Medical schools must only graduate medical students who:
- meet all of the outcomes for graduates AND
- are deemed fit to practise.
Any discussion about where to the student can be placed and what they might be able to manage should be as early as possible, and earlier than the penultimate year of study. This discussion can be an opportunity for the student to reflect on career plans.
Any discussion about student fitness to practise should be separate to conversations about support in relation to a disability or long term health condition.
If you are worried that a student cannot meet the criteria because of their health condition or disability:
- We have advice about students who might not meet our published outcomes for graduates. Schools must carefully consider whether this is the case.
- Schools must give advice on alternative career options, including pathways to gain a qualification (R3.16 from Promoting excellence)
- Schools must support students to address any concerns related to their health. One example is offering an additional year after graduation for students to gain additional clinical experience after they have completed all the formal components of the course.
- Our fitness to practise guidance gives advice on considering fitness to practise on the grounds of health (page 34) in exceptional circumstances, a student who cannot graduate can be removed from the course on health grounds - you can find more advice on this scenario (page 71).
It is good practice for schools to encourage any students who were involved in student fitness to practise procedures (for whatever reason) to apply early for provisional registration. This is to make sure their application is processed on time for them to start the Foundation Programme.
It is also good practice for medical students to have their final year placements in the area where they will be starting their foundation post, if this is practically possible.
Transfer of information process
The Transfer of Information (TOI) process exists to communicate information to the foundation school to put support and reasonable adjustments in place for incoming foundation doctors.
This happens through the TOI form, which is completed by the medical school and the student, and received by the foundation school a few months before the start of the Foundation Programme.
When graduating students complete their TOI forms, they are told to: 'provide sufficient information on the nature of your condition or disability to enable your foundation school to understand how it may affect you in your clinical training or work as a doctor, and to understand your support needs'.
The medical schools can encourage their graduating students to contact the occupational health services where their post will be based, or to give their consent for the employer to inform the occupational health services.
Where support arrangements cannot be made in an existing post, the foundation school and postgraduate dean may consider establishing an individualised post, subject to training capacity, GMC approval and resources.
Adapted version of TOI guidance for applicants
Pre-allocation through Special circumstances process
Medical schools can encourage disabled learners to consider applying to the Foundation Programme via the Special Circumstances process. This is a separate process to allocate graduates to a specific location for their foundation post.
A post in a specific geographical area can help with attending health appointments or continuing a treatment programme, while staying in a familiar location near support networks.
Disabled doctors told us that training in a familiar environment was helpful as navigating new NHS environments could be challenging.
A student or graduate can apply for pre-allocation under four criteria, two of which are relevant to having a long-term health condition or disability:
- Criterion 3: 'The applicant has a medical condition or disability for which ongoing follow up in the specified location is an absolute requirement.'
- Criterion 4: 'Medical school nomination for pre-allocation to local foundation school on the grounds of unique special circumstances'.
Foundation schools will review the special circumstances application forms. If a graduating student or doctor in training applies under Criterion 3, their application will include a supporting statement by the individual and information from occupational health. If a graduating student or doctor in training applies under Criterion 4, their application will include a supporting statement by the individual and information on their current situation by another signatory (a professional person who has recognised standing to support the application).