Equality and Human Rights Commission

This section explains doctors’ responsibilities in the teaching and training of future doctors. This is clearly an area where they can proactively promote opportunities for disabled people. There are comments on the following sections of the GMC's guidance:

• Point 16
• Point 17
• Point 18
• Point 19

16. If you are involved in teaching you must develop the skills, attitudes and practices of a competent teacher.

It is important that training includes such issues as disability equality and etiquette training. If this is not available doctors who are doing the teaching should demonstrate their awareness of disability equality issues and pass this on to their students.

It is good practice to ask questions which make students think about disability equality issues particularly if their patient is a disabled person. For example, when students answer a question about what they would do in a particular situation, challenge them by asking or illustrating the discussion with ‘what if’ questions, such as ‘what will you do if your patient is blind, old and physically weak or has a learning disability? Who would you ask to find this out?

Doctors organising written and clinical examinations should also ensure that questions and ‘live’ patient scenarios include disabled people both for their disability and for non-disability related questions to examine their susceptibility to diagnostic over-shadowing.

17. You must make sure that all staff for whom you are responsible, including locums and students, are properly supervised.

It is likely that the pressures experienced by junior staff will affect their behaviour towards patients. For example a junior doctor working under pressure and without proper disability equality competence may be more likely to mismanage an encounter with a disabled patient. For example, if they are under pressure how can they be supervised to act appropriately towards a very distressed child with a learning disability requiring a potentially frightening and invasive treatment such as taking a blood sample?

Discussion with junior staff on the following issues would be an example:
Do they know how to differentiate between behaviours in such circumstances? Do they know how to communicate with the child? Is sufficient weight given to their ability to remain calm themselves?

Senior doctors should also be prepared to give advice and support to junior doctors about how to prioritise or manage their workload. For example if a doctor is explaining a diagnosis to someone with a learning disability they may need to take longer to explain the diagnosis.

They should receive sufficient support to learn about and value diversity, and, the appropriate ways to give additional support to patients where this is necessary.

18. You must be honest and objective when appraising or assessing the performance of colleagues, including locums and students. Patients will be put at risk if you describe as competent someone who has not reached or maintained a satisfactory standard of practice.

Every medical service is a learning resource that can provide numerous examples of how patients are able to receive high quality service or if not, what needs to be improved.

For example, it is important where possible to facilitate disability equality training by involving disabled people as this will have more impact. If disabled patients are encouraged to give feedback on what does or does not work, this makes improving service more practical and ensures that any improvement measures are well grounded in experience. Patients should be able to give feedback in a way which is accessible to them.

Both clinical audit and peer review should include those ‘what if’s’ that apply technical medical knowledge to the very high proportion of patients covered by the Disability Discrimination Act (e.g. probably most older in-patients, or, those with long term conditions).

Key additional skills include the disability equality competence to be able to interpret and apply medical explanations and treatments so that they are understood and agreed to by disabled people.

As well as internal audit and review mechanisms, external sources of feedback should be sought from disabled patients or groups, and from patient surveys which cover such issues.

19. You must provide only honest, justifiable and accurate comments when giving references for, or writing reports about colleagues. When providing references you must do so promptly and include all information that is relevant to your colleague’s competence, performance or conduct.

It is important to note that increasing numbers of current medical staff (including perhaps yourself), trainees, and, medical students may be disabled. The effects of these impairments can appear similar to educational difficulties. It is vital that the trainer or instructor avoids discriminatory assumptions, and that they start to consider adjustments that can overcome most barriers to learning. Learners may require adjustments whilst in training sessions or in their job role. For example someone with dyslexia may require a specially adapted computer in order to read documents or complete assignments and type up medical notes of patients.