14 October 2010
Tomorrow’s Doctors (2009): Draft Supplementary Advice on Clinical
Placements and Assessment
1. The development of advice for medical schools on the implementation of
Tomorrow’s Doctors (2009) in relation to clinical placements, including Student
Assistantships, and assessment.
a. To approve the draft on assessment for wider circulation, subject to
any changes agreed, and to authorise the Undergraduate Board Chair to
agree the draft text before circulation (paragraph 16).
b. To approve that the draft on clinical placements for wider circulation,
subject to any changes agreed, and to authorise the Undergraduate Board
Chair to approve the draft text before circulation (paragraph 17).
c. To authorise the Chair of Undergraduate Board to approve the final text
of the advice documents on assessment and clinical placements for
publication, in light of comments received following circulation of the drafts
(paragraphs 18 to 22).
d. To note that draft advice on involving patients and the public, and on
developing teachers and trainers, will be brought to the Undergraduate Board
for consideration in January 2011 (paragraph 23).
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3. The 2009 edition of Tomorrow’s Doctors followed extensive engagement and
review and a full, formal consultation. In addition, since its publication medical
schools have had ample opportunity to comment on the new outcomes and
standards, especially through the implementation workshops organised by the GMC
and the 2009/10 Enhanced Annual Returns (EARs).
4. The report on the consultation on Tomorrow’s Doctors to the GMC Council in
8 July 2009 identified potential streams of further work, including six areas where
supplementary guidance could assist medical schools:
a. Assessment and external examiners.
b. Student Selected Components (SSCs).
c. Reasonable adjustments to the competences set out in Tomorrow’s
d. Supervision, Student Assistantships and electives.
e. Standards for undergraduate teachers and trainers.
f. Shadowing and induction into the Foundation Programme and the
5. In the subsequent period, the GMC has refined its guidance on reasonable
adjustments through the review of Gateways to the Professions – Advising medical
schools: encouraging disabled students. Medical Education England have addressed
the need to develop a more consistent approach to shadowing and induction of new
graduates into the NHS.
6. On 21 January 2010, the Undergraduate Board noted that:
a. 19 medical schools had called in their EARs for further guidance on
Student Assistantships, shadowing, support for teachers and trainers, and the
involvement of patients and the public in undergraduate medical education.
b. Any supplementary guidance developed would be advisory, rather than
mandatory, and aimed at supporting medical schools.
7. The Board agreed that:
a. Proposals be developed for supplementary guidance on assessment,
standards for undergraduate teachers and trainers, and placements.
b. Priorities for additional supplementary guidance be considered
following the merger of PMETB with the GMC, and in the light of the
challenges identified through the Enhanced Annual Returns and
c. To establish a working group of GMC members and key interests to
oversee the development of the supplementary guidance.
8. On 19 July 2010, the Undergraduate Board was informed that work was in
hand on assessment, clinical placements, teachers and trainers, and patient and
public involvement. Informal groups would be established to advise on the
development of the documents. In this light and given the timescale, it now appeared
unnecessary to convene formal meetings of an overarching steering group as had
been originally envisaged. Board members were invited to express interest in
commenting on drafts.
9. It is envisaged that the documents will be advisory only. They will contain no
new requirements or regulatory expectations. They need to be genuinely helpful for
medical schools particularly in implementing the requirements in Tomorrow’s Doctors
10. The GMC is not undertaking a full engagement process or a full three-month
consultation in the development of the advice. This is in light of the extensive review
and consultation on Tomorrow’s Doctors and the urgency of providing advice to
medical schools for the implementation of the new requirements. However, drafts will
be in the public domain and circulated for comment.
11. We are drawing on various sources in the development of the advice:
a. The QABME reports, published on the GMC website, contain useful
information about local arrangements including those which led to
requirements, recommendations and the identification of good practice.
b. Informed by the QABME reports and also the EARs, we have
contacted all medical schools for descriptions of local arrangements which
could be included in the advice. Inclusion in the documents will not indicate
that the GMC regards the local arrangements cited as particularly innovative
or worthy, but as illustrations of different approaches.
c. GMC guidance for example on patient consent and GMC
arrangements for example PLAB.
d. The academic literature particularly relating to assessment and to
public and patient involvement.
12. For each area, informal groups of expert advisers have been established.
They have been invaluable in scoping the documents, suggesting additional sources
and commenting on early drafts. In addition we have obtained views from:
a. The Employers’ Forum of NHS Employers, to whom we presented on
clinical placements on 18 August 2010.
b. Members of the Undergraduate Board and of the Equality and Diversity
Reference Group, to whom we circulated drafts on 16 September 2010.
c. The Education Sub-Committee of the Medical Schools Council which
met on 1 October 2010
13. The first documents to be published relate to assessment (Annex A) and to
clinical placements including Student Assistantships (Annex B): we envisage that the
final texts could be approved in December with a view to publication in December
2010 or January 2011.
14. The advice on developing teachers and trainers, and public and patient
involvement, will follow. We aim to bring drafts to the Undergraduate Board in
January 2011 with a view to publication of final documents in the Spring.
15. The draft advice on assessment at Annex A covers three areas:
a. Medical schools’ arrangements for oversight including an assessment
strategy, blueprinting to help ensure that the outcomes in Tomorrow’s Doctors
are met, clear governance and arrangements for quality improvement and
b. Medical schools’ assessment tools appropriately reflecting published
guidance and lessons from QABME.
c. Key processes such as supporting examiners, standard-setting,
making decisions, providing feedback.
Recommendation: To approve the draft on assessment for wider circulation,
subject to any changes agreed, and to authorise the Undergraduate Board
Chair to agree the draft text before circulation.
Clinical placements and Student Assistantships
16. The draft advice on clinical placements at Annex B covers two areas:
a. General considerations in relation to clinical placements including
issues relating to supervision and the agreements between medical schools
and placement providers set out in Tomorrow’s Doctors.
b. More specific advice on Student Assistantships including suggestions
on activities which Student Assistants could perform and reassurance from
the NHS Litigation Authority on indemnity.
Recommendation: To approve that the draft on clinical placements for wider
circulation, subject to any changes agreed, and to authorise the
Undergraduate Board Chair to approve the draft text before circulation.
Involving patients and the public
17. The project to develop advice on involving patients and the public is at an
early stage. However, we envisage that it might cover:
a. Advice on how medical schools can take a wide view of what counts as
patient and public involvement.
b. General considerations which include valuing the benefits of active
involvement, recognising diversity and how to prepare for and sustain lay
c. Four main areas for involvement: teaching; assessment and feedback;
the development of curricula and assessments; and quality management,
control and governance.
Developing teachers and trainers
18. The project to develop advice on developing teachers and trainers is at an
early stage. However, we envisage that it might cover arrangements for selection,
support, training and appraisal.
19. Subject to the Board’s view, we could aim to circulate the two early drafts on
assessment and on clinical placements by Monday 25 October 2010, provisionally to
those listed at Annex C. Comments would be sought during a five week period
ending on Monday 29 November 2010.
20. Alongside seeking detailed drafting comments, we would ask a few key
questions such as:
a. Would the advice be helpful to medical schools?
b. Is the advice of an appropriate length?
c. Does the advice have an appropriate tone?
d. Have we failed to refer to key documents or sources – and if so which?
e. How could the advice be strengthened from the perspective of equality
f. How could the advice be strengthened from the perspective of patient
safety, public confidence and service involvement?
g. What further changes would you make?
21. Following consideration of the comments, revised drafts could be prepared for
approval by the Undergraduate Board Chair during December so that the documents
could be published that month or early in the New Year.
Recommendation: To authorise the Chair of Undergraduate Board to
approve the final text of the advice documents on assessment and clinical
placements for publication, in light of comments received following circulation
of the drafts.
22. We are preparing drafts on involving patients and the public, and on
developing teachers and trainers, for consideration by the Board on
20 January 2011. That would be followed by wider circulation of drafts for
engagement over several weeks, revision in the light of comments, and publication
as soon as possible thereafter.
Recommendation: To note that draft advice on involving patients and the
public, and on developing teachers and trainers, will be brought to the
Undergraduate Board for consideration in January 2011.
23. We envisage that the draft circulation will be undertaken by email. The final
versions will be available on the GMC website and we envisage publishing 1000
copies of each document. The print runs will cost around £750 for each publication,
or £3000 for all four.
24. We have considered equality and diversity perspectives in developing the
draft advice and we have obtained external expert advice. As part of the wider
circulation, we will seek comments from organisations working in this field.
25. An Equality Impact Assessment has been prepared and will be completed in
light of feedback on the draft documents.
26. Draft documents will be circulated shortly, subject to the Board’s views.
A Communications plan has been developed for publication of the final advice.