As a public body and the professional regulator of doctors, the General Medical Council has several duties and considerations in this area. We explain our considerations in the next few sections, starting with our overall considerations and then following the different stages of medical education and training.
As a public organisation, we are subject to the Public Sector Equality Duty. This requires us to have regard for the need to eliminate unlawful discrimination and advance equality of opportunity. We share this with universities and their medical schools, postgraduate training organisations and employers.
Note: Section 49A of the Disability Discrimination Act 1995 defines the duty having due regard to the need to: (a) promote positive attitudes towards disabled persons, and (b) the need to encourage participation by disabled persons in public life.
Our standards for all stages of medical education and training, Promoting excellence, also set specific requirements for education providers in relation to supporting learners with disabilities.
One of the fundamental standards in Promoting excellence is that organisations must support learners to demonstrate what is expected in Good medical practice and to achieve the learning outcomes required by their curriculum. This includes: making reasonable adjustments for learners; learners having access to information about reasonable adjustments with named contacts; and learners having access to educational support and resources to support their health and wellbeing.
We quality assure organisations against our Promoting excellence standards, as part of our role in overseeing all stages of medical education and training. Therefore, if we become aware of organisations not fulfilling their obligations towards learners through these requirements, we will take proportionate action.
Panel 2: What do we do if we are concerned about organisations not meeting our standards?
We visit medical schools, postgraduate training organisations, and local education providers. We do this to check they are meeting our standards for undergraduate and postgraduate medical education. We focus our visits on areas of risk, which means we look at our evidence and decide which areas of education are most likely to be of concern. We also promote areas of excellence.
We cannot intervene on individual cases, but if we receive concerns from disabled learners we ask for documentation so we can triangulate with other evidence we have on an organisation.
For more information, you can read about how we quality assure medical education organisations.
There is shared responsibility between the medical education organisation and the learner in terms of their wellbeing. Organisations have a substantial role to play in offering comprehensive support. Learners equally have to take responsibility for looking after their own health and wellbeing.
It is inevitable that some medical students and doctors will experience ill health at different points of their studies and career. It is also inevitable that some people will join the profession with a disability, or acquire a disability at some point during their studies and career. As this guidance makes unequivocally clear, disabled learners are welcomed in to the profession and should be valued for their contributions. The aspect of taking responsibility for their own health does not relate to having a health condition or a disability, it relates to the expectations laid out in the standards for all registered doctors in the UK, Good medical practice (paragraphs 28-30), and the equivalent for medical students, Achieving good medical practice (paragraphs 31, 35, 38 and 40).
Meeting competence standards
All medical students and doctors, regardless of whether they have a long-term health condition or a disability, need to meet the competences set out for different stages of their education and training. These are the absolute requirements for medical students and doctors in training in order to progress in their studies and practice. They include:
Outcomes for graduates for medical students, setting out the knowledge, skills and behaviours that new UK medical graduates must be able to show. By the end of their course, medical students must meet all of the outcomes to graduate.
- Medical schools can make reasonable adjustments to the modes of assessment of those outcomes, except where the method is part of the competence that needs to be attained.
- An example of adjusting the modes of assessment would be a student with a hearing impairment using an electronic stethoscope to perform part of a physical exam. The student still meets the outcome of performing a full physical exam, but with a slightly different method than for another student.
- An example where the method is part of the competence that needs to be attained is carrying out procedures requiring a specific method, for example venepuncture, intravenous cannulation or an ECG. The student has to perform the specific method to meet the outcome, but reasonable adjustments could be made to other aspects. For example, an adapted chair if the student needs to sit down while carrying out the procedure.
- Medical schools should agree reasonable adjustments in collaboration with the student, and put these in place. (see 'How can medical schools apply their duties?').
- Outcomes for provisionally registered doctors for newly qualified doctors in their first year of training.
- Doctors with provisional registration with a licence to practise in the first year of the Foundation Programme (F1 doctors) must demonstrate the Outcomes for provisionally registered doctors to be eligible to apply for full registration. This includes core clinical skills and procedures, which provisionally registered doctors are required to undertake.
Outcomes for provisionally registered doctors are competence standards for the purposes of the Act. Therefore, provisionally registered doctors must meet all of these outcomes to progress to the second year of the Foundation Programme (F2). Reasonable adjustments can be made to the modes of assessment of these outcomes.
- These outcomes must be demonstrated on different occasions and in different clinical settings as a professional in the workplace demonstrating a progression from the competence required of a medical student.
- The Outcomes for provisionally registered doctors include a section on doctor's health.
The learning outcomes in the Foundation Programme curriculum developed by The Academy of Medical Royal Colleges and the specialty curricula for different training programmes developed by royal colleges and faculties.
- We approve all postgraduate curricula in line with our standards for postgraduate curricula and assessments (Excellence by design).
- Reasonable adjustments can be made to the modes of assessment of these outcomes. In addition to the responsibilities of employers and postgraduate training organisations, royal colleges and faculties are responsible for making reasonable adjustments for postgraduate assessments.