Fillable Medical School Qualification Review form (General Medical Council)

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Medical School Qualification Review form (General Medical Council)

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MSQR1
Medical School Qualification Review form
Please complete this form in full. If you do not provide us with all the required details and evidence listed, then your
review will be delayed. Please refer to our guidance
for help in completing and submitting the form.
If you need more space, please use on the supplementary information page at the end of this form.
Section 1: Contact details of your medical school
Name of Dean
Name of Medical School
Address
City and Country
ZIP / Postcode
Length of time at this address
Telephone number
Fax number
Email address
If your medical school has changed address or name in the last 10 years, please enter the previous
details
Name of Medical School
Address
City and Country
ZIP / Postcode
Length of time at this address
Telephone number
Fax number
Email address
This form was last updated on 24 May 2018.
MSQR1
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK)
Page 2 of 14
Section 2. The Primary Medical Qualification (PMQ)
2.1 Title(s) of the Primary Medical Qualification
(PMQ) awarded.
2.2 If applicable – please detail any previous titles
of the PMQ, and tell us when the title changed
2.3 Date when the programme of study leading to
the award of this PMQ was introduced at your
institution.
2.4 Please provide a copy of the current PMQ certificate (and any previous
certificates covering the last 10 years) that is awarded upon successful
completion of the programme of study.
Evidence
provided
Evidence
not
provided
2.5 Please provide a full outline of the full programme of study/curriculum
of the PMQ including full details of the clinical clerkships, using the table
provided in annex A.
Evidence
provided
Evidence
not
provided
Yes No
2.6 Is your institution currently listed in the World Directory of Medical
Schools?
2.7 Is the PMQ wholly in allopathic medicine? If no, please provide further
information on which parts of the course are not.
2.8 Please confirm:
a) the standard length of your institution’s PMQ course in years
b) the standard length of your institution’s PMQ course in clock hours
c) the minimum attendance that a medical student must have before
they can be eligible for graduation
d) whether evidence has been submitted to support your claims made
in questions 2.8 a)-c)
Evidence
provided
Evidence
not
provided
This form was last updated on 24 May 2018.
MSQR1
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK)
Page 3 of 14
Section 3: Studying at twinned medical schools and other campus locations of your medical school
3.1 Does your institution’s PMQ course involve studying: Yes
No
a) At more than one institution?
b) In a country other than the awarding body country?
c) In a different medical school as part of a recognised twinning
arrangement?
d) In another campus of your University/Medical School (not as
part of a twinning arrangement)?
If you answered no to all of the above, go to section 4.
If you answered yes to any of (a) – (d) above, please provide the name
and contact details for each location below and submit evidence of:
a) the total clock hours studied in each location
Evidence
provided
Evidence not
provided
b) information about the agreement between the
institutions/countries/medical schools/campuses for delivery
of the PMQ (see paragraph 31 in the guidance)
Evidence
provided
Evidence not
provided
Location 1
Name of medical school/campus
Country
Full address
Phone number
Fax number
Website address
Contact email
Name of Dean
Location 2
Name of medical school/campus
Country
Full address
Phone number
Fax number
Website address
Contact email
Name of Dean
This form was last updated on 24 May 2018.
MSQR1
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK)
Page 4 of 14
Section 4 - Course transfer arrangements
4.1 Does your institution accept students transferring from another:
Yes
No
a) PMQ course at another institution?
b) Non-medical course at your or another institution?
4.2 If yes to a) or b) above, what is considered and under what situations would you accept such
transfers? Please provide further detail below.
This form was last updated on 24 May 2018.
MSQR1
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK)
Page 5 of 14
Section 5: The clinical rotations undertaken as part of the PMQ (also known as clinical
clerkships)
5.1 Yes
No
a) Are clinical rotations/clerkships undertaken as part of your
institution’s PMQ programme of work? (If so, you must
ensure that these are reflected in the course outline
information provided at Annex A)
b) Does your medical school approve and oversee all clinical
rotations and clerkships? Please provide further evidence.
c) In all cases do they include exposure to both medicine and
surgery?
d) How many clock hours of clinical rotations /clerkship would
a medical student undertake in total as part of their PMQ?
5.2 Please provide further details of the above (see paragraphs 38 -44 in the guidance):
5.3 Does the PMQ include an undergraduate internship also part of
the programme?
If yes, please provide details of the undergraduate internship, and how it is distinct from the
clinical rotations/clerkships?
This form was last updated on 24 May 2018.
MSQR1
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK)
Page 6 of 14
This form was last updated on 24 May 2018.
MSQR1
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK)
Page 7 of 14
Declaration
I confirm that the information I have provided in this form regarding the PMQ that my medical school
offers is true and correct. I understand that the GMC and its staff may undertake any checks necessary to
establish the acceptability of this PMQ.
Signature of
Dean
Date dd mm yyyy
Print name
Stamp of
Awarding
body
This form was last updated on 24 May 2018.
MSQR1
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK)
Page 8 of 14
Supplementary information
Please use this page if you need more space to answer any of the questions in the form. Please state
clearly which question your answer relates to.
Annex A - outline of the full programme of study/curriculum of the PMQ
1. You must complete the below table with details of the full programme of study, including details of clinical clerkships/rotations if these form part of your institutions primary
medical qualification.
2. If your institution’s PMQ involves study in multiple institutions / countries / medical schools / campuses, you should specify at which location the student is based for each
module.
Year Semester Title of module / course component Core or
elective?
Length in
clock hours
Location
(If your institution’s PMQ involves study in multiple
institutions / countries / medical schools / campuses)
This form was last updated on 24 May 2018.
MSQR1
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK)
Page 10 of 14
Year Semester Title of module / course component Core or
elective?
Length in
clock hours
Location
(If your institution’s PMQ involves study in multiple
institutions / countries / medical schools / campuses)
This form was last updated on 24 May 2018.
MSQR1
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK)
Page 11 of 14
Year Semester Title of module / course component Core or
elective?
Length in
clock hours
Location
(If your institution’s PMQ involves study in multiple
institutions / countries / medical schools / campuses)
This form was last updated on 24 May 2018.
MSQR1
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK)
Page 12 of 14
Annex B - Evidence reference table: Medical School qualification review form (MSQR1)
1. To speed up our review, please complete this evidence reference table so that the purpose of each piece of evidence is clear. Please follow the steps below when labelling your
evidence and filling in this form:
• Number each file, and include this number in the file name of the document, e.g. “
2 –
Clinical rotations – xx Medical School”
• Ensure that you give each document a unique file name, and that this is connected to the evidence that the document provides.
• Insert the document number and title into the below table for each separate file.
• Look at the form, and identify which question each file provides evidence for. Add this number into the ‘Question number’ column.
• Provide a brief description of each document.
2. Rows 1 and 2 of the table have been completed as an example.
Document
number
Document title Question
number
Brief description
1
Blank current PMQ certificate
2.4
Copy of the current PMQ certificate awarded by
our institution.
2
Clinical rotations
5.1
Detailed breakdown of clinical rotations offered
by our institution
This form was last updated on 24 May 2018.
MSQR1
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK)
Page 13 of 14
Document
number
Document title Question
number
Brief description
This form was last updated on 24 May 2018.
MSQR1
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK)
Page 14 of 14
Document
number
Document title Question
number
Brief description
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