Student Fitness to Practise: Guidance for Students
May 2012
What is this document about?
This document is for chiropractic students, whether you are already a student
or are thinking about becoming one. It explains why fitness to practise is
important in your personal life and during your education and training, as well
as in your professional life. It also explains what we mean by ‘behaving
appropriately and in a professional manner’, the possible consequences if you
do not, and the different aspects we consider when you apply to register as a
chiropractor.
As a student of chiropractic, you are undertaking education and training for a
regulated healthcare profession in the UK. Being in a regulated healthcare
profession is a privilege − it is illegal in the UK for anyone to describe
themselves as a chiropractor, or to imply that they are a chiropractor, if they
are not registered with the General Chiropractic Council (GCC). But this also
brings with it certain responsibilities.
The GCC has three main duties:
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protecting the public by regulating chiropractors
setting the standards of chiropractic education, conduct and practice
ensuring the development of the profession.
We have produced a version of this document for chiropractic education
providers, and you might want to read that as well. Both documents have
been prepared through joint work between the GCC and the chiropractic
education providers, and this has included learning from the work of the other
healthcare regulators.
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Why is student fitness to practise important?
The main purpose of regulating healthcare professions is to protect patients
and the public. Patients and the public trust that health professionals will
practise competently and behave appropriately towards them. They also place
this trust in healthcare students, so it is important that you behave in a way
that promotes the best care of patients and upholds the reputation of the
chiropractic profession.
The GCC defines student fitness to practise as:
having the necessary health and character to demonstrate that you have the
capability to practise safely and effectively once you are registered. This will
be demonstrated by how you behave towards patients, other students, staff
and others; how you act during your education and training programme and in
your personal life; and how you conduct yourself generally within the
programme.
What does student fitness to practise look like?
It’s impossible to give a full list of the types of professional behaviour that
are expected of you if you are to show that you are fit to practise. The GCC
Code of Practice and Standard of Proficiency sets the standards that
registered chiropractors have to keep to. This in turn has a bearing on the
behaviour expected from chiropractic students and on behaviour that would
give cause for concern. So while you may at first think that the Code of
Practice and Standard of Proficiency does not apply to you until you are in
practice, or at least until you are in clinic, then this document should help you
to think again.
In table 1 below, we have described for you the professional behaviour that is
expected of you as a student, and behaviour that would give cause for
concern.
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Table 1: Professional behaviour expected of chiropractic students and that which
would give cause for concern
A You must respect patients’ dignity, individuality and privacy
There would be concerns if you:
• used inappropriate language or behaviour
• disclosed information about patients or
other students to anyone who was not
entitled to it (that is, if you breached
confidentiality)
• identified patients or made comments
about them on social media sites
• talked about individuals or groups of
people in a derogatory way at any time on
your course
This means you must:
1 respect patients’ privacy, dignity and
cultural differences
2 not discriminate in any way against the
people you provide care for
3 make sure your own beliefs and values do
not affect the care you give
4 keep information about patients
confidential
B You must respect patients’ rights to be involved in decisions about their healthcare
There would be concerns if you:
• had poor communications skills and found
it difficult to relate to patients, other
students or staff
• were rude to patients, other students or
staff
• did not get consent from a patient or
another student before assessing or
treating them
• did not complete patient records, left
important information out of records or
invented aspects of the records
This means you must:
1 show respect for patients by listening to
them, acknowledging their views and
respecting their decisions
2 be polite and considerate to patients and
others
3 clearly identify yourself as a student
4 give patients and carers information and
advice in a way they can understand so
they can make choices and decisions
about their care
5 make sure that patients have given their
consent to the assessment and care you
give
6 keep patient records which are legible,
attributable to you and truly represent your
interaction with the patient
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C You must justify public trust and confidence by being honest and trustworthy
There would be concerns if you:
• cheated in any way, including plagiarising
academic work (passing it off as your own
work)
• acted dishonestly (for example, by making
dishonest claims about your qualifications,
experience or status; or lying about the
reasons for being absent)
• misled patients, their carers or the public
in any way (for example, about what
chiropractic can achieve)
• asked someone else to do work on your
behalf, which you then claimed to be your
own; or did work for another student which
they then claimed to be their own
• signed in for other students and therefore
lied on their behalf
• had a criminal conviction or caution for
acting dishonestly or being untrustworthy
(for example, for theft or financial fraud)
• used internet and social networking sites
in a way that might bring the profession
into disrepute
This means you must:
1 act with honesty and integrity, and never
abuse your professional standing
2 establish and maintain clear professional
*
boundaries with patients
3 be honest, genuine and original in your
work, both academic and professional
4 cooperate with any inquiry into your
health, behaviour or performance
5 ensure that you are not influenced by any
commercial incentives
6 tell your education provider (and the GCC
when applying for registration) if you have
received any criminal convictions or
cautions
D You must provide a good standard of practice and care
There would be concerns if:
• your timekeeping and attendance were
poor
• your attitude was poor and you were not
willing to carry out the required duties and
tasks
• you did not follow instructions from college
staff or supervisors
• you did not respond to staff who were
trying to contact you or talk to you about
an issue
• you tried out techniques on patients or
other students that you had not been
taught or were not skilled enough to use
• you practised chiropractic at times when
you were not appropriately supervised
This means you must:
1 recognise and work within the limits of
your own knowledge, skills and
competence
2 take your studies seriously and be aware
of your own limitations and learning needs
3 ask for support when you need it and
accept the feedback you are given
4 only provide the care that is required for
the patient’s clinical needs
*
For more guidance see, for example, CHRE’s boundaries guidance covering education:
www.gcc-uk.org/files/page_file/A_report_on_education_and_training_Jan08.pdf
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E You must protect patients and colleagues from risk of harm
There would be concerns if you:
• exposed patients or other students to risk
of harm
• disobeyed any of the education
institution’s policies and procedures
• had a criminal conviction or caution
related to sex offences, including being
involved with child pornography
• had a criminal conviction or caution
related to physical violence
• had misused drugs or alcohol, were
dependent on them or had a criminal
conviction or caution related to drugs or
alcohol
• displayed aggressive, violent or
threatening behaviour to anyone
• had a persistent inappropriate attitude
towards your work, both professionally
and academically
• showed a lack of insight into your health
condition or disability and neglected its
management
This means you must:
1 raise concerns with the appropriate
person when patients or the public might
be put at risk
2 avoid acting in a way that may undermine
public confidence in the profession or
bring it into disrepute
3 be aware that your own poor health may
put others at risk, and ask for and follow
professional advice
4 monitor potential risks to health and
safety, and maintain appropriate health
and safety standards
5 assess and manage the risk of infection
6 follow legislation and regulations covering
the use of ionising radiation
7 get help immediately if someone you are
providing care for has suffered harm for
any reason
F You must cooperate with colleagues from your own and other professions
There would be concerns if you:
• discriminated against, or unjustly
criticised, another student, a member of
staff, or another health profession or
professional
• were uncooperative with other members
of the team, students, administrative staff
or other healthcare professionals
• suggested that chiropractic or private
practice was by its nature better than
other forms of healthcare or NHS
provision.
This means you must:
1 respect college staff and the team with
whom you work
2 value the role of other healthcare
professionals, and those training as
students in these professions, and the
contribution they bring to the health and
wellbeing of patients
3 make the best use of opportunities to
learn from the knowledge and skills of
other health and social care professionals.
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Am I expected to behave professionally from day one?
Yes, you are. You need to accept that, because you have signed up for an
educational programme which has the specific purpose of developing you as
a professional chiropractor, there are some additional responsibilities and
challenges placed on you by the very nature of the programme. You must act
in an honest and trustworthy way throughout your programme, properly
considering the effect of your actions on others. This includes in your personal
life. You will know that, before you could join the programme, there will have
been an enhanced Criminal Records Bureau check made on you. This was to
confirm that there is nothing in your background to bar you from undertaking
the course.
We realise that you are in a learning situation and are in the process of
developing into a professional. In this sense your knowledge and
understanding of professional behaviour will change, develop and mature
over time. The ethical complexities of healthcare, and the situations you
encounter during your course, will contribute to your development as a
professional and to your fitness to practise. This means that the expectations
placed on your fitness to practise will increase as your course goes on, and
your fitness to practise will be of specific concern when you are in the clinical
phase of your training. However, this is not an excuse to behave
inappropriately while you are in the early years of your programme. We, like
your education provider, will have concerns about any behaviour at any time
(whether on the course or in your private life) that raises questions about
whether you will be fit to practise as a healthcare professional. In the box
below we have given some examples of the types of behaviour that have
caused concerns before.
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Examples of the types of behaviour that have caused concerns and for
which warnings have been given
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A first-year student kept arriving late for lectures and either did not sign in
at all or signed in using an incorrect time. It was explained to them why
this was a problem and they were given a month to show changed
behaviour − which they did and continued on the course.
An assessor reported a third-year student for behaving inappropriately
during a mock OSCE examination. The student was given a verbal
warning and immediately apologised for their actions. No further action
was taken.
A final-year student in their clinic year was continually arriving late for
their clinic shift or management duties. They were given a formal verbal
warning of unprofessional behaviour and were told that their behaviour
would be monitored for three months, after which the warning would drop
off their record. However, if the behaviour happened again within the
three months, they would receive a formal written warning. If the formal
written warning was violated within three months, their case would be
referred to the Fitness-to-Practise Committee for consideration. After the
verbal warning the student did not arrive late again.
What if I have a disability or health condition?
All students are expected to behave as a responsible professional throughout
their education and training whether they are disabled or not. If you have a
disability or a health condition, you should receive support and ‘reasonable
adjustments’ to help you achieve the standards expected. However, this does
not change the standards you have to achieve. You can find more information
about becoming a chiropractor if you have a disability in our guide – go to
www.gcc-uk.org/files/link_file/Guide_for_disabled_people_WEBSITE_13dec10.pdf
Very occasionally, there may be instances when the fitness to practise of a
student with a disability or health condition is called into question. The main
concerns are likely to be about an individual who shows a lack of insight into
the nature or impact of their disability or health condition or who does not take
the necessary actions to manage their condition, particularly if this may affect
patient safety.
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What does registration mean?
Registration means you have the right to practise chiropractic without
restrictions. Once you are registered you commit to keeping to the standards
set out in the GCC’s Code of Practice and Standard of Proficiency and are
personally responsible for maintaining professional standards of practice. The
GCC does not place any restrictions on the way you practise chiropractic as a
registrant, nor does it note the register in any way when you register. (For
example, we do not put on the register whether you have a disability or a preexisting health condition.)
However, if your health worsens or you develop an ‘impairment’ that would
affect your ability to practise, you are responsible for making any necessary
changes to the way you work so that you can continue to provide good
standards of practice and care. This applies to all registered chiropractors,
whether or not they have a pre-existing health condition or disability. Deciding
whether you are − and remain − fit to practise, and able to continue to ensure
the safety of patients and the public, is a basic professional responsibility, and
a matter for every chiropractor to decide for themselves. That is why
developing this capability while you are a student is so important.
What happens if my fitness to practise is questioned as
a student?
Your education provider will be helping you to develop your fitness to practise
while you are a student. They will give you feedback, either informally or
through more formal assessments, as you go through the course. This should
help you understand what you have to do and how you should behave.
If there are specific concerns about your behaviour, then the concern will be
looked at through your institution’s student fitness-to-practise procedures. If
your fitness to practise is found to be impaired, then a range of sanctions will
be considered. Their main purpose is to protect the public, and also to help
you, where possible, learn and develop in the future. The sanctions range
from a warning up to dismissal from the programme for very serious offences.
If there is a fitness-to-practise concern raised against you, it is important for
you to cooperate with the process, be honest and use it as a way to learn and
develop for the future. In the box below are some examples of cases heard by
student fitness-to-practise panels and their outcomes.
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Examples of cases heard by student fitness–to-practise panels and
their outcomes
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A second-year student was accused by fellow students of bullying and
sexual harassment, and of describing how they had abused their partner
physically and sexually − showing photographs on their mobile phone.
This student was immediately suspended pending an investigation, and
after a formal student fitness-to-practise panel hearing was removed from
the programme. The GCC was informed.
A third-year student told the senior management team that they had been
found guilty of an offence related to distributing drugs. Their case was
immediately referred to the student fitness-to-practise panel, which heard
the case and decided that the student should be expelled from the
course. The student appealed against the decision but the appeal panel
upheld the student fitness–to-practise panel’s decision and so the student
left the programme. The GCC was informed.
A final-year student was suspended from clinic duty because they
reported for duty in the clinic smelling of alcohol and with a dishevelled
appearance. The student was referred to a student fitness-to-practise
panel. During the hearing, the panel heard about the personal difficulties
that the student had been trying to deal with outside of the college
systems. There was evidence that since being suspended, the student
had received counselling, and had undertaken cognitive behavioural
therapy to relieve their dependency on alcohol and was making good
progress. The student was allowed to return to clinic under close
supervision, successfully completed their programme of studies and is
now practising as a chiropractor.
A final-year student informed the college that they had been convicted of
a drink-driving offence. This was immediately referred to the student
fitness-to-practise panel. The case was heard and the student was
allowed to continue on the programme following discussions with
members of the senior management team about professional life and
personal life issues.
You can find more information on student fitness-to-practise procedures in the
guidance that comes with this document or by looking at the relevant
documents from your education provider.
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What do I have to do to register once I am qualified?
When you first apply to register with us, you must satisfy the Registrar that
you have a GCC-recognised chiropractic degree. You must also:
• declare if you have been subject to any sanctions over your fitness to
practise when a chiropractic student
• provide a character reference – this must be written, dated and signed by
someone of professional standing, acceptable to the Registrar, who has
known you for four or more years, and is not a patient, relative or
employee. For new graduates, it is expected that this character reference
will come from a senior manager in the chiropractic education institution
• declare all criminal charges or convictions (except speeding offences), no
matter when or where the offences were committed (registration is exempt
from the Rehabilitation of Offenders Act)
• confirm you are in good health − currently this means that you need to
provide a medical report from your GP. However, in the future when the
rules have been changed, applicants will be responsible for making selfdeclarations about their own health
• give details of registration with other regulatory bodies or associations in
the UK or elsewhere, and about any disciplinary action taken against you
by such a body
• give information about any allegations of professional negligence
considered by a civil court
• provide proof of professional indemnity insurance
• provide a birth certificate and proof of any change of name since then (for
example, a marriage certificate).
The Registrar has a duty to ensure that all applicants for registration are fit to
practise in line with the requirements of the GCC’s Code of Practice and
Standard of Proficiency. If necessary, the Registrar may ask for more
evidence about your health or character to make sure that you meet the
standard.
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General Chiropractic Council
44 Wicklow Street
London WC1X 9HL
Tel: 0207 713 5155
communications@gcc-uk.org
www.gcc-uk.org
May 2012
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