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What advice do you have for students who might not meet our published outcomes for graduates?

All students seeking to graduate and gain provisional registration must at that point be able to demonstrate all the Outcomes for graduates. These include outcomes for the doctor as a scholar and a scientist, the doctor as a practitioner and the doctor as a professional. The legal advice we received indicates that the standards and requirements set in Outcomes for graduates are effectively ‘competence standards’.

What does this mean in practice?

This means that the GMC is not able to require adjustments that would alter or lower the standard of competency. Whilst recognising that the competence standards cannot be adjusted or lowered, we are very clear that consideration must be given to making adjustments to the method by which these competencies are assessed which could include making adjustments to practical procedures.

We have no legal ability to grant a conditional, restricted or limited licence to practise at the point of initial registration, and medical schools are not empowered to grant students dispensation from the requirements set in Outcomes for graduates.

How can the school make a decision?

If, once the medical school has received all the relevant advice (as appropriate for each case), the consensus is that the student is not able to meet all the outcomes required, we would regrettably advise that the student should not be allowed to graduate. This is because by graduating a student with a recognised primary medical qualification, the medical school is declaring them fit to practise as doctor, and putting them forward for provisional registration - which would not be granted if the student did not meet the outcomes.

Before coming to any conclusion, we would strongly advise schools to engage closely with the student, and ensure that they have participated fully in any discussion about the difficulties they may be experiencing and potential solutions.

In some cases, the medical school and the student may not agree on the best course of action. When this happens, the medical school should use its fitness to practise process to make sure that the decision about the student’s future is impartial.

Before starting a student’s fitness to practise process, the medical school must make sure that it is able to show the support, interventions and reasonable adjustments it has made for the student. It should be able to show that it has made every effort to support the student to complete the course. Also see paragraphs 122-125 from Supporting medical students with mental health conditions.

What support must the school offer?

In the unfortunate scenario where the student was not allowed to graduate, it would be essential to offer the student career advice to consider how they can best utilise their knowledge and skills, and a possible exit route from their medical course.

Regardless of the outcome, it is important that the medical school keeps a record (audit trail) of all relevant evidence and decision-making.