Reasonable adjustments throughout the stages of medical education and training

We provide links to useful information, some key points you might want to consider, and tips from doctors who have gone through this stage of training.

Location: UK
Audience: All doctors
Updated: Monday 7 September 2020
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​Having a disability or long-term health condition is not an automatic barrier to becoming a doctor.

Reasonable adjustments are changes that organisations can make to premises, equipment, policies or practices to remove barriers disabled people face in training or the workplace.

In this section we have provided links to useful information, some key points you might want to consider and tips from doctors who have gone through this stage of training.

The GMC has published Welcomed and Valued, guidance on supporting disabled learners through medical education and training.

 

Applying to medical school

This section of the GMC Welcomed and Valued guidance may be useful for students planning their applications to medical school. It tells you what medical schools are expected to do to comply with their legal duties towards disabled applicants and students.

Medical schools need to consider the impact of a disability or long-term health condition on an applicant’s fitness to practise medicine. This is because they have a responsibility to ensure that all students will be eligible for registration by the General Medical Council. Where reasonable, they must make adjustments to premises, equipment, policies or practices to remove barriers and alleviate any substantial disadvantage that disabled students face.

Key points to consider

  • It is unlawful to discriminate against anyone applying to medical school because of disability, including those long-term health conditions which are classed as disability under the Equality Act 2010.
  • If you don’t tell potential medical schools that you are disabled and require reasonable adjustments before you apply, they will not be able to assist you during the application process.
  • You should contact the occupational health officer or disability support adviser who can advise on what kinds of reasonable adjustments the university already has in place for other students, and discuss what reasonable adjustments may be appropriate for your individual needs.
  • Medical schools may wish to test you or interview you. You must not be discriminated against because of your disability or long term health condition, and your medical school must provide assurance that all tests relate to a candidate’s suitability for selection. Reasonable adjustments should be provided for anyone that needs them to carry out the tests effectively, for example, extra time or information in accessible formats.
  • At all stages of application, any questions should be related to your requirements rather than your impairment or condition. For example, the question should enable you to say that the room should not have fluorescent lighting, not that you have epilepsy.

Some tips from former students

  • Don’t be put off doing medicine by your disability or health condition
  • Research potential medical schools in advance. Most medical schools have a dedicated service for disabled students (current and prospective) and some also offer tours in advance of application.
  • Don’t forget to think about issues like accommodation, transport, and social aspects of university life as well as course requirements
  • Talk to other disabled students or former students and find out how they were supported

 

At medical school

Medical schools are expected to ensure that all student services are accessible to disabled students. Medical schools must also consider the requirements of disabled students when designing a course so that it is as accessible as possible and to ensure that the learning environment is as inclusive as possible.

The GMC's guidance provides a list of potential reasonable adjustments that could be made available to you but you should liaise with your medical school for the most appropriate adjustments to suit your individual needs.

Key points to consider

  • It is common practice to ask all applicants who have been offered a place to complete a health clearance form. The process is designed for the school to identify anyone who will need support in advance, and to decide the most appropriate kind of support.
  • Decisions about what adjustments are made should always involve you.
  • Medical courses will include both academic and clinical/practical components and some students may need reasonable adjustments in place for either or both of these.
  • If you develop or become aware of a disability or health condition while at medical school, it is important that you talk to someone for advice on how best to move forward. A process should then be put in place by your medical school to determine the reasonable adjustments that you might need.

Examples of reasonable adjustments to the teaching and learning environment

  • Making assistive technology available: for example, laptops or hand-held devices for taking notes, magnification programmes, microscopes/stethoscopes linked to display screens.
  • Accessible teaching and materials: making course materials available in electronic and audio formats, availability of a note-taker for lectures, small groups for practicals, keeping the same group throughout.
  • Assignments and deadlines: additional learning support and coaching, adjustments to assignments, such as allowing a student to submit a piece of work on video rather than in writing, provision of study skills support covering essay writing or dissertation skills, additional time and flexible deadlines for assignments for those with variable conditions.

Some tips from former students

  • ‘If the adjustments that have been put in place for you are not helping, don’t just put up with it- tell someone so they can look again at how to support you.’
  • ‘There have been several practical skills that I have had had difficulty with, including performing CPR, suturing and intubation…I had a ‘case meeting’ early in my first year of medical school with various members of the departments involved to make preliminary assessments of skills I may find difficult.’

 

Application to foundation training

Chapter 5 of the GMC Welcomed and Valued Guidance has a wide range of useful information on the transition to foundation training.

At this stage in your training, you have rights as a disabled trainee to fair treatment in education from your postgraduate deanery, and you also have rights as an employee of an NHS organisation under the Equality Act 2010 (or equivalent in Northern Ireland).

You should contact your local deanery or Local Education and Training Board (LETB) to discuss reasonable adjustments in advance of you entering the Foundation programme to ensure that there will be no difficulties in progressing. For example, ensuring that the provision of reasonable adjustments will not affect any ongoing assessment, such as the Annual Review of Competence Progression (ARCP).

It is also advisable to contact the occupational health department or disability support adviser who can advise on what reasonable adjustments are already in place or have been provided for other trainees and discuss what may be appropriate for you.

Key points to consider

  • All medical students and doctors in training, regardless of whether they have a disability or long-term health condition, need to meet the competences set out for different stages of their education and training in order to ensure patient safety.
  • Medical schools can make reasonable adjustments to the modes of assessment of those outcomes, except where the method is part of the competence that needs to be attained
  • It can be difficult to know what adjustments are needed in an unfamiliar work setting. There is no onus on a disabled worker to suggest what adjustments should be made to assist them in the workplace. In any event, an employer cannot discharge its duty to make reasonable adjustments by simply relying on recommendations from the individual concerned

Examples of reasonable adjustments

  • A student with a hearing impairment is using an electronic stethoscope to perform part of a physical exam. The student still meets the outcome of performing a full physical exam, but with a slightly different method than for another student.
  • Making changes to the physical surroundings of the assessment centre
  • If a disabled candidate is physically unable to undertake a task, it may be possible to allow the candidate to instruct a proxy.
  • The early distribution of, or access to course materials to candidates with dyslexia or with other recognised specific learning needs

Post allocations

There are two processes that disabled learners, medical schools and foundation schools can use to make sure incoming foundation doctors are allocated to an appropriate post for their training. These are the Transfer of Information (TOI) process and the Special Circumstances pre-allocation process.

The TOI process communicates information to the foundation school (via the TOI form) to put support and reasonable adjustments in place.

Pre-allocation on the grounds of Special Circumstances is a separate process to allocate graduates to a specific location for their foundation post. A post in a specific geographical area can help with attending health appointments or continuing a treatment programme, while staying in a familiar location near support networks.

A student or graduate can apply for pre-allocation on the grounds of Special Circumstances under four criteria, including:

Criterion 3: 'The applicant has a medical condition or disability for which ongoing follow up in the specified location is an absolute requirement.'

Criterion 4: 'Medical school nomination for pre-allocation to local foundation school on the grounds of unique special circumstances'.

The process and application forms can be found on the UKFPO website.

Less than full time (LTFT) training may help disabled doctors too. Postgraduate educators can inform disabled doctors about the possibility of less than full time training, and direct them towards relevant information and guidance. You can read more about training LTFT here.

During rotations

Often, the challenges disabled medics face, such as securing suitable reasonable adjustments and dealing with negative attitudes and assumptions, reset at each transition. You can minimise potential difficulties by ensuring you remain in regular contact with occupational health and by discussing your needs early when moving between different rotations.

The GMC encourages postgraduate educators to consider minimising transitions that involve change in location to help disabled doctors in training. This is while still allowing them to demonstrate their skills and meet the competences required for their training. For example, a disabled doctor in training might benefit from completing all rotations of their Foundation Programme in one local education provider or in the same hospital.

 

Application to specialty training

Applicants who require reasonable adjustments to attend interview or take up a specialty training post should ensure that they contact the lead recruiter as soon as possible to discuss their requirements.

The GMC advises that Medical Royal Colleges should review their examination arrangements against a policy such as the Consideration of Disabilities and Special Needs in MRCP (UK) Examinations of the Federation of the Royal Colleges of Physicians.

Examples of reasonable adjustments during postgraduate training include:

  • Adjustments to rota and shift patterns
  • Extra time and rest breaks
  • Time off when needed for hospital appointments

Some tips from other doctors

  • Don’t be afraid to ask for help and be specific. You are not expected to know exactly what you need before you start.
  • Know your limits, concentrate on what you can do and work with your employer to adjust your duties accordingly
  • Be persistent – securing reasonable adjustments should be a process, not a one-off assessment. It is okay to go back and ask for things to be looked at again if they are not working for you.
  • Remember you are not alone: talk to the BMA or to doctor support groups who are there to provide you support and guidance
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