Dyslexia is a spectrum of varying levels of difficulties in reading, writing and spelling. Assessment should be made on an individual basis, allowing for personalised support strategies to be implemented. With an increasing number of health professionals with dyslexia progressing through training, it is important for these professionals to disclose their condition without fear of stigmatisation, to receive the appropriate assistance and be supported to carry out their professional duties.

Dyslexia and medical students

In 2007, 1.7% of medical students accepted into UK Medical Schools had a Specific Learning Difficulty (SpLD) such as dyslexia.1 The Equality Act 2010 states that reasonable adjustments should be made to support those with disabilities to provide ‘enabling environments’ to progress. During medical training these adjustments are well established and include support tutors and extra time in examinations, however, for students with dyslexia the transition to foundation training may exert additional pressures in areas such as communication, prescribing and organisation.2

Study objectives

We conducted a study to evaluate the prevalence of dyslexia in Foundation Trainee doctors at East Sussex Healthcare Trust (ESHT). Our aim was to raise awareness among clinicians and help identify and support Foundation trainees with dyslexia by guiding them to the appropriate supportive pathways.

Method

We collected information from Transfer of Information forms (TOI) submitted by Foundation Trainee doctors (FY). All trainees started at ESHT in August 2017. There were 78 Foundation Doctors in ESHT in 2017, 35 in their first year of training and 43 in their second.

Results

The full results are shown in table 1.

Foundation Year

Number of doctors

 Number with dyslexia

Percentage

FY1

35

6

17%

FY2

43

8

19%

Total

78

14

18%


Table 1: Table showing results from the transfer of information forms from the Foundation Trainees at ESHT in 2017

 

Case study: A struggling Foundation Doctor with dyslexia

The Foundation Director was made aware that a trainee had not passed the Prescribing Safety Assessment (PSA) and would shortly be looking to retake. The trainee moved to the next post and was understood to have settled in well, but soon after issues were raised regarding poor time management and lack of confidence. The trainee failed the PSA resit. For the final attempt the trainee would receive support from pharmacy to focus on specific issues.

Discussion with the Medical Education Team bought to light that the trainee was having trouble interpreting the context and framing of the questions during the PSA exam, causing the trainee to run out of time, but the questions the trainee did respond to were correct. Finally, a concern was raised around the interpretation of the rota which caused confusion and spelling mistakes made on a thank you card. 

At this point, dyslexia was raised as a possible contributing factor and it was agreed that this would be followed up on. We contacted the Foundation School who advised us to ask the trainee to self-refer to the Practitioner Health Programme. The trainee took the preliminary screening test and scored highly for dyslexia. In the second stage the trainee was tested by an educational psychologist within an independent dyslexia consultancy firm and the trainee scored highly for both dyslexia and dyspraxia. This subsequent report was discussed with the Foundation School who agreed to take the results into consideration for the final PSA attempt.  

During this time, the Foundation School reiterated their support and the trainee’s Educational Supervisor was involved and kept well informed. The trainee subsequently passed the final PSA attempt with extra time and the support they received from the Foundation school.

Discussion: how to identify and support trainee doctors with dyslexia

Dyslexia is an extremely common learning difficulty which affects 10% of the population. It has been described as a Specific Learning Difficulty, a collective term for conditions that include dyslexia, dyspraxia and dyscalculia, but also as part of a group known as "neurodiversity" where dyslexia, autism spectrum disorder and attention deficit hyperactivity disorder (ADHD) share common features.

Table 2 shows the possible difficulties experienced on a day-to-day basis for a trainee doctor with dyslexia. These challenges are commonly exacerbated by time pressures and can cause stress, anxiety and a feeling of humiliation when unable to perform the task asked of them. Alongside these difficulties are suggested adjustments that may be implemented.4

 

Area of difficulty

 

Possible adjustments

Reading

  • Reading patient notes / documentation
  • Misinterpreting information
  • Unable to read accurately aloud
  • Completing forms
  • Allowing extra time to read and complete tasks
  • Being given verbal as well as written instructions

Writing

  • Producing referral letters
  • Spelling
  • Time-pressured writing tasks
  • Documenting patient histories
  • Reflective writing
  •  Prescriptions – reversing dosage numbers.
  • Using assistive technology e.g. speech to text software.
  • Proof reading work / use of computer spell checkers.
  • Working in a quiet room to minimise interruptions
  • Saying numbers aloud / writing down calculations.
  •  Using templates to structure written work

Verbal communication

  • Expressing themselves
  • Handing over to colleagues
  • Giving presentations
  • Remembering names
  • Writing down key information
  • Discuss instructions one at a time
  • Awareness and support from team members.

Organisation

  • Managing time pressured tasks
  • Prioritising work
  • Writing down checklists
  • Verbally recording important information
  • Colour coding

 

Table 2: Difficulties experienced by trainee doctors with dyslexia and adjustments that may be made

 

Many affected doctors have developed coping strategies to deal with the difficulties they face at work, these come in various forms reflecting the continuum nature of dyslexia.5 Such ‘workarounds’ had a general theme of safety netting, checking work multiple times and preparing work in advance. A 2015 systemic review into this subject suggested that these individual strategies should provide a basis for future research into how doctors with SpLD can be regularly supported in clinical practice.6

Guidance for dealing with SpLDs in Postgraduate training

The London and South East (LaSE) branch of NHS Health Education England, which covers ESHT, has provided thorough guidance for dealing with SpLDs in Postgraduate training.7 Figure 3 shows the process for trainees within the LaSE Postgraduate Education region who have not previously been formally assessed and would like to be evaluated for dyslexia. The initial stage includes an Adult Dyslexia checklist which identifies areas a trainee may be having trouble and is not designed to be a diagnostic tool. If a SpLD is suspected, then an appointment with an educational psychologist will be arranged and the findings along with recommendations are produced in a report.

It is important that throughout the process the trainee maintains communication with their clinical/educational supervisor and discusses the recommendations with their Trusts Occupational Health Service to maximise their future working potential.

 

Dyslexia

 
Figure 3: Evaluation process for a trainee who would like to be formally assessed for dyslexia

 

The recommended reasonable adjustments will reflect the areas identified as needing support. Examples of these are included in table 1 and consist of practical solutions such as writing lists, colour coding, checking work and working in quiet environments. The use of assistive technology such as spellcheckers, dictaphones and mobile applications may also be effective as well as support and understanding from other members of the team.

Conclusion

Dyslexia is increasingly common in medical students and subsequent trainee doctors. It is important that clinicians are aware of the signs attributed to dyslexia and take care not to associate them with lack of ability. They should also be conscious that a doctor may have dyslexia that is undiagnosed or undisclosed due to fear or anxiety of the impact on their career, stigmatisation, or humiliation.8 It is essential for the trainees to understand that the role of identification and assessment of a SpLD such as dyslexia is to allow for the appropriate adjustments to be made for that individual and not to label underperforming doctors. The assessment process will also provide key information regarding their specific strengths and weakness allowing them to focus on these areas and encourage personal goal setting.9

Ensuring a trainee doctor with SpLD feels supported, effective communication is fundamental. Continual guidance and support from their supervisors and the Occupational Health Department should allow for a safe environment in which to disclose such conditions. If a trainee is unsure, the LaSE Postgraduate Medical Education website provides the pathway to a full assessment and the support network that is available.

 


Darby L, Skowronski C,  Rahmani MJH

East Sussex Healthcare NHS Trust

m.rahmani3@nhs.net


 

References

  1. British Medical Association Equality and Diversity in UK Medical Schools: London; British Medical Association [Internet]. (2009) http://www.nhshistory.net/bmastudentreport2009.pdf (accessed 30 May 2018).
  2. Dyslexia and the Equality Act 2010 [Internet]. (2018) https://www.bma.org.uk/advice/career/studying-medicine/common-challenges-while-studying/studying-with-dyslexia/dyslexia-and-the-equality-act (accessed 25 May 2018)
  3. British Dyslexia Association (BDA). About the British Dyslexia Association [Internet]. http://www.bdadyslexia.org.uk/about (accessed 25 May 2018).
  4. Health Education Wessex. Health Education Wessex Professional Support Unit Research Project into doctors with dyslexia [Internet]. (2015) http://www.wessexdeanery.nhs.uk/pdf/DyslexiaPSU2015.pdf (accessed 25 May 2018)
  5. Locke R, Alexander G, Mann R, Kibble S, Scallan S. Doctors with dyslexia: strategies and support. The Clinical Teacher. 2017; 14:355-359. DOI: 1111/tct.12578
  6. Locke R, Scallan S, Mann R, Alexander G. Clinicians with dyslexia: a systematic review of effects and strategies. The Clinical Teacher 2015;12(6):394–398 DOI: 1111/tct.12331
  7. London and South East Postgraduate Medical and Dental Education. Fit for Work Guidance [Internet]. https://www.lpmde.ac.uk/professional-development/fit-for-work-guidance/health-conditions/dyslexia (accessed 25 May 2018)
  8. Newland F, Shrewsbury D, Robson J. Foundation doctors and dyslexia: a qualitative study of their experiences and coping strategies. Postgrad Med J 2015; 91:121–126.
  9. London and South East Postgraduate Medical and Dental Education Fit for Work guidance [Internet]. https://www.lpmde.ac.uk/professional-development/dyslexia