Gateways guidance: 5.5 What does Tomorrow’s Doctors say?

Tomorrow’s Doctors is the GMC’s primary guidance on undergraduate medical education. It clearly lays down the ‘curricular outcomes’ required by the GMC for undergraduate medical education, setting out what is expected of new graduates. Tomorrow's Doctors:

• puts the principles set out in Good Medical Practice at the centre of undergraduate education
• makes it clear what students will study and be assessed on during undergraduate education 
• makes it necessary to provide rigorous assessments that lead to the award of a primary medical qualification.
  

In 2009 the General Medical Council completed a full review of Tomorrow’s Doctors and published a new edition. Medical schools must comply with the requirements in the 2009 edition from the academic year 2011/12. The 2009 edition includes an Appendix listing practical procedures that graduates from 2012 must be able to perform safely and effectively. The 2009 edition refers to this Gateways guidance and the importance of encouraging disabled students in the study of medicine.

Although adjustments cannot be made to the curricular requirements and outcomes set down in Tomorrow’s Doctors, reasonable adjustments can be made to the method of learning and the assessment by which the student demonstrates these skills. Likewise, specific conditions around these standards might be adjusted. For example, a requirement that a student should be able to complete a task within a certain time would only constitute a genuine competence standard if speed is an intrinsic part of the task.

Sometimes, it is the marginal requirements for entry to a course that lead to discrimination. In the same way, the use of blanket criteria can also discriminate against the individual. Such criteria might include skills, achievements or personal characteristics that are not relevant to the course, and that might be difficult or impossible for disabled people to attain.

Of course, a medical school is entitled to expect applicants to have certain qualifications, as long as these are genuine competence standards required for the course. As with any other applicant, a case-by-case judgement is acceptable. And in some circumstances it might be reasonable to waive the requirement for a particular qualification, especially if there is evidence that the applicant has achieved the necessary level of competence in another manner.

Medical schools should therefore prepare a statement of genuine competence standards for potential applicants and for the different stages of the course and be prepared to negotiate on an individual basis the ways in which these competences will be demonstrated by disabled students.