Fitness to Practice Fitness to practice has been defined as

1
Fitness to Practice Seminar   http//www.tcd.ie/d
isability/projects/fitness/index.php
Tuesday 16th January 2007 Declan Treanor
2
Agenda

• Welcome
• 2.15 The Disability Act and Equality Legislation
  implications for teaching and learning /
  reasonable accommodation
• 2.30 Clarification of what reasonable
  accommodations can be provided and what is
  unreasonable in Lecture / seminar, Lab work,
  Practice Education and Examinations, including
  assessment of practical or clinical skills.
• Discussion format
• Break
• 3.30 Decision-making route admissions,
  reasonable accommodations, practice education.
  What routes should be used? How are decisions
  documented? What steps are needed to produce a
  pro-forma that will enable College to act in such
  a way as to protected from possible
  discrimination and ensure standards? Discussion
  format
• 4.00 The next steps

3
Aims of Seminar

• To discuss Colleges responsibilities under
  relevant legislation (Disability Act 2005 and
  Equality legislation), including reasonable
  accommodations for practice education settings.
• To clarify what constitutes reasonable (and
  unreasonable) accommodations for students with
  disabilities undertaking professional courses. 
• To start the process to produce a pro-forma in
  relation to decision-making around admissions,
  reasonable accommodations and practice education.

4
Context
      University Strategic Plan      
College Admission policy - non-traditional
students Universities Act 1997
Equal Status Act 2000       Employment
Equality Act 1998       Disability Act
2005 HEA National Policies on
access/disability  College Policy on
disability 2000 onwards TCD Student
Disability Services Code of Practice
2004          
5
Disability Act 2005

• The Act brings a corporate whole institutional
  duty to promote disability equality
• Promote equality of opportunity
• Eliminate unlawful discrimination
• Eliminate disability-related harassment
• Promote positive attitudes towards people with
  disabilities
• Encourage participation by people with
  disabilities in public life
• May also involve treating people with
  disabilities more favourably

6
Discrimination

• There are two forms of discrimination that will
  be made unlawful
• failure to make a reasonable adjustment, where
  any arrangements, including physical feature of
  premises, or services place a disabled person at
  a substantial disadvantage in comparison to
  persons who are not disabled
• and
• unjustified less favourable treatment for a
  reason which relates to a disabled persons
  disability.

7
Reasonable Accommodation (RA)

• The most important area for the purposes of
  students with disabilities may be the provisions
  in respect of reasonable accommodation. The Act
  deals with the reasonable accommodation
  provisions, and states
• discrimination includes a refusal or failure
  to do all that is reasonable to accommodate the
  needs of a person with a disability if without
  such special treatment or facilities it would be
  impossible or unduly difficult for the person to
  avail himself or herself of the service

8
College definition of RA

• a reasonable accommodation might be any action
  that helps alleviate a substantial disadvantage.
  Making a reasonable accommodation might involve
  changing procedures, modifying the delivery of
  the course taken, providing additional services
  (e.g. examination arrangements, materials in
  large print), or altering the physical
  environment (College Code of Practice Students
  with disabilities 2004).

9
The situation
Reasonable accommodations established and put in
place.
College cannot discriminate, but must provide
reasonable accommodations
Disabled student applies to College

• If the student meets set competence standards,
  with the provision of reasonable accommodations,
  they pass and are fit to practice.
• If the student does not meet the competence
  standards, with reasonable accommodations, then
  they fail.

10
Requirement of College

• To assess what accommodations a student will
  require to complete the course.
• To assess whether these are reasonable and
  deliverable.
• To provide accommodations.
• The student then undertakes the course, with
  accommodations in place. If the student meets
  the demands, they are fit to practice.

11
Assessing What Is A Reasonable Adjustment
In assessing what is a reasonable adjustment
education providers will have to
consider Whether the adjustment would effect the
maintenance of academic and other standards. The
cost of the adjustment and the financial
resources available. Whether making the
adjustment or additional provision is
practical. The effectiveness of the adjustment or
additional provision. The disruption caused to
others. Whether the student, or others, should
provide the additional provision or
services. The importance of the service to which
access is being sought.
12
Fitness to Practice

• Fitness to practice has been defined as a
  persons ability to practice their profession in
  a way which meets appropriate standards, meaning
  that a person has the skills, knowledge,
  attitudes, character and health to perform
  necessary functions safely and effectively
  (adapted from HPC, 2005).

13
Definition of Fitness to Practice

• Framework for ensuring quality and safety
• Demonstrates fitness to learn, graduate and
  practice
• Knowledge, skills
• Competence
• Capability
• Attitudes, character, conduct
• Health

14
Not fit to practice - indicators

• Deficient performance
• Deficient competence
• Misconduct
• Ill-health, physical or medical
• Criminal conviction/caution

15
What is a competence standard?

• An academic, medical or other standard applied by
  or on behalf of an education provider for the
  purpose of determining whether or not a person
  has a level of competence or ability
• Need to differentiate between the standard and
  the process of attaining the standard
• Standard must be objectively justifiable a
  proportionate means of achieving a legitimate aim

16
What isnt a competence standard?

• Being able to cope with the demands of a course
• Having good health or fitness (if unnecessary)
• Attendance requirements (if unnecessary)
• Completing a course in a certain timeframe
• Speaking clearly
• Handwriting an examination

17
RA and competence standards

• Competence standards cannot be adjusted
• But assessment processes must be
• Anticipatory duty applies

18
Failing students

• If a student does not meet the course
  requirements, assuming that appropriate
  accommodations are in place, then they fail, as
  with any other student.
• The key is to ensure that all appropriate
  reasonable accommodations are in place.

19
Types of accommodations

• Lectures / Seminars
• Lab-work
• Practice Education
• Exams, including assessment of practical work.

20
Accommodations - Lectures

• These are typically as for any course and may not
  be specific to Health Sciences.
• Examples include
• Provision of lecture notes
• Appropriate venues
• Use of AT or human assistance (e.g. ISL
  interpreter, note-taker)

21
Accommodations lab work

• This includes a variety of practical work,
  including clinical skill areas.
• Examples of accommodations may include
• Lab assistant
• Interpreter
• Adaptation of course requirements and assessment
  method

22
Accommodations lab work

• It may be necessary for a student to develop
  their own methods of performing clinical tasks,
  provided that these are safe.
• More time may be needed to learn specific skills.

23
Accommodations - Exams

• Standard written examinations may require
  accommodations as for any College course, e.g.
  extra time.
• Viva and practical examinations may need
  alternative accommodations, such as an
  interpreter or adjustment of practical
  requirements.
• The key is that the student has the opportunity
  to demonstrate knowledge, skill and attitude as
  per the course requirements. A different form of
  assessment may be required.

24
Accommodations Practice Education

• It is the responsibility of College to provide
  reasonable accommodations to students in practice
  education.
• It may not be necessary for a student to do all
  forms of placement, provided that the
  accreditation bodys requirements are filled.
• Practice education should provide the student
  with the opportunity to demonstrate the core
  skills that are essential for competence in the
  area of work. Typically these are set down by
  the accreditation / registration bodies.

25
Accommodations Practice Education

• The types of accommodations will depend on the
  practice setting and on the student, but should
  be agreed in collaboration with the student and
  the practice educators.
• It is reasonable for a student to use a human
  assistant to perform tasks, provided that the
  students knowledge and skill are used, rather
  than that of the assistant.

26
Case Study 1

• Deaf / hard of hearing student
• Lecture accommodations use of an ISL
  interpreter and note-taker, as well as provision
  of notes.
• Lab accommodations use of ISL interpreter.
  Extra time to learn skills may be needed.
• Examination accommodation interpreter for viva
  and practical examinations.
• In practice education, interpreter is used.

27
Case Study 2

• Student with dyslexia
• Lecture accommodations provision of lecture
  notes, as writing / reading speed are slower.
• Lab accommodations were not necessary
• Examination accommodations include use of a
  computer and extra time.
• In practice education, a subject-specific
  word-book is used. Ideally the student would
  like to record notes using a computer.

28
Case Study 3

• Student with physical disability
• Lecture accommodations provision of lecture
  notes and lectures in accessible venues
• Lab accommodations use of lab assistant.
  Student directs assistant.
• Examination accommodations - extra time and use
  of computer
• In practice education assistant where
  necessary, choice of accessible locations / areas
  so that student can demonstrate core skills.

29
Case Study 4

• Blind or vision impaired student
• Lecture accommodations provision of lecture
  notes and alternate formats for information.
• Lab accommodations use of lab assistant. Audio
  description of tasks, longer time to develop
  skills
• Examination accommodations - extra time
  alternate format papers and use of computer
• In practice education reader if required,
  choice of venue / setting

30
Case Study 5

• Student with mental health condition
• Lecture accommodations provision of supports
  for study skills etc. (e.g. through Unilink)
• Lab accommodations none required
• Examination accommodations - alternate venue, if
  required.
• In practice education use of support, such as
  Unilink to manage stress, time management and
  other issues.

31
Deciding what is reasonable

• As well as issues under legislation (previously
  discussed), the accommodation must ensure that
  the student has the opportunity to demonstrate
  knowledge and skill in the area.
• It is not reasonable to use an assistant where
  the assistants skill is required - it is
  reasonable to have an assistant to enable the
  student to access information (e.g. ISL
  interpreter, reader) or if the student can direct
  the assistant safely.

32
Decision-making routes

• UK guidelines suggest that clear, consistent
  decision-making routes (with clear documentation)
  are essential to reduce the likelihood of
  discrimination.
• Decisions through all stages (admission,
  assessment of need, provision of supports, etc)
  need to be consistent and well documented. They
  should be individual-based (I.e. not
  prejudicial), but anticipatory duty is required.

33
Prejudicial views

• UK documentation warns against deciding that
  students with a given disability will be unable
  to perform tasks each applicant must be
  considered in terms of whether accommodations are
  possible, and then whether it is possible for a
  student to reach core competences with these
  accommodations in place.
• (The reality may be that it is not possible to
  accommodate certain disabilities, but the
  decision should not be a blanket ban on certain
  impairments.)

34
Employability

• It is NOT Colleges responsibility to decide
  whether a student will be employable.
• College is responsible for making accommodations
  for students as long as they are undergoing
  training.
• The student either passes or fails (as with any
  student) based on whether they have met the
  competences, with accommodations.
• Once a student graduates, they are fit to
  practice- it them becomes the role of the
  employer to provide reasonable accommodations.

35
The next steps

• College needs to establish
• Clear, consistent decision making route, from
  admissions to graduation.
• Standards / practices relating to reasonable
  accommodations for students undertaking
  professional courses (similar to document that is
  already in existence)
• Professional bodies need to establish
  interpretations of core competences

36
Next Steps Continued

• Decision-making route admissions, reasonable
  accommodations, practice education. What routes
  should be used? How are decisions documented?
  What steps are needed to produce a pro-forma that
  will enable College to act in such a way as to
  protected from possible discrimination and ensure
  standards?

37
How can College move forward?