Dr Adrian Brooke, Acting Postgraduate Dean for the East Midlands, was part of the expert working group who oversaw the review of our advice on supporting disabled doctors and medical students. To mark the publication of Welcomed and valued, Adrian reflects on his involvement in the project, and how the updated guidance now includes more practical advice for postgraduate educators.
What makes a good doctor? We can all think of attributes like having technical skills, expertise and know-how as being important. But the thing that patients often remember is our ability to communicate, our humanity and above all, our empathy. If you step back from the individual clinician, the profession’s ability to care for our patients must rest in our ability to reflect their demography, make-up and diversity. We have for too long maintained the idea that medicine is made up of elite characters without flaw or deficit, that has been founded in a paternalistic mould.
As society changes and develops, so must the profession, to maintain the close connection we have with the public who entrust us so fully with their health and wellbeing. Key to this is including disabled people and those with long term health conditions in medicine, so their lived experience is an integral part of the humanity and empathy of medical practice. However, trust in clinicians is not unconditional; it is dependent on all doctors maintaining the highest standards of professionalism.
Working together to resolve consultation feedback
In reconciling the equally important and relevant aims of maintaining standards and making medicine more accessible, I was privileged to be involved in the working group that oversaw the review of the GMC’s original advice, Gateways to the professions. Gateways was aimed primarily at medical schools and gave suggestions on how to support disabled medical students and doctors through their education and training. While this version was useful, there was room for more practical advice and a greater focus on postgraduate medical training.
The review of Gateways started in 2017 and I became involved the following year as a Postgraduate Dean representative from the Conference of Postgraduate Medical Deans (COPMeD). This coincided with the time the GMC went out to public consultation on the updated draft guidance, Welcomed and valued.
The working group had detailed and searching discussions on how to resolve several issues that were raised during the consultation, which for some members seemed to be conflicting. These conversations revolved around how we would reconcile the responsibility of all doctors to practise medicine to a high standard and meet required learning outcomes, while making sure disabled people were not inadvertently but unfairly prevented from entering the profession.
During this process we realised that there were two different situations. A doctor who becomes ill or disabled once qualified may be able to continue practising in a modified or restricted way. But this will not necessarily be the same for someone with a similar disability or illness who is trying to enter and progress through medical education and training.
The nub of this issue is around the minimum practical skill set required for registration, which must reflect the broad range of skills a foundation doctor needs to have. Later in their career a doctor’s required skillset will be more specialised, and it may be easier to adapt their practice at this stage, compared with earlier in their training.
What is expected of newly qualified doctors has recently been clarified through the publication of the updated Outcomes for graduates and the list of practical skills and procedures. In these documents the GMC makes clear their expectation that medical schools should provide supportive and pragmatic adjustments for disabled learners and those with long term health conditions, to help them meet the required standards.
Making the guidance relevant to postgraduate training
In addition to untangling some of these perceived conflicts, together with colleagues I was able to help make sure the revised guidance was relevant to postgraduate trainees and those involved in their training. It now describes how to involve occupational health services so learners can have reasonable adjustments made to both work and learn. It also encourages a proactive relationship between doctors in training, their employers and responsible officers, where effective information sharing supports trainees in their efforts to succeed in medicine.
The changes to Welcomed and valued will help to make sure that the necessary standards of professionalism are maintained, while allowing medicine to become appropriately inclusive. I look forward to working with trainees, educators, employers and the GMC to translate the laudable aims of this guidance into more doctors, who represent a wider pool of talent, progressing through medicine and practising at the highest levels for the benefit of all.