Autistic role modelling in medical education

Shaw, Sebastian C K; Grosjean, Bernadette; McCowan, Sue; Kinnear, Malcolm; Doherty, Mary

doi:10.1080/14739879.2021.1996277

Cited by 6 publications

(5 citation statements)

References 4 publications

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“…However, we know that autistic people communicate highly effectively with one another 36 . It is therefore important for autistic students to have access to autistic peers and role models within medicine 37 — not only to promote peer support and camaraderie but also to allow for improved social modelling, self‐efficacy and motivation. The importance of autistic role modelling in medicine is further supported by wider research, which shows that having never worked with another doctor they suspected of being autistic was actually associated with higher rates of suicidal thoughts in autistic doctors 38 .…”

Section: Discussionmentioning

confidence: 99%

The experiences of autistic medical students: A phenomenological study

2023

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BackgroundIncreasing recognition of autism is reflected in the growing awareness of autistic health care providers. Regulatory bodies including the UK General Medical Council and the UK Medical Schools Council have published guidance fostering inclusion. Whilst many autistic doctors and students are thriving, many may not disclose their diagnosis unless difficulties arise, which perpetuates stereotypes. No studies have explored the experiences of autistic medical students. We aimed to do this.MethodsThis was an interpretive phenomenological study. Autistic medical students were recruited using Facebook announcements. Participants underwent audio‐recorded, loosely structured interviews. Recordings were transcribed verbatim and underwent an interpretive phenomenological analysis.ResultsFive participated from five different UK medical schools. Constructed themes included: Autistic profiles and stereotypes—‘I'm a lot better with patients than I am with my peers, with staff, which is hard for a lot of people to understand’; sensory processing and the learning environment—‘noises really hurt my ears … It actually hurts’; me, myself and masking—‘so, medicine's hard. But I'm also studying myself and I'm figuring myself out and that degree is harder’; the social world—‘I always feel like I'm watching my back’; and navigating the system—‘[they say] “but you're going to be a doctor one day, so you need to get used to it”’.ConclusionParticipants longed for understanding and support from their medical schools. They reported experiences of isolation, bullying and anxiety. Most felt themselves to be victims of the system, whereby they were expected to adapt themselves in order to appear non‐autistic. When participants reported not coping due to being autistic, most were advised to ‘take time out’. None were offered personalised adjustments to their learning environment. All reported strengths associated with being autistic. This supports the assertion that autistic people can be safe, effective and skilled doctors.

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Section: Discussionmentioning

confidence: 99%

The experiences of autistic medical students: A phenomenological study

2023

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“…Whilst this is an association and not a causation, this may provide some preliminary evidence to support the assertion that openly autistic role models play a key role within medical education and the wider medical workforce. As previously argued, “witnessing colleagues with whom we can identify and being able to learn from their successes and struggles may make the difference between leaving a career we dreamed of, or pursuing it, more aware of our strengths, our vulnerabilities and the right to advocate for accommodations” ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

“…Stereotypes surrounding autism permeate all facets of society, including the medical workforce ( 17 ). In a symbiotic fashion, such stereotypes may be both born of and act to reinforce the tragedy narrative surrounding autistic people ( 18 ). Being autistic in such an environment may foster internalized ableism and may promote a lack of disclosure.…”

Section: Introductionmentioning

confidence: 99%

The experiences of autistic doctors: a cross-sectional study

et al. 2023

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IntroductionMedicine may select for autistic characteristics. As awareness and diagnosis of autism are growing, more medical students and doctors may be discovering they are autistic. No studies have explored the experiences of autistic doctors. This study aimed to fill that gap.MethodsThis is a cross-sectional study. A participatory approach was used to identify the need for the project and to modify a pre-existing survey for use exploring the experiences of autistic doctors.ResultsWe received 225 responses. 64% had a formal diagnosis of autism. The mean age of receiving a formal diagnosis was 36 (range 3–61). Most were currently working as doctors (82%). The most common specialties were general practice / family medicine (31%), psychiatry (18%), and anesthesia (11%). Almost half of those working had completed specialty training (46%) and 40% were current trainees. 29% had not disclosed being autistic to anyone at work. 46% had requested adjustments in the workplace but of these, only half had them implemented.Three quarters had considered suicide (77%), one quarter had attempted suicide (24%) and half had engaged in self-harm (49%). 80% reported having worked with another doctor they suspected was autistic, but only 22% reported having worked with another doctor they knew was autistic. Having never worked with a potentially autistic colleague was associated with having considered suicide.Most preferred to be called “autistic doctors” (64%). Most considered autism to be a difference (83%). Considering autism to be a disorder was associated with preference for the term “doctors with autism,” and with having attempted suicide.ConclusionAutistic doctors reported many challenges in the workplace. This may have contributed to a culture of nondisclosure. Mental health was poor with high rates of suicidal ideation, self-harm, and prior suicide attempts. Despite inhospitable environments, most were persevering and working successfully. Viewing autism as a disorder was associated with prior suicide attempts and a preference for person-first language. A neurodiversity-affirmative approach to autism may lead to a more positive self-identity and improved mental health. Furthermore, providing adequate supports and improving awareness of autistic medical professionals may promote inclusion in the medical workforce.

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“…This is in keeping with previous research, which found that autistic medical students desired openly autistic role models within the medical profession [ 14 ]. Here, if our participants’ desires for positive role modelling are met, it may well steer them onto a path of increased self-confidence and reduced internalised ableism–helping them to pursue their dreams and advocate for their needs–instead of one that leads to burnout and attrition [ 22 ]. This may help students to embrace their differences, rather than suppressing them.…”

Section: Discussionmentioning

confidence: 99%

“…These groups are often discredited and dismissed when sharing their experiences–a concept known as epistemic injustice [ 21 ]. In the case of neurodivergence, access to such stories may also prove helpful for neurodivergent students/trainees through positive role modelling, promoting the celebration of difference and acceptance of oneself [ 22 ]. Research over recent years has led to the inclusion of dyslexic, dyspraxic, and autistic voices within the literature [ 23 – 25 ].…”

Section: Introductionmentioning

confidence: 99%

The experiences of medical students with ADHD: A phenomenological study

Godfrey-Harris,

Shaw

2023

PLoS ONE

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Attention Deficit/Hyperactivity ‘Disorder’ (ADHD) is a form of neurodivergence, characterised by lifelong differences in attention, impulsivity, and hyperactivity. University students with ADHD underachieve academically and tend to have lower levels of self-esteem. Medical schools have an obligation to minimise barriers for students with ADHD. Understanding the experiences of medical students with ADHD is vital to promote inclusive approaches. Our exploratory research question was: “What are the experiences of medical students with ADHD?” This was an interpretive phenomenological study. Loosely structured interviews were conducted with participants (medical students with ADHD) over Zoom. Subsequent transcripts were analysed using interpretive phenomenological analysis. Six people participated. Our analysis identified the following themes: Identity and diagnosis; ADHD profile; system issues; conflict, competition and compensation; improving the experience. Participants reported experiences of bullying and isolation at medical school, perpetrated by doctors and peers, as well as feelings of alienation when unable to conform on placement and in exams. From this, participants adopted survival strategies, such as masking, to avoid being ostracised. All recognised their ADHD status when their mental health deteriorated during their medical studies. Of those who disclosed their diagnosis, none were offered personalised support. Participants feared disclosure, largely due to weaponised professionalism and the effects of toxic competitiveness in medicine. They yearned for a sense of belonging. Participants reported strengths associated with ADHD such as empathy and working well under pressure, which are highly desirable aptitudes for doctors. This study has highlighted areas where medical schools can be instrumental in cultivating an environment where medical students with ADHD can thrive, not just survive. This may take the form of peer support groups, alongside reasonable adjustments throughout medical school–particularly for Objective Structured Clinical Examinations, for example. Enabling these students to thrive may help to prevent early burnout and subsequent attrition from medicine.

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Autistic role modelling in medical education

Cited by 6 publications

References 4 publications

The experiences of autistic medical students: A phenomenological study

The experiences of autistic medical students: A phenomenological study

The experiences of autistic doctors: a cross-sectional study

The experiences of medical students with ADHD: A phenomenological study

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