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Supporting PGDiTs with a disability or health condition

Overview

Many postgraduate doctors, dentists and public health practitioners in training (PGDiTs) have a disability, long-term health condition, or chronic illness. Some will have lived with their condition since before entering training; others will develop one during their training or career. With appropriate support and adjustments, the majority will successfully complete their training and go on to have full clinical careers.

As an educator, you play a critical role in shaping what that experience is like, practically, through your involvement in supervision and adjustments, and culturally, through the tone you set in your and the example you model. 

The most important thing educators can do is to approach disability and long-term conditions as a normal part of working life, rather than as an exception or a problem. PGDiTs with long-term conditions often report that the difference between a good experience and a poor one rests on the attitude of their educators and team, including reactions to disclosure and whether they feel that adjustments are treated as a routine professional matter, or as a concession that they should feel grateful for.

This page is intended to help you support PGDiTs with disabilities and long-term conditions effectively, work constructively with the systems and processes around adjustments, and recognise where additional support, for the PGDiT or for you, may be needed.

An important note on terminology

Whilst one person with a specific condition may view themselves as having a disability, somebody else with the same condition may not. This is a highly personal interpretation and can depend upon the impacts each individual's experiences.

Public sector bodies, including employing trusts, have defined duties within the Equality Act 2010 and as such we adhere to the legislative definition of 'disabled': a physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on your ability to do normal activities.

Our usage of 'disabilities' or 'disabled' within these pages reflects this definition. 

It isn't your role to 'diagnose' a PGDiT or decide if they are disabled, which can make them feel pathologised. Your focus is to understand if the PGDiT has any support needs and ensure they can access and receive the right support and adjustments for them as an individual, when they need it. This approach aligns with the social model of disability. 

 

Contents

  • Understanding the legal and professional context
  • Responding to a disclosure
  • Reasonable adjustments
    • Facilitating reasonable adjustments
    • Access to Work
    • Examination adjustments
  • Less than full time (LTFT) training
  • Approaching training difficulties
  • Supporting yourself
  • Resources

Understanding the legal and professional context

The Equality Act 2010 places a legal duty on employers to make reasonable adjustments for disabled employees, and prohibits discrimination on the grounds of disability. Under this legislation, a disability is defined as: a physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on your ability to do normal activities This duty applies throughout training, including to working conditions, examinations, and progression, and the legal responsibility for implementing adjustments sits with the PGDiT's employer.

However, training-specific considerations including placement allocation, rotation planning, supervision arrangements, portfolio expectations, and the relationship between curriculum requirements and the PGDiT's clinical context, are areas where educators have substantial influence. The most successful arrangements for PGDiTs with disabilities and long-term conditions are usually those where employers, educators, and the PGDiT work together constructively.

The General Medical Council and General Dental Council are both clear that a disability or long-term condition does not, in itself, raise fitness to practice concerns. What matters is that the PGDiT manages their condition appropriately, follows medical advice, and practises safely. 

Research evidence demonstrates the strengths of clinicians with disabilities and the value they add to the workforce, particularly for improving health outcomes for patients with a disability.

We encourage you to read personal accounts of clinicians with disabilities on the GMC's Disabled doctors exist: celebrating their contribution to medicine webpage.

Responding to a disclosure

If a PGDiT discloses a disability or long-term condition to you, the conversation that follows can shape much of the rest of their experience. 

We recommend considering the following: 

  • Disclosure can make PGDiTs feel incredibly vulnerable, especially if they have had less positive experiences when disclosing in the past. Treat it with the same professional respect you would any other significant information about their training environment. Thank them for telling you and acknowledge that the conversation matters. 
  • The conversation should first focus on understanding the PGDiT's experiences and their needs before you ask practical questions about adjustments and/or occupational health referrals.
  • Clearly explain who you may need to share this information with and seek the PGDiT's input and consent on what is shared and how. This may include occupational health, other educators and rota coordinators. It is also good practice to be explicit about what you won't share and with whom. Information should be shared on a 'need to know basis. 
  • Be certain about the support or adjustments that can be implemented. It's better to say "I'm not sure, but I'll find out and come back to you" than to commit to something that may not be feasible. 
  • A brief written summary of what was discussed and agreed can be valuable for both of you and ensures continuity if circumstances change later.
  • Make sure the PGDiT is aware of appropriate support mechanisms which may include, occupational health, Professional Support and other deanery resources. 

Reasonable adjustments

Under the Equality Act 2010, reasonable adjustments are the responsibility of the employer. These include modifications to the working environment, equipment, working hours, and the way work is organised, where these are reasonable and would address a substantial disadvantage faced by the disabled employee.

Facilitating reasonable adjustments

Whilst the employing trust has legal responsibility for reasonable adjustments, in the context of postgraduate medical training the identification and application of reasonable adjustments is expected to be a collaborative effort between the employer, the PGDiT and their educators. This ensures an individualised and holistic approach is taken to both clinical and educational accommodations.

The following recommendations can guide you through the process of discussing support needs with the PGDiT and to facilitate appropriate reasonable adjustments:

  • Focus on the individual and not their condition. Two PGDiTs with the same diagnosis may have very different experiences, capabilities and needs, educationally and clinically. You should always use the individual PGDiT's own account of what they need and what works for them as a starting point and personalising your approach should be a standard part of inclusive educational practice. 
  • If occupational health or another assessor/professional recommends adustments, treat them as a starting point for a constructive conversation and not a hurdle to overcome. Most adjustments are easy to implement and bear minimal cost. Where adjustments are difficult or ambiguous, work collaboratively with the PGDiT and if appropriate, their employer, to find practical solutions. 
  • The PGDiT may not know what adjustments or support they need, particularly if it is a recently acquired disability or condition, and others' expectation that you will know exactly what you need can be frustrating. Where a PGDiT isn't sure what would benefit them, a conversation with occupational health and/or a workplace needs assessment can be very valuable. 
  • For PGDiTs with conditions that require ongoing management, for example, regular medical appointments, treatment cycles or fluctuating symptoms, anticipate and plan around them as much as possible as it is far easier than responding reactively. A short conversation early in a placement about what the PGDiT may need can prevent significant difficulty later.
  • Implementing adjustments effectively and consistently often requires communication with team members or rota coordinators. This can be done without disclosing the underlying medical reason and the default approach should be to share the minimum information necessary. Others don't need to know the why of adjustments, just the what. 
  • PGDiTs with long-term conditions often describe their experiences not in terms of single incidents, but small repeated systemic frictions: having to re-explain the same needs to each new supervisor and employer, being asked to justify adjustments that have already been agreed, encountering colleagues who treat their condition as a topic of curiosity. Awareness of these experiences and their cumultive effect can help you and the PGDiT's clinical team avoid contributing to it. 

It is important to remember that a conversation about reasonable adjustments is not 'one and done'. You should review the efficacy of adjustments regularly, with time frames agreed with the PGDiT, to ensure they remain appropriate and in case any newly arising support needs require action.

Access to Work

Access to Work is a government scheme that can fund adjustments and equipment beyond what an employer would normally be expected to provide. Access to Work assessments are based on individual need rather than diagnosis, and grants awarded can fund specialist equipment, support workers, travel costs, mental health support, and a range of other provisions.

The Access to Work Mental Health Support Service is delivered by Able Futures and Maximus and provides up to nine months of personalised mental health support at work, at no cost to the individual or employer. This service can be a valuable signpost for PGDiTs with mental health concerns affecting their work.

More detailed guidance on these schemes is available on our Reasonable Adjustments and Practical Support page.

Examination adjustments

Reasonable adjustments to postgraduate examinations are applied for separately, through the relevant royal college or examining body. Educators are sometimes asked to provide supporting information for these applications and we would encourage you to engage with these requests promptly and constructively, recognising that the timeline for processing examination adjustments is often tight, and that delays can have significant consequences for the PGDiT.

Less than full time (LTFT) training

Some PGDiTs with long-term conditions benefit from training less than full time. LTFT training is increasingly accessible to PGDiTs whose health would benefit from it, and educators should be aware of this option and supportive of PGDiTs exploring it. For iformation on LTFT training and how to apply see the NHSE YH LTFT Standard Operating Procedure and Guidance.

Approaching training difficulties

Sometimes a PGDiT with a long-term condition encounters training difficulties. This might include struggling with particular aspects of clinical work, falling behind with their portfolio, or experiencing a deterioration in their condition that affects their work. In these situations, it is important to recognise the role that the condition or its management may be playing, without conflating clinical performance with disability.

Such concerns should be addressed in the same way you would for any PGDiT, while ensuring that any contribution from the disability or long-term condition is properly understood and addressed. This often means:

  • Reviewing whether existing adjustments are sufficient and being implemented effectively
  • Considering whether further occupational health input would help
  • Exploring whether the PGDiT's condition has changed or destabilised
  • Thinking about LTFT training or other flexible options if these have not already been considered

What is rarely helpful is treating a disabled PGDiT's training difficulties as exclusively a performance issue, without considering the context of their condition. Equally unhelpful is treating performance difficulties as inevitable consequences of the condition that cannot be addressed. The right approach is usually to hold both possibilities in view and to work them through systematically.

Supporting yourself

Supporting PGDiTs with a disability or long-term condition can sometimes be complex, particularly where systems are not working as they should or where the PGDiT's needs are significant. It is reasonable to find some of these situations challenging, and important to access support yourself where you need it. The same resources available to PGDiTs are available to you: NHS Practitioner Health, BMA Counselling and your trust's occupational health and employee assistance programme. Peer conversations with other educators, and where it exists, formal reflective practice, can also be valuable.

Additional resources

 

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