What is expected of medical education organisations and employers?

Meeting Promoting excellence standards for medical education and training

We have specific standards and requirements within Promoting excellence about supporting learners overall, and supporting learners with disabilities (including long term health conditions) in particular.

What does Promoting excellence say about supporting disabled learners?

Promoting excellence makes it clear that the purpose of providing effective support to students and doctors is for them to demonstrate what is expected in Good medical practice and achieve the learning outcomes required by their curriculum.

We require organisations to:

give learners access to resources to support their health and wellbeing, and to educational and pastoral support, including (R3.2) confidential counselling services, careers advice and support, and occupational health services.

make sure learners are not subjected to behaviour that undermines their professional confidence, performance or self-esteem (R3.3)

make reasonable adjustments for disabled learners, and to make sure learners have access to information about reasonable adjustments, with named contacts (R3.4)

give learners information and support to help them move between different stages of education and training. The needs of disabled learners must be considered, especially when they are moving from medical school to postgraduate training, and on clinical placements (R3.5)

give learners timely and accurate information about their curriculum, assessment and clinical placements (R3.7). This is particularly relevant for disabled learners, as having this information in advance will help put any reasonable adjustments or other arrangements (eg travel arrangements for placements that are further away) required in place

support, where reasonable, learners whose progress, performance, health or conduct gives rise to concerns to overcome these and, if needed, given advice on alternative career options (R3.14).

Medical schools also have responsibilities towards the very small number of medical students who may not be able to meet the competences in Outcomes for graduates, after they have exhausted the options for support.

Promoting excellence makes it clear that students must not progress if they fail to meet the required learning outcomes for graduates. In these cases, medical schools are required to give advice on alternative career options, including pathways to gain a qualification if this is appropriate. Doctors in training who are not able to complete their training pathway should also be given career advice (R3.16).

Panel 7: Is there any type of support for a student that is not compatible with clinical practice in the future?

Panel 7

Medical schools must make reasonable adjustments for students with a disability to allow them to demonstrate they have achieved the Outcomes for graduates.

There may be times where an adjustment is both unreasonable on a course of study and in the workplace. If a certain level of support or an adjustment may not be available in a specific workplace environment, it does not necessarily mean that a medical school is not obliged to provide it. Ultimately, decisions on reasonable adjustments are matters for medical schools to be taken on the facts of the particular case.

When considering support for a student, the key thing to consider is whether providing a particular form of support or reasonable adjustment would enable a student to demonstrate a relevant competence standard - in this case the Outcomes for graduates. We recommend this approach because:

  • Outcomes for graduates is an objective set of criteria which every medical student needs to demonstrate, developed with a range of experts in medical education
  • there is a risk of making subjective judgments about the student's future abilities as a doctor and the setting where they will practice
  • clinical environments vary hugely, and postgraduate educators are responsible for allocating a doctor in training appropriately. This includes finding a post where appropriate support will be available

It cannot be predicted how someone's health condition or disability will affect them in the future.