 10 working days of the Panel deciding on any outcomes.

These outcomes are not about punishing you, they are instead designed to ensure that patients are protected and able to trust medical staff.

The Panel can decide to give at least one of the following outcomes:

  • Dismiss the case and take no further action
  • Give a formal warning
  • The student is to come to an agreement with the Medical School which acknowledges that their fitness to practise is impaired.
  • The student is given certain conditions to meet so that they can be allowed to continue with their studies
  • Suspension from the programme for a set time period, or until conditions are met
  • Expulsion from the medical programme

Please note that suspensions and expulsions may have visa and financial consequences. Contact the International Advice Team ([email protected]) for support on this as soon as you can.

When there is concern that the public may be at risk, the outcome of the hearing will be shared with partner medical Schools and other relevant bodies. If you receive a sanction or your clinical studies are stopped, the GMC, other UK clinical schools, and postgraduate deaneries will be informed after the appeal process.

Students who are excluded will be added to the Medical Schools Council’s register.


You can appeal to Senate if one or both of the following grounds are present:

  • You had extenuating circumstances which the Panel did not and could not know about, and that these circumstances would have a significant impact on the Panel’s decision. You will need to explain why you did not share these circumstances before.
  • Procedures were not followed, and this would have had a significant impact on the decision and it leads to doubt around whether the Panel’s decision would have been different if procedure had been followed properly.

You need to email senate@ within 10 working days of your outcome letter, explaining that you wish to appeal the Fitness to Practice Panel decision. When you email, you need to give your contact details and student ID, the decision you are appealing, the grounds for your appeal, and what you would like to happen as a result of your appeal. This is called the ‘intimation of an intention to appeal.’

You’ll have another 10 working days after this to submit a full appeal with all your evidence. If any of your evidence is not in English, you must provide a certified translation with the original document.

You should appeal on time, as Senate can decide not to consider late appeals. You can request an extension to the intimation of intention to appeal, and to submitting the full appeal. For both of these, you must email Senate before the deadline. When you email, you need to explain why you are seeking an appeal, and provide evidence of why this is needed (for example medical or other circumstances).

Senate will decide whether to accept extension requests for intimation of intention to appeal. The Chair of the Appeal Assessment Committee will decide if they will accept extensions for the full appeal.

Appeal Assessment Committee

The Committee will be the Master (or delegate) as Chair, a GMC-registered clinician who is not part of the University, and a representative from another UK Medical School who has been involved in Fitness to Practise cases before. The Executive Officer to the University Court & Senate will be secretary and take notes. All members of the Committee will be new to the case and will not have worked with you previously.

The Committee will decide if you have grounds to appeal. As part of this, they will review the Fitness to Practise process in your case by looking over your written evidence, the other papers given to the Panel, a report of the hearing, and the outcome letter you received. The Committee will do this review in private, no one else will attend except the secretary to take notes.

Appeal outcomes

You will receive your outcome letter normally within 10 working days of the Committee making their decision.

The Committee can make the following decisions:

  • To agree with the Panel’s original decision and reject your appeal.
  • To send the case back to the School of Medicine with instructions, and the Panel is to review its decision in light of the new evidence. The Panel’s decision after this will be final.
  • When you appealed based on procedure not being followed correctly, the Committee may send the case back to the School of Medicine, and possibly instruct that a new Panel is established. If you appeal the decision of the new Panel, the Executive Officer to the Court & Senate along with the Chair of the Appeal Assessment Committee may decide to either:
    • Dismiss the appeal,
    • Ask the original Appeal Assessment Committee to review the appeal,
    • Have the appeal reviewed by a new Appeal Assessment Committee.

The Committee will decide by majority. The Appeal Committee is the last step in University procedures.

External review

If you feel that the outcome of the process was unfair or inaccurate, you can contact the Scottish Public Service Ombudsman to review how the University handled your case.

Process for Applicants

The School of Medicine Professionalism and Welfare Committee will review Fitness to Practise concerns about applicants.

Conduct Concerns

Applicants who have previously had Fitness to Practise procedures brought against them will not be allowed to become students at the University. If there is false or plagiarised information in an application, that application will not be considered.


When applying, applicants must honestly say if they have any of the following from any country:

  • A criminal conviction or caution
  • Found guilty of or pled guilty to a criminal offence
  • A police caution, warning, or equivalent
  • A fixed penalty fine
  • A formal warning or reprimand
  • A fiscal fine or equivalent

The Medical School has the right to check this information. If you say you have any past or current criminal proceedings, the School of Medicine Professionalism and Welfare Committee will consider these. If you receive any of these outcomes after applying, you must keep the Medical School informed.

You will be asked to give further details if you have received a caution, warning, or equivalent. All information will be treated in confidence.


The Dean of Medicine will come to one of the following decisions:

  • Let the applicant go to the next stage of admissions
  • Refer the case for further investigation
  • Set conditions for the admission
  • Reject the application in cases where the applicant would not pass GMC requirements for full registration, or where there are serious Fitness to Practise concerns

You can make a complaint about the outcome of your fitness to practice case if there is evidence of the policy not being followed properly. Check out our Complaints against the University guide for more information.