How can medical schools apply their duties?

Once support is in place

Evolving needs

Medical schools should keep in mind that the needs of disabled learners may change during the duration of the course.

It is good practice for the school to take steps to assess the effectiveness of the support given to disabled learners. These could include:

  • regular ‘checking in’ conversations with the student
  • means for the student to raise any issues about the support they are receiving
  • a more formal review scheduled at regular intervals, e.g. termly or yearly.

The key contact from the medical school can handle small changes in the support received by the student, in liaison with the appropriate services.

If there are significant changes, the key contact from the medical school may wish to call another case conference or joint meeting to discuss how these can be accommodated. This is particularly relevant for deteriorating or degenerative conditions. If a student’s condition changes significantly, the medical school support group may need to re-assess whether the student can still be supported to meet the Outcomes for graduates.

Taking time away from the course

Some students may become unwell during their studies and need to take time away from the course to recover.

If the school or a medical student themselves thinks that they would benefit from taking time away from the course, the support group could meet again to reach a decision (involving the student if appropriate). The discussions could cover:

  • why the student would benefit from/may want to take time away
  • how long it is recommended for the student to take.
    • missing a considerable amount of teaching time or placements can make it impossible for a student to catch up on their work. The school needs to balance this with the negative effect that retaking a year can have on the student, so decisions need be made on a case-by-case basis
  • what the student is expected to do, or what the student aims to do during that time (e.g. attend treatment programme)
  • where they will be based during their time away: for example, locally and using university facilities, or returning home to have support from family and friends
  • what level of contact they will have with the medical school and university
  • how the school can help them reintegrate into the course when they return.

There will be times when the school and a student disagree about whether taking time away from the course is the right thing to do. The school should take reasonable steps to understand the difference of opinion and to develop an appropriate plan with the student.

The school should provide a high level of pastoral support as this will be a difficult time for the student. The same applies once a student who has taken time off returns to the course.

The school should think about ways to build flexibility into courses, so that students are able to catch up on the time they have missed.

Note: This section is based on the advice given to medical schools on this topic in Supporting medical students with mental health conditions (joint guidance with the Medical Schools Council).

Panel 13: Can schools provide an adjustment that is not considered as realistic?

The assessment is designed to test specific competence standards. A reasonable adjustment can be made to enable a disabled student to meet the same standard expected of all students - it cannot change or lower that standard. The key factor is whether the element adjusted is part of the competence standards tested in that assessment.

Extra time is a possible reasonable adjustment. It depends on whether the medical school decides that the time component is part of the competence standards tested in that particular assessment. This also applies to other components, for example whether a competence you want to test is spelling, punctuation and grammar, or the language used in the questions.

Medical schools can consider adjustments like the following examples. These examples are illustrative and decisions always need to be made an individual basis.

  • additional time for an assessment or specific components of an assessment
  • not marking down on spelling, punctuation and grammar
  • allowing students to use pen and paper
  • allowing students to take the assessment in a quiet environment - for example, a person with dyslexia may find it very difficult to concentrate in busy overcrowded environments

When arranging support for assessments that simulate the clinical environment, medical schools may wish to consider that:

  • it is natural for medical students to be more stressed than usual for an assessment. Stress can exacerbate a number of conditions - eg making a stammer worse than usual
  • medical students and doctors are individuals of high ability and can develop successful coping strategies in clinical practice. For example, using templates to help structure written work; spellcheckers, dictation of notes, visual/audio methods, checklists, medical apps, and speech recognition software

Requests for adjustments need to be substantiated by the student, for example through a report by an educational psychologist. Similarly, schools have to substantiate declining requests for adjustments. A blanket policy is unlikely to be reasonable.

What is considered reasonable, and whether a particular adjustment would prevent the competence standard from being demonstrated, is a decision for each medical school to be taken based on the facts of each particular case.

Panel 14: What can medical schools do when students are diagnosed with a health condition or disability as a result of failing an assessment?

If a student fails an assessment or a specific component unexpectedly, the school may explore if it is because of a long-term health condition or disability.

  • Medical students are individuals of high ability, so it is possible that any health condition or disability affecting exam performance was hidden through school and other academic studies. Students could also think that a diagnosis at a young age is irrelevant because it has not affected their performance in previous assessments
  • The nature of assessment at medical school is particular to that setting, so students would not have been in that exam environment before.

There are hidden disabilities that can affect exam performance - for example the International Dyslexia Association says 'Dyslexia affects 1 in 10 individuals, many of whom remain undiagnosed and receive little or no intervention services'.

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