Factors associated with declaration of disability in medical students and junior doctors, and the association of declared disability with academic performance: observational study using data from the UK Medical Education Database, 2002–2018 (UKMED54)

Abstract

ObjectivesTo examine factors associated with declaration of disability by medical students and doctors, and the association of declared disability with academic performance.DesignObservational study using record-linked data collected between 2002 and 2018.SettingUK Medical Education Database is a repository of data relating to training of medical students and doctors. Disability and other data are record-linked.ParticipantsAll students starting at a UK medical school between 2002 and 2018 (n=135 930).Main outcome measuresDeclared disability was categorised by the Higher Education Statistics Authority. Outcomes related to undergraduate academic performance included scores in the educational performance measure (EPM), prescribing safety assessment and situational judgement test. Performance in postgraduate examinations was studied, as well as prior attainment in school examinations and aptitude tests.ResultsSpecific learning disability (SLD) was the most commonly declared disability (3.5% compared with the next most commonly declared disability at 1.0% of n=129 345 all cases in the study), and during the period covered by the data, SLD declarations increased from 1.4% (n=6440 for students starting in 2002) to 4.6% (n=8625 for students starting in 2018). In a logistic regression, the following factors predicted recording of SLD on entry to medical school ((exp(B)±95% CI), p<0.0001 unless otherwise stated): attendance at a fee-paying school (2.306±0.178), graduate status (1.806±0.205), participation of local areas quintile (1.089±0.030), age (1.034±0.012). First year medical students were less likely to declare SLD if they were from a non-white ethnic background (Asian/Asian British 0.324±0.034, black/black British 0.571±0.102, mixed 0.731±0.108, other ethnic groups 0.566±0.120), female (0.913±0.059; p=0.007) or from a low index of multiple deprivation quintile (0.963±0.029); p=0.017. In univariate analysis with Bonferroni corrections applied for multiple tests, no significant difference was observed in the recording of SLD according to socioeconomic class (χ2=5.637, p=1), whether or not a student’s parents had a higher education (χ2=0.140, p=1), or whether or not a student had received a United Kingdom Clinical Aptitude Test (UKCAT) bursary (χ2=7.661, p=0.068). Students who declared SLD at some point in medical school (n=4830) had lower EPM normalised deviate values (−0.390) than those who did not (−0.119) (F=189.872, p<0.001). Those for whom SLD was recorded were as likely to complete the course successfully as those who did not declare disability (93.0% successful completion by those for whom SLD declared from year 1 (n=2480), 92.2% by those for whom SLD declared after year 1 (n=2350), 91.6% by those for whom SD not declared at any point (n=85 180)) (χ2=6.905, p=0.032). Of 3580 first year students who declared SLD, 43.1% had not sat the UKCAT Special Educational Needs aptitude test (which gives extra time for those with special educational needs), while 28% of 2400 registrants for whom SLD was recorded as medical students did not declare it at General Medical Council registration.ConclusionsSubstantial increases in declaration of SLD may reflect changes in the social and legal environment during the period of the study. Those who declare SLD are just as likely to gain a primary medical qualification as those who do not. For some individuals, disability declaration appears to depend on context, based on differences in numbers declaring SLD before, during and after medical school.

The Utility of Multiple-Choice Assessment in Current Medical Education: A Critical Review

“…From 2002 to 2018, approximately 4.6% of medical students and newly qualified junior doctors in the United Kingdom declared a specific learning disability such as dyslexia, dyspraxia and attention-deficit/hyperactivity disorder [ 5 ]. Legislation in the United Kingdom requires higher education institutions to be anticipatory of the needs of students with disabilities, and this includes making reasonable adjustments during MCQ assessment.…”

“…In this review, the elements of the utility equation are discussed for MCQ assessment in healthcare education, with a particular focus on validity and reliability. Beyond the utility equation, the impact of neurodiversity and use of feedback are also considered, as these topics have become increasingly significant for institutions in healthcare education in recent years [ 4 , 5 ].…”

Legibility: knowing disability in medical education inclusion

“…This suggests some people who may benefit from accommodations do not pursue them due to how disability is understood. Identifying oneself as disabled appears further complicated insofar as disability is stigmatized in the field, aligned with notions of incompetence and vulnerability, and therefore perceived incompatible with a medical learner role (Fox et al, 2011 ; Meeks & Jain, 2018 ; Meeks et al, 2020c ; Murphy et al, 2022 ; Nolan et al, 2015 ; Stergiopoulos et al, 2018 ). Studies document that learners strategically disclose and cover disability experiences in response to the potential for stigmatization, seeking to elevate perceptions of their competence (Easterbrook et al, 2015 ; Mayer et al, 2022 ; Sibbald and Beagan, 2022 ).…”

Disability, medicine and widening participation: A whole system approach

“…3 It is no wonder then that many medical applicants, students and practitioners are reticent to declare their disability, particularly during key moments of transition into medical education and the profession. 4 In thinking about disability in terms of widening participation, one must pay explicit attention to the unique culture and context of medicine.…”

“…In medical schools, disability is often framed as a chronic physical or mental deficit, where people with disability are commonly defined only as recipients of care rather than a legitimate and necessary part of the medical workforce 3 . It is no wonder then that many medical applicants, students and practitioners are reticent to declare their disability, particularly during key moments of transition into medical education and the profession 4 …”