January 29, 2009, by Teaching at Nottingham

Objective Structured Clinical Examinations OSCE – reasonable adjustments for students with disabilities within the Division of Nursing

Sally-Ann Bradley, Lorraine Roberts and Nicki Walsh:

Background and significance: “Since the Special Educational Needs and Disability Act (2001) was added as an amendment to the Disability Discrimination Act (1995), it has been unlawful for any educational institution to treat a disabled person ‘less favourably’ for a reason related to their disability. Educational institutions are required to make reasonable adjustments to ensure that a disabled person is not placed at a substantial disadvantage and this legislation applies to admissions and enrolment services, and other student services including assessment and teaching resources. Work within the University of Nottingham has identified reasonable adjustments for academic work, however some disciplines have assessed practical components and consideration is needed. The Division of Nursing examines practical clinical skills using Objective Structured Clinical Examinations (OSCE). These assess a student’s clinical skills and knowledge using a simulated patient scenario. The new legislation also highlights that reasonable adjustments should not compromise professional standards and competencies, there is a need to match any possible reasonable adjustment against professional codes to ensure that that this does not happen. Telephone enquiry to the Nursing and Midwifery Council (NMC) by a member of the project team, elicited that guidelines, competencies, proficiencies and essential skills are produced by the NMC, but it is for each School of Nursing to define their own reasonable adjustment. Therefore, further exploration of the issues surrounding reasonable adjustment within OSCEs and the development of possible guidance has resulted in this project.

Methodology: “A questionnaire was administered by email to all students within the Division of Nursing (5 centres), on the diploma/degree in nursing course, who had reach the stage within their training where they had had an opportunity to undertake an OSCE assessment (n= 2000). Sampling was considered problematic due to issues of confidentiality. There were estimated to be 199 students within the School registered with a disability at the time of the project. However all students were e-mailed in an attempt to capture those both registered and those who were not. Descriptive statistics were used to analyse the characteristics of the group but due to the qualitative nature of some of the questions, an overall thematic approach was adopted. The rationale for this was to capture the true student experience.

Results: “Twenty-three questionnaires were returned (11%). Findings highlighted:

• A lack of parity across the 5 sites. There was a lack of consistency with applying adjustments – some adjustments were made that had not been recommended, so people did not seem to understand the DD Act. This matter has been fed back to appropriate module groups for actionM
• A group for students who had a problem not identified under the DD Act were highlighted and this matter has been referred to Occupational health for guidance.
• A range of actual and requested adjustments were identified, arranged under themes and mapped against various guidelines and practices. The findings have resulted in feedback to relevant committees and groups for action and the development of guidelines on what is and is not a reasonable adjustment (these are guidelines that can be developed further as new issues come to light).

“Example of guideline- students with dyslexia asked for documentation in an alternative colour e.g. red. There was no problem with academic material i.e. exam instructions being in red but NMC guidelines, trust policies etc state that official documentation should be in black. Documentation such as treatment charts cannot have the colour changed as this would not be acceptable in practice, this could disadvantage another student with a different colour preference and duplication of charts could be a safety issues. An alternative solution could be a coloured overlay.

“This project has helped to produce initial guidance on what is a reasonable adjustment. It is hope that it can be included on the School of Nursing OSCE website so that it is accessible to both staff and students. As a result of this local study guidance can be used within other academic departments to assist in their development of local guidelines for reasonable adjustment within practical assessments.”

Paper presented at the University’s Fourteenth Learning & Teaching conference (January, 2009).

Sally-Ann Bradley
School of Nursing, Midwifery & Physiotherapy

Lorraine Roberts
School of Nursing, Midwifery & Physiotherapy

Nicki Walsh
Lecturer In Adult Nursing
School of Nursing, Midwifery & Physiotherapy

This article was originally published as part of PESL’s Teaching at Nottingham collection.

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