The GMC and medical students with disabilities

There are a lot of rumours going around about the GMC's position on medical students with disabilities, particularly those in wheelchairs. Peter Rubin, chairman of the GMC's education committee sets the record straight

Students with disabilities have gone to medical school in the United Kingdom for many years--certainly, to my knowledge, as far back as when I was a medical student. This continues to be the case and an informal (and anonymous) survey that I carried out in 2002 confirmed that students with a wide range of disabilities are currently in our medical schools. Although dyslexia tends to be by far the most common disability, many students with difficulties associated with mobility, hearing, or vision successfully progress through the course.

Despite the reality of the situation, there is a belief that the General Medical Council (GMC) stands in the way of such students getting into medical school in the first place. We don't and the law wouldn't permit us to even if we wanted to. The purpose of this brief article is therefore to explain the GMC's position with respect to students with disabilities applying to medical school.

The GMC's position

The GMC, universities, and the NHS all have different responsibilities for medical education. The GMC exists to protect the public, and this responsibility begins by ensuring high quality medical education. We have legal powers to determine the content and standards of the medical curriculum, and these are described in terms of learning outcomes that must have been achieved by a doctor at the time of graduation. These outcomes cover knowledge, skills, and attitudes and are set out in Tomorrow's Doctors.¹ Universities are responsible for selecting students into their medical schools and for providing a curriculum that will deliver the learning outcomes required by the GMC. The NHS has a statutory responsibility to make available the facilities necessary for the delivery of clinical elements of the curriculum.

The GMC does not have legal powers over medical school admissions and never has done--these are entirely a matter for universities. Having said this, medical schools often seek our advice on either general issues or on specific students. This is partly because we have a lot of accumulated experience in this area. Partly it is also because once a student has received a medical degree from an approved UK university, that new doctor's name automatically goes on to the GMC register--we have no discretion in the matter. So although we have no legal powers over admission, we obviously have an interest in who enters medical school.

The principles that underpin our advice are published in Tomorrow's Doctors, in the section on Student Health and Conduct: "... students with a wide range of disabilities or health conditions can achieve the set standards of knowledge, skills, attitudes and behaviour. Each case is different and has to be viewed on its merits. The safety of the public must always take priority."

We have been deliberate in not listing "approved" disabilities because every case is different and generalisations can be unsafe. The specific issue of students who require wheelchairs has generated some considerable interest. However, our message is clear. The GMC's view is that, with adequate support, being in a wheelchair should not necessarily prevent a student achieving the learning outcomes that we require. As with all disabilities each case must be viewed on its merits.

The newly qualified doctor has to spend a year as a preregistration house officer and spends most of that time in the acute specialties of medicine and surgery. It was recognised a long time ago that doctors with certain disabilities would find it impossible to carry out some of the clinical tasks associated with acute practice. For many years, the Medical Act (which governs what the GMC can do) has therefore made special provision for doctors with a lasting physical disability, ensuring that they can obtain alternative and relevant experience.

The world does not stand still and the expectations of both society and individuals are constantly changing. Conscious of this, the GMC's education committee and its officers maintain a watching brief over educational developments in countries with similar expectations. Our aim is to ensure that medical education in Britain retains its reputation for excellence and that the GMC continues to provide clear leadership. But above all else, we are ever mindful of our overriding duty to protect the public and it is this that will continue to drive our policies and our actions.

1. General Medical Coucil. Tommorrow's doctors. London: GMC, 2002. www.gmc-uk.org/med_ed/tomdoc.pdf (accessed 8 Oct 2003.)
2. Poynter D. The self-publishing manual. Santa Barbara: Para, 2003.

       

           

Responses published this month Articles Responses CAREERS The GMC and medical students with disabilities       Peter Rubin (November 2003) christine sathananthan (August 21, 2003) Read this response CAREERS The GMC and medical students with disabilities       Peter Rubin (November 2003) christine sathananthan (August 21, 2003)       3rd year (intercalated BSc) GKT medical school, Kings College London christine.sathananthan@kcl.ac.uk After having read this article in the August 2003 issue of the Student BMJ, I was rather disappointed at the attitudes of medical students towards the importance of cultural awareness. I was surprised that "tomorrows doctors" had very little regard for respecting the impact that their patients' cultures, values or beliefs would have on their healthcare decisions and lifestyles. I am fortunate to say that at my university ( GKT Medical School,Kings College London)we are taught an Ethics and Law module mainly in the pre-clinical years of study though the emphasis of it is also taught within the clincal years. There is a slight heir of snobbery from some students about this area of study within Medicine, most of this group of students feeling that it is time wasting, snapping out phrases like, "This isn't real medicine." However, it has to be said that in being culturally aware we are infact learning the practise of "real medicine". Although not a clinical student yet, I feel that I have benefitted from learning about cultural diversity just from observing medical consultations withtin a surgery and also from work experience within a surgical ward. It has made me more aware of my own healthcare decisions with respect to both my own and others' culture and values. I strongly agree with Dr. Beagan's point of view and hope that notice will be taken by medical students of her formula for producing better, socially equipped doctors. Yours sincerely, Christine Sathananthan