Submission to Working Group on Undergraduate Medical Education and Training Response Form

How does the undergraduate medical education and training system impact on your organisation?

NDA mandate under the National Disability Authority Act 1999

The National Disability Authority (NDA) welcomes the opportunity to make this response to the Working Group on Undergraduate Medical Education and Training.
The National Disability Authority was established in June 2000 as an independent statutory body operating under the aegis of the Department of Justice, Equality and Law Reform. The National Disability Authority Act [1999] defines the principal function of the Authority as to advise the Minister and keep him or her informed of developments in relation to any disability of persons which concern issues of policy and practice [Section 8.1].

The National Disability Authority Act defines disability thus: 'disability', in relation to a person, means a substantial restriction in the capacity of a person to participate in economic, social or cultural life on account of an enduring physical, sensory, learning, mental health or emotional impairment. Section 8 of the National Disability Authority Act details the Authority's policy, research and standards functions.

8.2(a) to act as a central, national body, which will assist the Minister in the co-ordination and development of policy relating to persons with disabilities;
8.2(b) to undertake, commission or collaborate in research projects and activities on issues relating to disability and to assist in the development of statistical information appropriate for the planning, delivery and monitoring of programmes and services for persons with disabilities;
8.2(c) to advise the Minister on appropriate standards for programmes and services provided or to be provided to persons with disabilities and to act as an advisory body with regard to the development of general and specific standards in relation to such programmes and services.'

The Mission of the NDA is, on behalf of the State, to promote and help secure the rights of people with disabilities. The Authority aims to achieve this by:

  • influencing public policy and legislation
  • ensuring that services to people with disabilities are of the highest standards and quality. [2004]

The Working Group's Terms of Reference indicates that its recommendations have potential to positively promote

  1. the recruitment and retention of people with disabilities in medical training
  2. the improvement of service delivery to people with disabilities.


Therefore, it work is of direct relevance to the NDA statutory remit.

In this section, the NDA outlines

  • the social and human rights model of disability on which we base our work
  • our principles and values
  • the model of health that we employ.

Social and human rights model of disability

The work of the NDA is grounded in a commitment to a social and human rights model of disability. This model recognises how social organisation creates disabling conditions that result in social, economic, political and cultural exclusion and is in keeping with the definition of disability in the National Disability Authority Act [1999] given above. The social model of disability locates disability within society and how society functions and adapts to disability. The aim of the social model is to create a society that recognises diversity and works towards inclusion and equality for all. The medical model of disability locates the disability within the person and views it in terms of a deficit.

Principles and values

The NDA is dedicated to work towards the creation of a society in which people with disabilities have the right and opportunity to

  • influence and shape policy at all levels
  • develop and fully use their abilities, talents and skills
  • live learn and work in environments appropriate to their needs
  • live as independently as possible
  • enjoy equality and participation
  • make informed choices on issues
  • participate in and receive support from, national and international organisations that effectively represent their interests
  • have systems of support sufficient to ensure a reasonable standard of living in the community of their choice.

In adopting a rights-based approach, the NDA seeks to:

  • ensure that the needs and rights of all people with disabilities are enshrined in all aspects of Irish life
  • promote the empowerment of people with disabilities and their participation in decisions that effect their lives
  • underpin the promotion of an inclusive vision among all constituencies in Irish society.

The determinants of health

The NDA uses the World Health Organisation's definition of health:
To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is positive concept emphasising social and personal resources, as well as physical capacities. [The Ottawa Charter 1986]
We recognises that health is determined by a broad range of factors, most of which are outside of the health sector. As acknowledged in the national health strategy: Social, economic and environmental factors (are) the main external or structural determinants of health. At an individual level factors such as age, sex, hereditary factors and lifestyle choices are important. [Department of Health and Children 2001: 10]. This highlights the importance of health promotion and public health activity, as well as change in care and treatment services.

Comment

The National Disability Authority has identified health, education and employment and training as three of five priority areas for action (with transport and income adequacy). The Terms of Reference of the Working Group indicate that its recommendations have potential to positively promote

  • the recruitment and retention of people with disabilities in medical training
  • the improvement of service delivery to people with disabilities.

The NDA also recognises the potential for the Working Group to re-orientate:

  • curriculum/syllabus
  • teaching methods/delivery methods
  • other aspects of the organisation and delivery of undergraduate medical education and training

towards a social and human rights model of disability. We believe that this re-orientation would promote inclusive, equitable, person-centred medical education and training, and practice.

Opportunities / Threats faced by the System

The current policy and legislative context for health and disability present a number of opportunities.

National policy context

The NDA commissioned report Towards best practice in provision of health services for people with disabilities in Ireland [Pilinger, 2004] health policy and activity is currently being shaped by the following key national policy developments:
A Strategy for Equality: Report of the Commission on the Status of People with Disabilities
Quality and Fairness - A Health System for You
The report also reviews international human rights, disability and health instruments.

A Strategy for Equality: the Report of the Commission on the Status of People with Disabilities

The NDA was established on foot of a recommendation in A Strategy for Equality: Report of the Commission on the Status of People with Disabilities [1996]. A Strategy for Equality represents the findings of extensive consultation including consultation with the mental health sector. The NDA recommends that the Working Group consider A Strategy for Equality as an important source document.

The three guiding principles of the Commission to inform its work were:

  • equality
  • maximising participation
  • enabling independence and choice.

The Commission noted that the key principles that have informed recent international legislation and practice are:

  • the recognition that disability is a social rather than a medical issue
  • the adoption of a civil rights perspective, and
  • the recognition of equality as a key principle of the human rights approach.

Through its consultation over a two-year period, the Commission concluded that:
People with disabilities are the neglected citizens of Ireland…many of them suffer intolerable conditions because of outdated social and economic policies and unthinking public attitudes. Changes have begun to come about, influenced by international recognition that disability is a social rather than a medical issue, but many of those changes have been piecemeal.
The picture that emerged was one of a society, which excludes people with disabilities from almost every aspect of economic, social, political and cultural life. People with disabilities made it clear that they want equality that they want to move on from a reliance on charity towards establishing basic rights. They want, and are entitled to, equality and full participation as citizens.

Emerging themes included the:

  • frustration experienced by people with disabilities at having to deal with a 'myriad of oppressive social barriers'
  • experience of being kept at, or pushed to, the margins of society
  • the lack of information available to people with disabilities and their carers
  • the silence of relevant official statistics.

The Commission identified the following as among the principal determinants of the status of people with disabilities:

  • the level and nature of their education
  • the level and nature of employment
  • the presence or absence of education about a particular group aimed at combating prejudicial and discriminatory attitudes.

The Commission noted that achieving status in one area significantly increases the likelihood of achieving it another. Status is influenced by the level and amount of social differentiation, which exists in society at large. The more egalitarian the political, economic, social and cultural organisation of a society as a whole, the more egalitarian it is likely to be for any given group. Thus improvement in the education, employment and social profile of people with disabilities can make significant contributions to their overall status in Irish society.

The forthcoming disabilities bill

The establishment of the Working Group is timely in light of the forthcoming disabilities bill. At the request of the Minister for Justice, Equality and Law Reform, the NDA has facilitated the work of the Disability Legislation Consultation Group (DLCG) whose membership includes representatives from disability organisations. The DLCG has produced Equal Citizens: Proposals for Core Elements of Disability Legislation [2003]. This document was developed following reviews of international disability and human rights legislation and policy, a series of consultation meetings and analysis of 68 written submissions.

The document articulates a vision for disability legislation based on a social and human rights model of disability and proposes the following core elements of disability legislation:

  • independent needs assessment and service co-ordination
  • advocacy
  • mainstreaming
  • accessibility
  • disability awareness / equality training
  • public service employment.

The work of the DLCG represents a significant consultation with the disability sector. The NDA considers that its work can usefully inform that of the Working Group.

The reform of the health system

Towards best practice in provision of health services for people with disabilities in Ireland [Pilinger, 2004] outlines a number of opportunities presented by the current reform programme in health.

Obstacles to progress of system

At present there appear to be a number of barriers to

  • the recruitment and retention of people with disabilities in medical training
  • the improvement of service delivery to people with disabilities.

People with disabilities experience a range of barriers to education and employment as detailed in the NDA's recent report Towards Best Practice in the Provision of Further Education, Employment and Training Services for People with Disabilities in Ireland [2004].

The NDA has responded to these individual, cultural and systemic barriers organisational by recommending below action in the areas of:

  • Social and human rights model of disability
  • Data
  • Disability awareness training
  • Disability / equality proofing
  • Information
  • Recruitment
  • Involvement of people with disabilities in undergraduate education and training
  • Support Services
  • Model of teaching
  • Review of medical specialisms

Suggestions for improvement

The NDA recommends the following actions:

Social and human rights model of disability

  • Revision of the current curriculum to include training on:
  • the social and human rights models of disability
  • the holistic model of health including socio-economic determinants of health, health promotion and public health
  • working with service users to promote their active participation in decision-making regarding their individual care and the strategic development of services
  • working with advocates
  • the World Health Organisation's International Classification of Functioning.

Data

Collection of data on the numbers of people with disabilities applying for, entering and completing undergraduate medical training and education.

Disability awareness training

Provision of disability awareness training for:

  • medical students throughout their undergraduate training and education
  • academic staff
  • practitioners supervising medical students on placement.

Disability / equality proofing

Development of a system of disability / equality proofing undergraduate medical education and training, including recruitment and retention of people with disabilities and people covered by the other grounds under equality legislation.

Information

Provision of accessible information about:

  • undergraduate education training to encourage people with disabilities to apply
  • course content to facilitate the retention of people with disabilities in undergraduate medical education and training.

Recruitment

Pro-active recruitment campaign to encourage people with disabilities to consider a career in medicine.

Involvement of people with disabilities in undergraduate education and training

Involvement of people with disabilities, including medical practitioners who have disabilities, in:

  • Curriculum development
  • Direct teaching
  • Quality assurance mechanisms such as the development of codes of practice and guidelines for best practice in education, training and provision of services to people with disabilities.

Support Services

Provision of services is required to support people with disabilities to complete and maximise their performance during undergraduate education and training. These services need to be developed in a systematic and equitable manner. Such services include the provision of adaptive technology, course materials in accessible formats, readers, signers, personal assistants, counselling. Supporting students with disabilities also includes the negotiation of flexible training arrangements and the use of accessible training spaces. Medical training is both lengthy and costly. It is essential that students with disabilities do not incur additional costs due to disabling educational and social barriers.

Model of teaching

Direct contact between undergraduates and service users from an early stage in training, in order to promote the development of holistic, person-centred practice. The Working Group should consider applied teaching approaches such as that pioneered by the McMaster University, Canada.

Review of medical specialisms

Review of the current range of medical training, including specialisms, to identify access issues for students with disabilities in order to make recommendations as to how these access issues can be positively addressed.

Any other comments

The NDA welcomes this opportunity to contribute to the Working Group on Undergraduate Medical Education and Training. We are available to provide any further assistance to the Working Group in order to promote:

  • the recruitment and retention of people with disabilities in medical training
  • the improvement of service delivery to people with disabilities.