Reasonable adjustments and Day One Competences

Reasonable adjustments and competence standards 

All veterinary students, regardless of whether they have a long-term health condition or a disability, need to demonstrate that they meet the RCVS competence standards. The Equality Act does not require schools (providers) to make reasonable adjustments to competence standards. However, the Act states that schools must consider if a reasonable adjustment could be made to the way the competence standard is implemented or assessed. Vet schools are responsible for arranging individualised reasonable adjustments for vet students.

While offering a different, valid and reliable assessment tool or offering conditions for the assessment such as more time to complete it or a different environment could be deemed possible reasonable adjustments in some academic situations, schools cannot change the competency standard itself.

The RCVS competence standards are not time-restricted, meaning additional time could be offered to a student as a reasonable adjustment, subject to the context of the competence in question. However, the tasks within them are mandatory for all students to successfully complete. In addition, students must currently demonstrate these competences across all relevant UK species and areas of practice, namely companion animal, farm and production animal, and equine.

To clarify, when considering potential reasonable adjustments to the assessment of a competence standard that states a student 'must perform' a skill or competency, for example a simple surgical procedure, the adjustment cannot involve a different method of assessment that can only assess knowledge or understanding of the procedure instead. This would not be a valid assessment and would constitute a change to the competence standard itself. However, reasonable adjustments could be made to the environment, accessibility, or time associated with the assessment of the student’s performance.   

Consequently, some students might have disabilities that have such a profound and significant impact on them that they are unable to meet the RCVS competence standards, even with reasonable adjustments. However, as highlighted later on this page, as assistive technology advances rapidly, and equipment and mechanisms for support become more readily available, the focus for decision-making may become more on how 'reasonable' the adjustment or support required is in terms of resources, rather than simply whether it can be implemented. 

Examples of how reasonable adjustments could be made to the assessment of competence standards may include:

• A student with a hearing impairment using an electronic stethoscope to perform part of a physical exam. The student still meets the outcome of performing a full physical exam, but with supportive equipment that involves a slightly different approach or method.
• A student with severe anxiety could take regular breaks after performing an examination, and could have a quiet space available beforehand and afterwards. The examination task would remain the same, but the reasonable adjustments would help minimise the impact of their anxiety.
• A student with a neurodevelopmental condition could be given additional time in between tasks to consider and process information. The task would remain the same, while the reasonable adjustment would enable the space and time needed to process the information so they could make the required diagnosis and decisions.
• A student with mobility difficulties could be provided with adjustable tables and chairs in the examining room to help them access the animal at the correct level for them. The task would remain the same, but the environment and equipment would be adjusted to ensure the barrier of reaching the animal is removed.

Using lay people to assist students

In addition to the above, reasonable adjustments may also be possible for students through additional support from other individuals.

There may be aspects of performance which do not need to be 'hands on', for example, with support from an aide, a student may be able to perform aspects of a physical examination semi-remotely (for example, from outside a pen or stable) through directing an assistant to use technology such as a Go Pro camera, a pulse probe or a digital stethoscope.

Where other individuals are used as part of the reasonable adjustment and support for a student with a disability, in relation to the assessment of a competence standard, this must be a lay person.

When a lay person is being instructed by the student during the assessment of a competence standard, the same principle applies that such support cannot change the competence standard itself, which means they cannot carry out part of the task to the point that the student is no longer demonstrating their ability.

Acceptable support may include a lay person restraining an animal for the student so that they can perform an examination, or picking up a hoof to give the student better access to perform an examination or carry out a treatment or intervention.

Although it is accepted that within the higher education setting (HEI), the 'lay person' may, in reality, be a member of academic staff with clinical knowledge and skills themselves, in such circumstances it is essential that the HEI can provide evidence that the individual providing support did so in a lay capacity. They must also demonstrate that the individual did not use their clinical knowledge or skills during the process. This ensures the student demonstrated their own capability relating to the competence standard.

In other cases, the method may be part of the competence standard itself that needs to be demonstrated, and therefore this cannot be changed - for example, intravenous cannulation. The student must perform the specific method to demonstrate the competence, but reasonable adjustments could be made to other aspects. For example, an adapted chair if the student needs to sit down while carrying out the procedure.

Annex A contains the RCVS competence standards (Day One Competences) that require a student to perform or demonstrate a hands-on task.

Principles for the basis of reasonable adjustment decisions

In order to provide the appropriate support for students with disabilities so that they can demonstrate their competence, reasonable adjustments should be made through the provision of additional time, resources, facilities and technology. If providing these still won’t enable the student to meet the RCVS Day One Competence/EPA across all species (namely small animal, farm and production animal, and equine) then a lay person could be directed to assist with a task as fully instructed by the student, enabling the student to perform the competence standard independently.

When developing the high-level principles for reasonable adjustments, the RCVS Day One Competences (see Annex A) were considered in their current format, but also in relation to the existing RCVS Entrustable Professional Activities[1] (EPAs). The RCVS is currently reviewing and developing its existing EPAs as a mechanism to better describe how individual competences are applied into holistic performance as required in practice.

The definition of a lay person

For the purposes of this guidance, the definition of a lay person is someone who has no veterinary knowledge or training and would only be permitted to carry out an activity that any non-veterinary person would legally be permitted to do, such as restraining an animal or picking up a hoof. Activities must only be carried out if it is deemed safe for the animal, student, and lay person involved

As noted earlier, in a HEI setting, the 'lay person' may need to be a member of academic staff, who is likely to have veterinary clinical knowledge and skills. Under these circumstances, the HEI must be able to provide documentary evidence that the specific individual providing support as a reasonable adjustment did so in a lay person capacity, and did not use their clinical knowledge or skills whatsoever during the process. This will enable the HEI to evidence that the student demonstrated their own capability relating to the competence standard.

Tasks a lay person can carry out under instruction

The lay person cannot be directed to carry out any part of the competency standard; the student must demonstrate that on their own. The lay person can carry out assistive tasks under direct instruction that would enable the student to then perform the competency standard independently. For example, picking up a hoof so the student can check for heat or the pulse.

In educational settings, including placements, a veterinary team member can act as a lay person. However, it is imperative that they do not use any veterinary knowledge or skills. They can only carry out activities a lay person can legally do, and only under the guidance of the vet student as necessary to complete the competence assessment.

[1]   Developed from the AAVMC/CBVE Entrustable Professional Activities for the Veterinary Graduate Development Programme (VetGDP).

Please note: this general guidance does not purport to be legal advice and is not to be relied upon as legal advice. Students and education providers should take their own advice in the particular circumstances and as required.