Challenging the exclusion of autistic medical students

Abstract

In December, 2021, the Medical Schools Council urged medical schools to challenge exclusion in their Active Inclusion framework.1Medical Schools CouncilActive inclusion: challenging exclusions in medical education.https://www.medschools.ac.uk/media/2918/active-inclusion-challenging-exclusions-in-medical-education.pdfDate: December, 2021Date accessed: February 7, 2022Google Scholar The council acknowledged a lingering inequity problem regarding disability, and challenged UK medical schools to "strive to make their environments inclusive".1Medical Schools CouncilActive inclusion: challenging exclusions in medical education.https://www.medschools.ac.uk/media/2918/active-inclusion-challenging-exclusions-in-medical-education.pdfDate: December, 2021Date accessed: February 7, 2022Google Scholar As experts in autism and medical practice through experience, training, or both, we welcome this change. It provides a great opportunity to challenge common myths surrounding autism, ensuring that autistic students continue to qualify and thrive, bringing an array of associated strengths to the profession. Challenging the traditional stereotypes of autism, many autistic doctors are practising successfully and are receiving highly positive multisource feedback, including on professionalism and teamwork, which is certainly true of our autistic authors. Having experienced being different, we are more likely to accept others without judgement. A heightened sense of ethics and justice can promote high levels of professionalism,2McCowan S Shaw SCK Doherty M Grosjean B Blank P Kinnear M A full CIRCLE: inclusion of autistic doctors in the Royal College of Psychiatrists' values and equality action plan.Br J Psychiatry. 2022; (published online Feb 14.)https://doi.org/10.1192/bjp.2022.14Google Scholar which contrasts with the deficit-based view of autism in medicine, reflected in the wording of current diagnostic guidelines. These criteria stem from and are reinforced by research fields in health care, which often operate independently from other disciplines. This discourse is dominated by researchers trained under the predominantly deficit-focused praxis of our time; therefore, outcomes often seek to validate deficit-based assumptions. Nevertheless, the non-medical literature on autism provides an additional wealth of knowledge, often adopting a neurodiversity-affirmative approach. For example, considerable debate suggests that autistic people do show empathy, just in unconventional ways.3Fletcher-Watson S Bird G Autism and empathy: what are the real links?.Autism. 2020; 24: 3-6Google Scholar Autistic students might have communication differences, as might non-autistic students. However, having communication difficulties is not synonymous with being autistic. Autistic people can embody strong communication skills. The ability to adapt to treat everyone with respect and dignity—to listen and communicate effectively, regardless of differences—is crucial to good medical practice. As a minority group who tend to place active focus on communication, many autistic people have learned the ability to adapt communication styles for different settings or people from a young age. Additionally, autistic people tend to use more precise language, which is more easily understood across all communities. Being autistic tells us nothing of someone's ability to practice medicine safely and expertly. Mirroring non-autistic people, some autistic practitioners will be highly capable, and others may not. There is no robust evidence to support assumptions that being autistic increases the likelihood of poor consultation skills or professionalism. An autism diagnosis alone provides no reason to bypass equality legislation, nor to question a previously capable student's ability to study or to practice medicine. At postgraduate level, the value of autistic doctors is beginning to draw recognition.2McCowan S Shaw SCK Doherty M Grosjean B Blank P Kinnear M A full CIRCLE: inclusion of autistic doctors in the Royal College of Psychiatrists' values and equality action plan.Br J Psychiatry. 2022; (published online Feb 14.)https://doi.org/10.1192/bjp.2022.14Google Scholar, 4Shaw SCK McCowan S Doherty M Grosjean B Kinnear M The neurodiversity concept viewed through an autistic lens.Lancet Psychiatry. 2021; 8: 654-655Google Scholar, 5McCowan S Shaw SCK Doherty M Grosjean B Blank P Kinnear M Vive la difference! Celebrating and supporting autistic psychiatrists with autistic doctors international.BJPsych Open. 2021; 7: S40Google Scholar Autistic strengths can benefit patient care and autistic doctors can meet high standards. As a matter of social justice, we should nurture such neurodivergence within the medical profession. We call for medical schools to adopt a neurodiversity-affirmative approach, in line with the new Active Inclusion framework, to the recruitment, support, and training of autistic students. SCKS, MD, and SM are autistic doctors and are all leading members of Autistic Doctors International. SM represents Autistic Doctors International in the Royal College of Psychiatrists autism group. SCKS and MD are also part of the steering group for a project concerning health care for autistic adults and autism training for general practitioners at London South Bank University (London, UK), funded by the John and Lorna Wing Foundation. MD is a member of AIMS-2-Trials Autism Representatives Steering Committee. ID is not autistic but was the inaugural autism champion for the Royal College of Psychiatrists, is co-lead for the Cheshire and Wirral Partnership NHS Foundation Trust Adult Autism Service, and is chair of the steering committee (but not an applicant) for the 3Di Assessing Adult Autism research. ID was also involved in the systematic review and network meta-analysis on autism spectrum disorder, funded by the National Institute for Health Research.

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