Supporting neurodivergent PGDiTs
Overview
A significant proportion of postgraduate doctors, dentists and public health practitioners in training (PGDiTs) are neurodivergent. This means their cognitive profile differs from what is considered neurotypical. Common forms of neurodivergence include ADHD, autism, dyslexia, dyspraxia, dyscalculia, and dysgraphia.
Many neurodivergent PGDiTs bring valuable strengths to clinical work, including creative problem-solving, hyperfocus, attention to detail, pattern recognition, and empathetic communication. Where neurodivergent PGDiTs experience areas of challenge, appropriate support and adjustments can enable them to successfully complete training and contribute richly to the profession.
As an educator, your understanding of neurodivergence and your support for neurodivergent PGDiTs has a direct impact on whether their training experience enables them to thrive or if their experiences of work and training are harder than they need to be.
This page is intended to help you support neurodivergent PGDiTs effectively, work proactively with the deanery's neurodiversity support mechanisms and access support for yourself in this role.
Contents
- Framing
- Common impacts on postgraduate training
- Strengths suited to clinical professions
- Yorkshire and Humber Neurodiversity Assessment and Support Pathway
- Day-to-day support
- Approaching training difficulties
Framing
The content of this page takes a neuroaffirmiative perspective, is framed on the social model of disability.and applies the following principles and practicalities.
Neurodivergence is a description of difference, not deficit
Neurodivergent people think, learn and process information in ways that differ from the neurotypical majority. These differences come with strengths and challenges and we encourage a strengths-first approach.
Identification is increasingly common in adulthood
Many PGDiTs are discovering they are neurodivergent during their postgraduate training, which has been associated with a recent increase in societal awareness, characteristic fluctuation during transition points (for example, from Foundation to Core training, or from one hospital base to another) and a decreased ability to rely upon compensatory (or masking) strategies as the cognitive demands of training and clinical working increase.
A PGDiT doesn't need a diagnosis to be eligible for support
Many of the most useful adjustments and strategies are available without a formal diagnosis, including eligibility for reasonable adjustments. An increasing number of individuals choose to self-diagnose or self-identify as neurodivergent, often owing to long assessment waiting lists or a personal preference not to seek a formal diagnosis. The PGDiT's own understanding of their cognitive profile is the most important starting point.
No two neurodivergent people are the same
Neurodivergence is heterogeneous: one autistic person's experiences, strengths and support requirements will not be the same as another. The specific needs of the individual nerodivergent PGDiT need to be understood to apply an individualised approach to support and not a 'one-size-fits-all' assumption.
Language matters
Different neurodivergent individuals prefer different language about themselves, for example, "autistic" or "austistic person" vs "person with autism", or "dyslexic" vs "person with dyslexia". We recommend asking a neurodivergent PGDiT if they have a preference that you should use.
Common impacts on postgraduate training
Postgraduate training is a uniquely demanding environment for many neurodivergent PGDiTs. The combination of high cognitive load, frequent context-switching, social and sensory complexity, examinations and portfolio requirements, and rotation between environments can amplify challenges that may have been manageable during medical school and earlier in life.
Indicative examples of areas where neurodivergent PGDiTs may experience particular difficulty include:
- Time management, organisation, and prioritisation in unstructured or rapidly changing clinical environments
- Cognitive load and working memory during ward rounds, on-call shifts, and complex clinical situations
- Examination preparation, particularly where exam formats privilege certain cognitive styles
- Portfolio engagement and keeping on top of reflective and assessment requirements
- Communication and social aspects of teamwork, particularly in settings with shifting team membership
- Sensory environments, including noisy clinical areas, fluorescent lighting, and the cumulative sensory load of busy wards
- Transitions between posts and clinical environments
Strengths suited to clinical professions
A strengths-based approach to supporting neurodivergent PGDiTs is more accurate, and more useful, than one that focuses solely on challenge. This is particularly valuable in harnessing an individual's strengths to develop practical and positive support strategies to mitigate any areas of challenge.
Many personal narratives and research have emphasised the strengths that neurodivergent PGDiTs bring to clinical work which have real value. Examples include:
- Pattern recognition which benefits accurate diagnosis
- Hyperfocus which supports complex and long tasks, such as surgery
- Attention to detail which supports safe patient care
- Empathetic communication which benefits patient relationships, particularly for those who are neurodivergent
More broadly, research has identified that neurodivergent patients are more likely to engage with care if delivered by neurodivergent clinicians, correlating in improved health outcomes.
Yorkshire and Humber Neurodiversity Assessment and Support Pathway
The deanery has a dedicated assessment and support pathway for PGDiTs who suspect they may be neurodivergent or who have an existing diagnosis and need support. The pathway includes:
- Funded neurodiversity assessments for PGDiTs without a prior diagnosis where suspeced neurodivergence is impacting training progression
- Funded neurodiversity specialist coaching for PGDiTs whose assessment recommends it (or who have a prior diagnosis and meet the eligibility criteria), where Access to Work funding is not immediately accessible
- Recommended sources of support, including deanery-commissioned and external services, resources and more
Full details of the pathway, including eligibility, the request process, and how educators contribute, are available on our Neurodiversity Support pages.
Two areas where educator involvement is particularly important are highlighted below.
Funded neurodiversity assessments
If a PGDiT suspcts they are neurodivergent they are encouraged to discuss this with their educators. Your role is generally to listen, take it seriously, and if eligible, support them with the neurodiversity assessment request process. You may need to help the PGDiT identify if the assessment is right for them, how it may benefit them, and the implications of the assessment outcome.
You don't need to make a judgement about whether they "really" are neurodivergent, that is what the assessment is for. However, you do need to be confident in their eligibility for a funded assessment, as the PGDiT's Training Programme Director will need to provide a supoorting statement contextualising the impact potential neurodivergence is having on their training when submitting an assessment request.
After the assessment, we expect PGDiTs to share a copy of the high-level assessment outcome report with their educators and for you to have a collaborative and constructive discussion about support recommendations and any reasonable adjustments that should be applied to their training and/or clinical work.
Neurodiversity specialist coaching
Where a PGDiT's funded assessment recommends specialist coaching (or where they have a prior diagnosis and meet the criteria), and where Access to Work funding is not immediately accessible and more urgent support is needed, the deanery may fund up to eight hours of specialist coaching. The PGDiT should discuss the need for timely coaching support with you and the Training Programme Director will need to provide this context when submitting the neeurodiversity coaching request form.
Day-to-day support
Beyond the formal assessment and support pathway, much of what makes a difference for neurodivergent PGDiTs is in the day-to-day aspects of training. At the start of your educational relationship, we recommend having a conversation with any PGDiT about rhe way they like to work so you can tailor your approach to their specific needs. This is even more critical for neurodivergent PGDiTs who have differing processing styles and speeds.
The following considerations can provide you with a starting point:
- Neurodivergent PGDiTs often benefit from clarity that neurotypical PGDiTs may not need to the same degree, so it is important to be explicit about expectations. This could be written confirmation of agreed actions, providing clear deadlines or giving explicit feedback. This is rarely difficult to provide, and it costs little.
- Moving between posts, teams, and supervisors is challenging for many neurodivergent PGDiTs. Where you can, support continuity and provide context: a handover note about adjustments and what works can prevent the PGDiT from having to start over each time they rotate.
- Some neurodivergent PGDiTs find verbal communication difficult, particularly in pressured or social settings; others find written communication more challenging. Identify the PGDiT's preference and support them with it. If appropriate, multiple channels of communication may be required (for example, a verbal conversation followed by a written summary).
- Many neurodivergent PGDiTs spend significant cognitive and emotional resources on appearing neurotypical at work; often called masking or camouflaging.. This compensatory effort, while often invisible, is real, accumulates and can be a significant contributor to burnout. Creating an environment with psychological safety and inclusion that lessens the necessity to mask help everyone.
- Feedback that is vague, indirect, or socially coded may not be understood or may be misinterpreted. Direct, specific, and actionable feedback is more useful, and better practice for all PGDiTs.
- Neurodivergent PGDiTs may approach tasks, communicate, or process information differently. Different is not the same as worse, and the goal of support is not to make neurodivergent PGDiTs more neurotypical but to enable them to work effectively in their own way.
Approaching training difficulties
If a neurodivergent PGDiT is experiencing training difficulties, the same principles apply as for any disability or long-term condition: address the difficulties seriously, while ensuring that the contribution of neurodivergence is properly understood and supported.
This often means:
- Reviewing whether assessment, adjustments, or coaching have been considered and accessed
- Considering whether existing support is sufficient or whether more would help
- Identifying any systemic barriers that are impacting their progress
- Engaging the PGDiT in identifying what they think would make a difference
Performance difficulties in a neurodivergent PGDiT are not, in themselves, evidence that they can't succeed in training. Many neurodivergent PGDiTs experience early difficulties that resolve substantially once appropriate support is in place. The aim is to put that support in place promptly and give it time to take effect, not to use early difficulty as evidence that training is not the right path.
You may find NHS Resolution's Supporting Neurodivergent Practitioners: The Role of NHS Resolution's Practitioner Performance Advice Service page provides valuable guidance and resources on recognising when neurodivergence may underlie performance concerns, understanding how to address these issues appropriately, supporting practitioners, and maintaining patient safety. Whilst primarily aimed at employers, much is transferable to the context of postgraduate training.