The effect of specific learning difficulties on general practice written and clinical assessments

Abstract

Background: Substantial numbers of medical students and doctors have specific learning difficulties (SpLDs) and failure to accommodate their needs can disadvantage them academically. Evidence about how SpLDs affect performance during postgraduate general practice (GP) specialty training across the different licencing assessments is lacking. We aimed to investigate the performance of doctors with SpLDs across the range of licencing assessments.Methods: We adopted the social model of disability as a conceptual framework arguing that problems of disability are societal and that barriers that restrict life choices for people with disabilities need to be addressed. We used a longitudinal design linking Multi-Specialty Assessment (MSRA) records from 2016 and 2017 with their Applied Knowledge Test (AKT), Clinical Skills Assessment (CSA), Recorded Consultation Assessment (RCA) and Workplace Based Assessment (WPBA) outcomes up to 2021. Multivariable logistic regression models accounting for prior attainment and demographics were used to determine the SpLD doctors' likelihood of passing licencing assessments. Results:The sample included 2070 doctors, with 214 (10.34%) declaring a SpLD.Candidates declaring a SpLD were significantly less likely to pass the CSA (OR 0.43, 95% CI 0.26, 0.71, p = 0.001) but not the AKT (OR 0.96, 95% CI 0.44, 2.09, p = 0.913) or RCA (OR 0.81, 95% CI 0.35, 1.85, p = 0.615). Importantly, they were significantly more likely to have difficulties with WPBA (OR 0.28, 95% CI 0.20, 0.40, p < 0.001). When looking at licencing tests subdomains, doctors with SpLD performed significantly less well on the CSA Interpersonal Skills (B = À0.70, 95% CI À1.2, À0.19, p = 0.007) and the RCA Clinical Management Skills (B = À1.68, 95% CI À3.24, À0.13, p = 0.034). Conclusions: Candidates with SpLDs encounter difficulties in multiple domains of the licencing tests and during their training. More adjustments tailored to their needs should be put in place for the applied clinical skills tests and during their training.

Religiosity, stress, and depressive symptoms among nursing and medical students during the middle stage of the COVID-19 pandemic: A cross-sectional study in Morocco

“…Medical education is one of the most demanding training programs in both academic and emotional dimensions (1). Previous studies have reported higher rates of poor mental health among nursing students (1)(2)(3)(4)(5)(6).…”

The role of groups in assessing learners with specific learning difficulties

“…As the field of health professions education (HPE) shifts towards creating more equitable learning environments, researchers and educators have increasingly underscored the importance of equity in assessment processes. In a recent article published in Medical Education , Botan and colleagues 1 conducted a study on how specific learning difficulties (SpLDs) impact physicians' performance on various assessments. Their study sample included 2070 physicians, of whom 214 (10.34%) declared having a SpLDs, such as dyslexia (difficulty with reading), dysgraphia (difficulty with writing), dyspraxia (difficulty with coordination), or dyscalculia (difficulty with calculation).…”

“…Their study sample included 2070 physicians, of whom 214 (10.34%) declared having a SpLDs, such as dyslexia (difficulty with reading), dysgraphia (difficulty with writing), dyspraxia (difficulty with coordination), or dyscalculia (difficulty with calculation). Botan and colleagues 1 found that physicians with SpLDs may have more difficulty with licensing examinations and assessments encountered throughout their training than learners without SpLDs. They therefore encouraged medical educators to understand the specific needs of learners with SpLDs and to accommodate these needs as part of ongoing assessment processes.…”

“…Botan and colleagues 1 pointed to a critical equity issue within HPE; however, the implications of their work were primarily oriented towards individual medical educators as opposed to groups . As part of the global shift towards competency‐based medical education, there has been a movement towards having groups, rather than individuals, make decisions about learner competence 2 .…”

“…In this case, the CC member who possesses information about a learner's SpLD must decide whether to speak up when the learner is being discussed. Although there is no hard and fast rule about when it is appropriate to share information that has been disclosed by a learner with other committee members, Botan and colleagues 1 highlighted the importance of accommodating learners with SpLDs according to their unique needs, which would not be possible without all CC members being aware of what these needs are.…”