Being proactive and planning for reasonable adjustments

This anonymised account reflects the views of an individual, and not the General Medical Council.

An FY1 doctor with a physical disability talks about the prejudices and assumptions they’ve faced during medical school and the challenges they’ve had to overcome to secure reasonable adjustments.

Dealing with misinformed assumptions and prejudice

I am currently a Foundation year 2 (FY2) working less than full time in a supernumerary capacity and I have a physical disability. Having a disability and the personal experiences of being a patient undeniably influenced my decision to become a doctor. Not only am I able to fully empathise with my patients, but I feel I can also be a better advocate for them.

Prior to medical school, I emailed several admissions departments to gauge their views on medical students with disabilities and what support they would be able offer me if I applied to study medicine.

Some were encouraging, but said I'd need an occupational health assessment to ensure I'd be 'fit' to cope with course requirements and foundation programme. One school told me that I would be better off doing another course and then following graduation to consider applying to do medicine there. Frequently there was a lack of awareness of how schools could provide reasonable adjustments to allow students with disabilities to achieve course outcomes.

At one interview I was asked whether I could independently do CPR. The interviewer raised the issue by saying 'I probably shouldn't ask this but...'. This contravenes the Equality Act 2010.

Once I started medical school I found some of the consultants had a bullying nature and their views were outdated, prejudiced and discriminatory. One consultant supervisor asked 'did I think I should consider changing course, and wouldn't it be easier for me to do something else?'. This showed a complete lack of understanding of any reasonable adjustments I may need during clinical teaching and a failure to implement them.

My GP supervisor submitted a concern form about me not being able to walk up stairs on home visits during my GP placement. This was despite the fact I had sent them detailed information about my disability and my limitations prior to starting the attachment.

Lack of planning for reasonable adjustments

In my first OSCE, I was allowed to have a short rest break midway through my exam. The same adjustment was initially not allowed for my second OSCE however, as I was told I had not flagged this up. For my finals OSCE exam there was an initial lack of planning and failure to make reasonable adjustments for practical and logistical issues, such as a long walking distance to get to the exam. No one had considered these issues beforehand, and it was up to me to foresee these potential difficulties.

This left me feeling isolated and victimised. I felt there was no one to stand up for me, my tutor wasn’t a clinician and did not know about all the GMC guidance. I also did not know anyone else going through a similar experience.

Proactively asking for adjustments

For some clinical attachments, I met up with my consultant supervisor or attachment lead prior to starting the placement. This enabled any potential issues to be flagged up early on, and I could resolve them ahead of time. However, I had to be proactive and arranged most of these meetings myself.

I was allowed to have a central location for my clinical placements to minimize travelling distances and reduce fatigue. I was given a mobility scooter and was also allowed to have a chair for ward based teaching.

My occupational health assessment prior to starting FY1 says that I don’t have to do on-calls or night shifts because of my reduced stamina. This has been agreed as I’m supernumerary and therefore not required to make up numbers in the on call rotas. The trust and postgraduate training organisation I work for have been very flexible in terms of rotation length. They have let me choose what hours I work and I can also switch rotations.

What I would change…

  • Have a contact at each medical school who supports students with disabilities, offering advice and answering queries objectively before the application process.
  • Have proactive and empathetic student disability support officers who are advocates for students with disabilities.
  • Have mentors for medical students who are independent from the university or medical school. This could be a doctor in training with a disability, who can offer pastoral support and practical advice when required.
  • Improve dissemination of information by introducing an optional standardised form that students can fill in before each attachment to describe their disability and ask for additional support.
  • Educate consultant supervisors about reasonable adjustments to help students achieve course outcomes.
  • Although the foundation programme outcomes are now clearly defined, career advice beyond this stage of training is vague and inconsistent. There needs to be more clarity about realistic and practical career options in medicine for those with physical disabilities.