NDIA Accountability Project

Submission 114 — Australian Medical Students' Association — Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability

‹ PrevPage 1 of 6 · Source p. 1Next ›

SUB.001.03419_01_0001

December 2022am a ………….,._

Commissioners: The Honourable Ronald Sackville AO KC, Ms Barbara Bennett

PSM, Dr Rhonda Galbally AC, Ms Andrea Mason OAM, Alastair McEwin AM, The

Honourable John Ryan AM, The Honourable Roslyn Atkinson AO.

Re: Royal Commission into Violence, Abuse, Neglect and Exploitation of People

with Disability

Dear Commissioners

Thank you for the opportunity to provide a submission to the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability. We write on behalf of the Australian Medical Students’ Association, the peak representative body for Australia’s 18,000 medical students at 23 universities. Our submission has been presented in line with the terms of reference of the Royal Commission and provides recommendations in the following areas:

  • Entry pathways for students with disabilities into medicine;
  • Retention of students with disabilities in medical school; and
  • Medical education regarding patients with disabilities. We note that this submission should be read alongside submissions from other medical advocacy groups such as Doctors With Disabilities Australia, the

Australian Medical Association and Medical Deans Australia New Zealand. Our

submission is purposefully narrowed in scope to the medical student experience, however AMSA recognises that there are a number of institutional barriers that exist beyond medical school that are profoundly impacting the ability for us to have a representative workforce of doctors with disabilities, in particular with obtaining registration, inflexible work environments in junior doctor years, and discrimination faced in employment and access to specialty training pathways.

We look forward to further engaging with you during the process of the royal commission. Please do not hesitate to contact us should you have any questions.

Kind regards

Jasmine Davis Tish Sivagnanan

2022 President 2023 President

president@amsa.org.au

WWW.AMSA ORG.AU

SUB.001.03419_01_0002

am a                             .............,._                          1. Entry pathways for students with disabilities into medicine

Background

People with disabilities have been discriminated against in their ability to enter medical school and other tertiary degrees, with many students still facing significant discrimination and/or barriers to entry.[1] Disability advocates have fought hard, especially in recent years to make changes to what was historically called the ‘inherent requirements’ that were a set of physical and mental capabilities proposed as necessary for individuals to enter medical school and practice as a doctor.[2] These inherent requirements have been replaced by the Medical Deans Inclusive Medical Education Guidelines.[3] These guidelines are far more inclusive and have better support from the medical practitioner disability community. Despite this, students with disabilities still face a number of barriers upon entry into medical school which can be categorised into three main areas being: (1) entry examinations into medical school; (2) complex entry requirements; and (3) bias or discrimination from university policies and/or staff. Entry examinations into medical school such as the based around assessing aptitude have been reported to be ableist, and even with adjustments, are frequently a barrier to entry for people with disabilities due to the length of the examination, the inflexible nature of the examination, and other barriers such as cost and geographical location.[4,5] The complexity of entry requirements for medicine are profound, with numerous applications often needed, high scores in prior degrees or high school studies, significant number of extracurricular activities, and high stakes interviews that are likely not conducive to those with mental illness or people who are neurodivergent.[6] Such complexity in entry requirements and high selection criteria may be warranted should applicants be coming from the same starting point, however it is well evidenced that people with disabilities are likely to have experienced discrimination and setbacks in the leadup to their application, and therefore it is often unequitable to judge them against the exact same criteria as students without disabilities. Such criteria is frequently different for students from other disadvantaged backgrounds such as low SES students, First Nations students, or students from rural and remote areas.[1,4]

WWW.AMSA ORG.AU

SUB.001.03419_01_0003

These entry schemes may possibly introduce significant bias, dependentam a                                   ..,.,.,_-·            on the makeup of interview panels, selection committees and who

designed the selection criteria.[7]

Recommendations

  1. Ensure medical school admission requirements are flexible, transparent and can be reasonably adjusted for students with disabilities, eliminating admission bias and assuring equitable admission;

  2. Universities to have a specific Disability Entry Pathway, to ensure prospective medical students with disabilities have equitable access to medical entry, which should include: allocating a proportion of admission offers to prospective medical students with disabilities; and setting targets in collaboration with the disabled community for entry pathways and reporting on outcomes;

  3. Connect with prospective students with disabilities prior to the admission process to provide support throughout the selection process and subsequently maintain support throughout the degree if students are successful;

  4. Universities to reassess their use of entry examinations such as the UCAT and GAMSAT for students with disabilities;

  5. Universities to assess their criterion for entry into medical school with a disability advisory committee, and ensure that interview panels or selection committees has adequate representation of people with lived experience of disability; and

  6. University staff to undertake training in how to reduce bias or discrimination against people with disabilities in their entry into medical school.

  7. Retention of students with disabilities in medical school

Background

Numerous medical schools have worked to increase the number of students with a disability entering medical school. Alongside this, a number of medical schools have been faced with the experience of students acquiring their disability whilst undertaking their medical studies. There is no national data collection on the number of medical students entering with disabilities, or the number of medical students graduating with disabilities, therefore understanding the retention rates of students with disabilities is difficult. Despite this, AMSA has found over time anecdotally

SUB.001.03419_01_0004

that there has been a significant number of medical students witham a                                   ..,.,.,_-·                  disabilities leaving medical school due to inadequate support.

With a short open survey undertaken in the leadup to our submission AMSA has discovered that there are four key areas in which there is insufficient support for students with disabilities which may be resulting in poor retention. These findings are consistent with international research. [8,9]. These key areas are: (1) lack of specific support for medical students; (2) staff not understanding or adhering to accommodations that have been approved; (3) learning environments not being conducive to certain disabilities; and (4) lack of flexibility in the medical degree. Students have reported that where there is a specific disability support unit in the medical school that they are likely to have much better support, similarly, if there are academics or staff members with disabilities that they are more likely to have good levels of support. One student claimed “…there are minimal people at the university I am at who have medical disabilities so that makes it extremely difficult and isolating.” It was concerning to find that a number of students reported having accessibility plans or special consideration, but that at times it wasn’t followed by staff, or students had to frequently explain it to staff which they found onerous and at times embarrassing. “ Getting access to my disability provisions, which aren’t excessive, such as being provided lecture slides before the class has at times been extremely difficult and not possible.“ “Some lecturers do not follow my access plan, or they point it out, which makes it incredibly difficult or embarrassing in front of my peers.” One student with a hearing impairment reported: “Some lecturers will not turn on subtitles because they “talk too fast’% they do not make the lectures available prior… it is extremely hard when you have a hearing disability and they make the majority of content compulsory lectures where they all speak too fast and you are not able to slow them down.” Alongside staff at times not understanding or adhering to accommodations, and learning environments and modes of delivery not being conducive to some disabilities at times, there is also an inherent lack of flexibility in medical degrees. This is frequently in regard to the number of hours students are required to be on placement, lack of ability to take time off from the degree, inability to complete the degree part time, and

SUB.001.03419_01_0005

much of the delivery of content being in person on campus or at theam a                                   ..,.,.,_-·                hospital. This is likely a remnant of a very homogenous population studying

medicine historically, and must be changed in order for our profession to become more diverse and representative of the population.

Recommendations

  1. Each university medical school should have a specific disability support unit for students in the medical school, with dedicated staff (such as a Disability Liaison Officer) to support them both on campus, and on clinical placements;

  2. All staff to undergo training with regard to accessibility and adjustments to ensure that students with reasonable adjustments are accommodated for and not required to educate staff in front of other students;

  3. Provide an inclusive, non-discriminatory environment that supports students with a disability during their medical studies, including but not limited to accessible physical, educational and recreational environments within the university; and

  4. Provide flexibility in enrolment, attendance and assessment requirements to students with a disability by: (i) Recognising that students with a disability may require absences from placements or assessments that are unexpected and unpredictable, and allowing them to do so without penalty; and (ii) Providing alternative assessment arrangements that respect students with a disability, without compromising quality education.

  5. Medical education regarding patients with disabilities

Background

Increasing the number of doctors with disabilities is one way in which the medical profession can contribute to reconciling and preventing further discrimination by doctors and medical professionals toward people with disabilities. Alongside this, it is essential that medical students have education about patients with disabilities that is up to date, evidence based, focused on reducing bias, and is informed by the community. Medical education has long been focused on stereotyping of people with disabilities, which may lead to bias, misconceptions, and a lack of holistic care for people with disabilities.[1 O] In order to reduce discrimination in medicine, education needs to be improved at the medical student level, and continued through prevocational and vocational years, as well as being an ongoing part of CPD for doctors.

SUB.001.03419_01_0006

am a         Recommendations                                   ..,.,.,_-·               1.  University medical schools to provide disability education, in both

preclinical and clinical years, that covers a wide range of contexts, giving students a broad understanding of how best to provide care for patients with disabilities, and to:

a. Consult the disability community when developing teaching plans; b. Involve disability self-advocates in providing this teaching, where appropriate and volunteered by the individual;

c. Incorporate teaching specific to vulnerable communities such as CALO people and LGBTQIA+ individuals with a disability;

  1. Educate medical students about the barriers of communication and how to communicate with people with disabilities in a respectful and non-judgemental way by:

a. Including providing opportunities for students to acquire specialised communication skills, such as AUSLAN and how to use non-verbal communication boards;

b. Including teaching students how to appropriately work with interpreters, so that the patient is still at the centre of their care;

  1. Educate medical students on how to involve people with disabilities, and, where appropriate, their carers or other healthcare professionals, in developing care plans;

  2. Educate medical students on the functioning of NDIS and other disability support services, particularly how to refer patients to the appropriate services;

  3. Educate medical students on the specific health and wellbeing challenges and barriers to healthcare access that people with disabilities and their carers face, as well as potential solutions that can be implemented; and

  4. Educate students about the importance of autonomy and self determination for people with disabilities.

References

  1. https://tinyurLcom/universitydisabilityreport

  2. https://gamsat.acer.org/fi Ies/Med ica I Dea nslnherentReg uirements.pdf

  3. https://medicaldeans.org.au/md/2021 /04/lnclusive-Medical-Education-Guidance-on-medic al-program-applicants-and-students-with-a-disability-Apr-2021-1.pdf

  4. https·ttwwwtheage com a11toational/victoria/one-woma o-s-figbt-to-scrap-discriminatory-m edical-school-entrance-exam-20220916-p5birg.html

  5. https://pubmed.ncbi.nlm.nih.gov/29388087/

  6. https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-014-0267-0

  7. https://pubmed .ncbi.nl m.nih.gov/32037326/

  8. https://www.tandfonline.com/doi/abs/10.1080/09687599.2019.1647149

  9. https://onlinelibrary.wiley.com/doi/abs/10.1111/medu.14878

  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678304/