Working with doctors Working for patients

Gateways guidance: appendix

Examples of reasonable adjustments

Medical schools could keep a record of reasonable adjustments they have made and the costs involved, so that they can share their experiences and perhaps achieve future economies of scale.

Physical environment

Preparing buildings and access requirements

  • Ramps to all necessary locations.
  • Accessible lifts and lift buttons.
  • Automatic doors.
  • Accessible external paths and landscaping.
  • Accessibility within buildings, including their interior layout.
  • Vibrating and light fire alarms for people with hearing loss.
  • Adapted fire alarms and door bells in university accommodation.
  • Vibrating pagers.
  • Fire refuges or alternative escape routes for people with mobility impairments.
  • Quiet refuges and first aid facilities where people with epilepsy, for example, might go after an attack
  • Rooms without fluorescent lighting.
  • Enhanced signage and colour or tone contrasts to aid orientation.
  • Enhanced lighting to facilitate lip reading.
  • Effective sound system with T loops.
  • Desks, laboratory benches, work surfaces and reception desks at varying or flexible heights.
  • Appropriate seating.
  • Reserved areas in all teaching and learning locations, including the library.
  • Accessible technology, including screen readers, and libraries.
  • Accessible toilets.
  • Accessible services, such as catering facilities.
  • Convenient and reserved parking spaces.
  • Lowered kerbs.

Application process

Reasonable adjustments to the application process

  • Text phones for the enquiry stage.
  • Information, such as university policies and course leaflets, in potentially accessible formats: such as email, braille, easy read, large print, audiotape, and computer disc.
  • Electronic information that can be accessed by a range of screen readers and assistive software.
  • Staff trained in communicating with a wide range of disabled people.

Where possible, all information should be:

  • Offered in both visual and audible formats.
  • Available in different font sizes.
  • Available with different background and foreground colours.
  • Available without enhancements such as boxes.
  • Easily navigable, if electronic, using either a mouse or keys.

Teaching and learning

Reasonable adjustments involving documents

  • Plans, summaries, notes, handouts and overheads available in advance of lectures.
  • Prioritised reading list.
  • Glossary of technical terms/specialist vocabulary.
  • Copies of overheads, diagrams and so on created in class provided also in paper form.
  • Additional inter-library loans.
  • Documents printed on different coloured paper.
  • Documents printed with larger font.
  • Subtitled / transcribed video material where this is used in lecture situations.
  • Availability of notes in electronic format to enable use of assistive software (such as text to speech; speech to text; mindmapping software).
  • Intranet material that meets established guidelines for compatibility with specialist software.
  • Availability of searchable reference texts.
  • Written materials available in audio format.
  • Comments on course work in alternative formats.

Reasonable adjustments through human assistance

  • Proof reader for written assignments.
  • Note-taker to attend lectures.
  • Teaching staff asked to face the class at all time when giving a lecture.
  • Additional regular 1:1 tutorial support.
  • Support in researching booklists for those unable to ‘browse’ in the library.
  • Provision of study skills support covering essay writing or dissertation skills.

Reasonable adjustments through allowances

  • Extensions to deadlines.
  • Extended library loans.
  • Permitted periods of absence.
  • Breaks permitted in teaching sessions.
  • Assignment work marked with a yellow sticker and appropriate guidance issued to markers.

Reasonable adjustments through equipment

  • Staff using a microphone for all lectures.
  • Permission to record lectures.
  • LOOP system during teaching.
  • Laptop to take notes.
  • Use of an amplified stethoscope.
  • Stethoscope linked to a display screen.
  • Chair available in teaching sessions.
  • Hand-held devices for taking notes.
  • Spell checkers.
  • Screen readers.
  • Microscopes linked to CCTV screens.
  • Compatibility of online teaching resources with the student's software magnification programmes.

Reasonable adjustments to the teaching and learning environment

  • Good lighting during lectures.
  • Elimination of background noise.
  • Adjustments to the physical environment.
  • Additional training for teachers in making teaching and learning more accessible to disabled students.


Reasonable adjustments involving documents

  • Coloured overlays.
  • Exam papers on coloured paper, for example pale yellow, cream, salmon pink or grey.
  • Exam papers in larger or non-serif font.
  • Single side papers.
  • Larger size papers or exam sheets.
  • Instructions in written form.

Reasonable adjustments through allowances

  • Extra time in written or oral exams.
  • Additional reading time to view exam paper.
  • Breaks permitted in exams for example for rest or toilet breaks.
  • Permitted to use eat, drink or use insulin, medication, eye drops or inhaler.
  • Extensions to individual assessment deadlines.
  • No penalty for poor spelling, grammar, punctuation, syntax or structure where the meaning is clear.

Reasonable adjustments through equipment

  • Computers for exams or in-course assessments.
  • Spellchecker.
  • A3 optical mark reader for MCQs or slides (the marks then transposed onto A4 sheets for marking).
  • Special lighting.
  • Desk with extra space.
  • Writing slope.
  • Supportive furniture or cushion or lumbar support.

Reasonable adjustments relating to locations

  • Private rooms or separate supervision, for example so questions can be read aloud.
  • A smaller, separate venue.
  • Seat near the door to allow student to have toilet breaks.
  • Seat at the front or the back of the examination room.

Other reasonable adjustments to written exams

  • A scribe.
  • A reader.
  • Scrap paper available.
  • Student circles her answer on her question paper and after the exam has finished she sits with a member of staff who completes the optical mark sheet with her.
  • Gap of at least two hours between exams.
  • Scheduling so that student did not take two exams in one day.
  • Visual prompts given to signal the start and end of exams.
  • Oral instructions given individually.

Reasonable adjustments for practical assessments such as OSCEs

  • Chairs.
  • Gloves.
  • Ear defenders.
  • Sphygmomanometer with a red flipper valve for a Blood Pressure station.
  • Amplified stethoscope.
  • Student permitted to summarise verbally at the end of each station.
  • Student permitted to use an agreed alternative word or expression.
  • Student permitted to write down a word if unable to verbalise it.
  • Extra question reading time.
  • Paper copies of the instructions for each station.
  • Extra time at station assessments that do not directly replicate clinical practice.
  • Student individually timed at each station once they had entered that station.
  • Physical stations in OSCE to be followed by a rest station or placed at the end of the exam.
  • Where OSCEs are being held at more than one location, efforts made to place candidates at the site which is easiest to navigate.
  • Allocation to a specific morning or afternoon slot.
  • Face to face interaction ensured with student positioned suitably for all sessions.
  • A reader.
  • A 'competent other' provided in the station who could be instructed by the student in conducting the resuscitation task.
  • Additional practice sessions and support given prior to the OSCE.
  • Timing of OSCE exams to earlier rather than later in the day.
  • Individual circuit for OSCE assessments.
  • OSCE stations made more accessible, for example a resuscitation manikin placed on a couch.
  • Examiners briefed about individual trainee requirements.
  • A signer entering the assessment cubicle with the student to place a microphone on the manikin while the student reads the instructions.

Other reasonable adjustments to assessments and examinations

  • Appropriate timing during the day.
  • Flexibility in ways of enabling students to answer, such as: an oral rather than written assessment; a written exam, extended essay, or PowerPoint presentation rather than a verbal presentation.
  • Partial retakes and deferred exams for those with illness.
  • Extension of the registration and completion period for Royal College examinations.

Clinical placements

  • Avoidance of immuno-suppressed patients.
  • Placements arranged close to student’s home.
  • Car parking.
  • Placements with good transport links or which are otherwise easy to access.
  • Taxis to placements.
  • Rotations in more manageable order.
  • Additional coaching and mentoring.
  • Opportunities to sit down.
  • Additional support for students in finding placements that meet their requirements.
  • Buildings made accessible for wheelchair users and others with mobility impairments.
  • Checking of lighting and obstacles.
  • Alternative learning opportunities where placements cannot be made accessible.
  • An electric scooter for getting around a hospital.
  • Replacement sets of wheels for entry to the operating theatre.
  • Training of work placement providers in disability equality and how to work with disabled students.
  • Increased supervisory support.
  • Slowing of ward rounds, help in carrying notes.
  • Arrangements made to ensure that disabled people can take personal assistants or assistive technology with them where necessary.
  • Amplified stethoscopes.
  • Compatibility of patient records, X rays and test results with the individual’s software magnification programmes.
  • Flexible working hours.
  • Adjustments to working hours, for example reduced hours, reduced daytime on-call duties, fewer or no night time duties or weekend calls.
  • Adjustment made to duties, for example no crash calls for wheelchair users.
  • Part-time placements.
  • Extra time and time out.
  • Time off to fit treatment schedules, therapy and out-patient appointments.
  • Placements modified to allow attendance at signing and lip reading classes in the evening.

Other support

  • Mock PBL session set up for applicants to medical school.
  • Tutors made aware of student’s condition.
  • Student allowed to wear medic alert and carry medication at all times.
  • Student Support ID card asking for reasonable adjustments.
  • Specialist ICT equipment in accommodation.
  • Option to use personal radio system in exams, taught sessions, ward rounds and theatre sessions.
  • Time out from studies for those with illness.
  • Appropriate treatment assured.
  • Links with specialist organisations if help is needed, for example by dyslexic students.
  • A mentor or additional mentoring.
  • Local ‘buddy system’ between disabled and non-disabled students.
  • Disability-awareness training for staff to increase awareness of common disability related issues.
  • Staff in accommodation blocks made aware of the disabled student’s needs.
  • Staff trained in communication with a hearing impaired person.