University and Disability: Being a Medical Student.

Part two of a three-part LUNA Project Series, by Rachael Banks and Ally Lloyd”

My assumption was that studying medicine with a chronic illness or disability was likely to be an experience in which you felt supported, as the staff would understand what is going on. Your perspective would be valued, as the kind of doctor who had first-hand experience with various conditions. However, neither of these things are consistently true. The profession has been relatively slow to recognise that doctors (and by extension medical students and those in medical schools) can themselves have health challenges. It has only been recently that the General Medical Council has had a policy for supporting disabled doctors; only 4% percent of medical students identifying as having a disability compared to 16% of working age adults (between 18 and state pension age). In this article you will read the experiences of three medical students, living with three entirely different disabilities.

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Hena

I’m Hena, a medical student studying at the Imperial College School of Medicine. I was diagnosed with Ulcerative Colitis in 2018, but I was experiencing symptoms from the summer of 2017 onwards, in my second year of university.

At first, I felt so alone and confused about whether I should even be at medical school because I had so many absences because my symptoms were not being well-controlled with the medications, and to this day my disease is very active. I also get tired very quickly, and my symptoms are worse in the morning. This is particularly difficult as a medical student because you are expected to be in early for ward rounds or clinics. Therefore, being late from spending more time in the bathroom than normal or being unable to commute (I frequently have to make 45 mins+ journeys around London on the tubes or bus, where there is limited bathroom access) can make you look unprofessional.

Since the clinical years in medicine are very much skill and experience-based, attendance is important and compulsory for progression. As a result, I was threatened with having to take a year out to complete the missed placements. This was always framed to me positively as “an opportunity to let your symptoms settle, and return in full health” which always seemed really problematic to me – there was no guarantee a year out would help my symptoms, considering I have been flaring on and off ever since diagnosis.

I have a personal tutor who has been very kind and helpful, but often my academic issues had to be referred onwards to the Head of the Year, and the Senior Welfare Tutor. I also had access to the Disability Advisory Services, who were great in arranging exam adjustments but have not been that useful for my condition aside from this. I was also referred to occupational health, which was useful in determining my COVID risk. I had access to a College counsellor for a while but there were only 7 sessions available a year, and the waiting list was very long.

I think I have definitely had the best experience in terms of support compared to a lot of other people I have discussed my issues with, both within my university and compared with other unis too. I think the one thing I would like to see more of is open diversity in terms of disability and long-term illness. I feel as though a lot of effort has been made towards showcasing diversity from a racial, gender, or LGBTQ+ point of view, but there still seems to be this mentality within my med school that doctors/med students are superhuman and never suffer from any ailments. I think I would have felt a lot less alone at the start of my disease if I didn’t feel like I was the odd one out, or that I was broken. I would love for my institution to demonstrate that having a disability or long-term illness is definitely compatible with a career in this field.

Marina

I’m Marina, a third- year medical student at the University of Glasgow and I have lived with an eating disorder for the past seven years. I would say that university wasn’t a massive worry for me, partly because education and studying have always been coping mechanisms for me.

The University of Glasgow has a medical school welfare department, which is made up of some really wonderful individuals whom I have a good relationship with. However, sometimes I find it difficult that the focus is helping you “survive” and get from one day to the next when you are struggling, rather than helping you to thrive! One of the biggest problems with this system is it always relies on you reaching out and saying you're struggling, which is a double-edged sword. Many people fall through the gaps as they don’t reach out, and then for the people who do access the service it’s tricky because just by doing so there is an assumption that it can't be that bad because you are self-aware, which is often not the case. I also registered with disability services but, in the end, I deregistered. This was largely due to my own internalised stigma.

There are many things that the medical school could do to support students with disabilities more. For instance, there needs to be a culture shift of it not being seen as a “failure” if your mental illness is something you have to manage daily long term. A lot of the conversations around mental health end up being like ‘Oh I was struggling for a period of a couple of months but now I have overcome that and am thriving!’ when actually for the vast majority of people with a mental illness this just isn’t the reality, but it can leave you feeling like the minority.

I think that there is sometimes a gap between the rhetoric Unis have with wanting to talk about and support students who struggle with their mental health, and the reality. For example, if you have an eating disorder then you cannot access the uni counselling services, but it is also near impossible to access NHS services. It feels like surely the Uni could recognise this really dangerous gap and see it as a priority.

Beth

I’m Beth, one of the LUNA trustees and like Marina I am a third- year medical student at the University of Glasgow. I was diagnosed with JIA (Juvenile Idiopathic Arthritis) when I was 18 months old.

I would say that health is a big concern with me when thinking about not just my course but all the other things that go with university. For one I really care about my course and I really enjoy it and I have never wanted health issues to be a barrier even though there are many aspects of it that I find challenging. It is also a very vocational course so I have often felt like if I couldn’t manage something in University then how would I manage it when we have to do all of it as Doctors. This was something I thought a long time about before coming to University and I found it difficult that there wasn’t really anyone who I could ask these questions to. Like Hena, after a six- week stint in hospital in the second semester of first year I was advised to take a year out and although I’d like to believe that the university had my best interest at heart I felt a lot of the time like things weren’t being communicated to me and decisions were being made behind my back. I likely would have taken this year if I hadn’t been dealing with it for so long, but this wasn’t something in which I felt supported by the medical school. As Hena also alluded to absences can also be a cause for concern and I felt very pressured trying to keep on top of both University work and managing appointments.

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here was support provided by the university, but I have not always found many the formal forms of support to be very helpful. I have never reached out to the Med School Welfare after being coerced into a very unproductive meeting after the hospital stay in first year. I have talked with my advisor of studies who is lovely but often does not know what to suggest which isn’t always very solution focused. I’ve found talking to my heads of year and facilitators far more helpful than any form of formal support as often, I find it is these people who can make your life a little easier.

For instance, a really beneficial thing was my anatomy teacher arranging for a PhD student to meet with me once a week and go through all the parts I’d missed, something which was incredibly kind of them both and really helpful. I’ve not had too positive experiences with disability services, having been once and being told to ‘watch the tree roots’ and then the assessment with exam arrangements taking almost a year to reach the medical school but I am aware that for some people they have been very helpful.

There are many things I find challenging about my course from a health perspective but often the attitude is simply to ‘get on with it’ and work out your own solutions. Whilst there are benefits to this approach, I feel there would not be any harm to providing more support to medical students with disabilities. There are many ways I feel this could be done, either through a mentorship scheme where older students or doctors with disabilities mentored a younger student or even just providing more support and training to advisors of studies. Up top with the GMC and BMA there is a shift in representation and support just unfortunately it doesn’t seem like it is trickling down to medical schools quickly enough.

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We know that times are changing, with increasing cases of individual members of staff and peers who are incredibly supportive. However, the variation in support is evident. There still exists a problematic culture within medicine, where disparities between “talking the talk” and “walking the walk” are apparent. Hena, Marina, and Beth’s account’s all show the real potential and the beginnings of change in the field of medicine, and how disability is being thought of and discussed. However, it also reflects the problem of working within a culture where the “superhero” image is perpetuated, leaving Disabled doctors and medical students feeling alienated.

(originally published 12/10/20)