A Clinical/Practicum Accessibility Guide: Tips for Faculty

Introduction

This guide is intended to support faculty members and supervisors with improving accessibility practical learning settings. It provides general information about how faculty can support students with disabilities in meeting the essential practical requirements of their program. The context of this guide assumes that most Canadian post-secondary institutions have similar service provision infrastructures in place, such as an accessibility office.

Definitions

Field Placements

Field placements, also known as practicums and/or clinicals are a mandatory, academic experiential learning component of a degree program. The placement is approved by the governing faculty (i.e. School of Nursing, Faculty of Social Work). The student is usually required to work under a licensed professional and can receive either a passing or failing grade.

Disability

AccessTracks uses the terms medical condition, injury and disability to describe a diagnosable condition that impacts permanently or temporarily impacts a person’s functioning. The World Health Organization uses the overarching term “disability” to describe most of these conditions. Here are just some examples of medical conditions that are considered a disability in Canada. See Appendix 1 for a list of conditions the Canadian Government defines as a disability.

Accommodations

Accommodations are tools, interventions, assistive technology, and equipment that reduce barriers/functional impacts for people with disabilities so that they can meet the expectation of the job. In some cases, a student may not identify as having a disability, but they may have an on-going medical condition that would make them eligible for accommodations.

Functional Impacts

A functional impact describes how a person’s medical condition or disability affects the way they work and learn. For example, a person may have difficulty interacting socially or experience on-going migraines (See Table 1). A person’s medical diagnosis is considered confidential; therefore, employers should accommodate based on how a person’s functioning is impacted, rather than on their diagnosis.

Table 1 – Example Functional Impacts and Accommodations

Functional Impacts	Adaptations
Sitting	Stretch breaks
Standing	Stool/chair for rest
Stair Climbing	Accessible Workspace
Communication	Assistant / Interpreter
Fatigue	Stretch breaks/extra time
Attention / Concenration	Distraction reduced environment
Social interactions	Redistribution of workload / accessible space
Information Processing	Extra time, repeat instructions
Memory	Project management software
Time Management	Time management software

 

Accessibility Office

Most institutions have an accessibility office that students can register with to request academic accommodations. Accessibility professionals within this office can often support faculty supervisors in determining reasonable accommodations for field practicums.

Accommodation Letter

If a student is registered with their accessibility services office, their accessibility professional may send a letter to a faculty member outlining approved field placement accommodations.

Essential Requirements

Essential requirements are learning milestones that a student must meet to receive a passing grade in their courses. These requirements can also be described as learning outcomes in the course syllabus. Field placements allow students to demonstrate that they have learned a specific set of practical skills that help qualify them for future employment.

 

Accommodations

Starting Out the Semester

Here are some tips to prepare for students who need may require clinical/practicum accommodations.

• At the beginning of the semester, remind students who may need accommodations for a practical or clinical placement to meet with an professional in your accessibility office to discuss their needs, even if the student is not sure what they need yet.
• Accommodations can take time to implement, so the earlier the student can notify the accessibility office that there is a practical component to their program, the better. It is recommended that faculty supervisors still try to accommodate students who have disclosed a disability or ongoing health condition even the student does not want to access services through the accessibility office.
• Including information about accessibility in your syllabus is a good way to start the conversation about accommodations early.

Receiving an Accommodation Letter

If you receive an accommodation letter for a student:

• Set aside some time to speak with the student privately about how to best support them in the field/practical setting (unless otherwise specified in their accommodation letter).
• If you are still unsure of how to implement the recommended accommodations, try contacting your accessibility office for assistance. Accommodations are usually based on medical documentation provided by a certified healthcare professional.

Maintaining Confidentiality

Medical information is considered personal and confidential.

• If a student has not disclosed to you, avoid asking if they have a health condition or disability. The most effective way to approach this situation is to build trust, offer support and allow the student to disclose information as they are comfortable.
• If a student discloses and/or you receive an accommodation letter for a student, refrain from disclosing this information to other students or faculty members in your department. Set a side to speak to the student about their accommodations privately and contact your accessibility office if you require support.

Disclosure

If you think a student may be struggling in their clinical/practicum placement due to a disability or health condition:

• Set aside some time to speak privately with the student to discuss their academic progress in their field placement.
• Avoid attributing the student’s struggles to a disability or medical condition. Instead, ask if they are accessing any student services to help support them with their learning this semester.
• Refer the student to your institution’s general student services desk to triage services (if any) that best support them.

Disruptive Behaviour

Issues with behaviour can be a functional impact related to a disability, therefore, efforts must be made to accommodate the student.

• If a student exhibits disruptive behavior, set aside some time to speak privately with the student about your concerns to see if the issue can be resolved.
• If the disruptive behaviour continues and the student is registered your accessibility office, encourage the student to connect with their accessibility professional to review accommodations. If the student is eligible, there are a number of accommodations that may minimize problems with behaviour.
• If the behaviour becomes a safety concern, you may need to connect with your faculty leadership to discuss your institution’s safety protocols.

 

Essential Requirements

Assessing essential requirements

If you believe an accommodation may compromise an academic requirement of your degree program,
here are some options to consider:

• Contact your institution’s accessibility office for assistance with determining whether the student would be otherwise qualified to participate in a field placement if reasonably accommodated.
• Consult your chair, dean, other post-secondary institutions and/or other related resources for possible accommodation solutions.
• Review your clinical/practicum standards and requirements to ensure that they are in line with minimum learning/performance qualifications.
• Make sure students have been clearly informed of all behavioral and clinical performance standards.
• Work with your field/practicum host to come up with possible accommodation solutions Oakley, B., Wideman, M., & Parsons, J., 2012).

Impacts vs. Learning Outcomes

There is a difference between functional impacts related to a disability and a non-ability to meet learning outcomes (See Table 2). For example, a nursing student with a hearing impairment may be required to demonstrate an ability to build rapport with patients. In this scenario, building rapport is the learning outcome and hearing is the functional impact. This functional impact could be accommodated using technology such as an FM system and safety concerns could be mitigated by developing protocols that will help keep both the student and the patient safe.

Table 2– Examples Functional Impacts vs. Learning Outcomes

Functional Impacts	Learning Outcome	Concern	Accommodation
Hearing Impairment	Build rapport	Difficulty hearing patient	FM Pen; Safety training
Fatigue	Administer meds on schedule	12-hour shift	Split shifts; different learning environment
Memory	Write case notes	Incomplete, inaccurate charting/notes	Notetaking, recording, confidentiality plan

 

According to Pardo & Tomlison (1999), “The duty to accommodate…includes a willingness to be creative and directed in the search for accommodating students; that more than an negligible effort is require in devising an academic accommodations; and that is the accommodation must be meaningful to the student’s individual needs”. (p. 15).

 

Denying An Accommodation Request

Students with disabilities must be able to perform the essential tasks of his/her profession in a competent manner with reasonable accommodations in order to be eligible for a field placement (Pardo & Tomlinson, pg. 49, 1999)

If you choose to deny an accommodation, here are some ways to prepare for this decision:

 

• Be prepared to illustrate that the requirement is an essential part of the degree program. (pg. 50)
• Explain how accommodating a student with a disability would lower the academic requirements
• If applicable, explain how the accommodation “would create a significant risk of substantial harm to the health or safety of others [direct threat] and no reasonable accommodation is available that would allow the student to perform the essential requirements/and or functions without creating such a risk” (Sorley, 1994, P. 531).
• Be confident that you have thoroughly investigated all possible accommodations and/or removal of environmental barriers and include the student in the program of study in the discussion.

 

Creating A Policy

If your specific faculty does not have an accessibility policy related to your field for accommodating students, here are some tips for developing one:

• Before creating a policy custom to your faculty for accommodating students with disabilities, make sure to consult legal counsel.
• If a student is at risk of termination or discipline in your program, make sure the student is advised as such prior to dismissal or disciplinary action.
• The policy should indicate to what degree the student can rely on the assistance of another (i.e. educational assistant) in making clinical assessments and decisions. For more support see Identifying Essential Requirements: A Guide for University Disability Service Professionals.
• Encourage students who have disclosed that they have a disability to use the resources available through the accessibility office.
• Students who have been terminated from the program or have received disciplinary action have a right to challenge the decision through an appeal process.

 

References

2017 Canadian Survey on Disability (2018, November 28). Retrieved August 6, 2019, from https://www150.statcan.gc.ca/n1/pub/11-627-m/11-627-m2018035-eng.htm

BC Public Service Agency. (2019, June 04). WorkSafeBC Coverage & Claims. Retrieved August 2, 2019, from https://www2.gov.bc.ca/gov/content/careers-myhr/all-employees/safety-health-well- being/workplace/worksafebc/coverage-claims

Oakley, B., Wideman, M., & Parsons, J. (2012, June 13). Identifying Essential Requirements: A guide for university disability service professionals. Retrieved from https://www.academia.edu

Pardo, P., & Tomlinson, D. (1999). Implementing academic accommodation in practicum/field settings. University of Calgary Publications. Retrieved from http://contentdm.ucalgary.ca/digital/collection/ucpub/id/49826/

Sorlie, D. E. (1994). The Americans with disabilities act: Implications and suggestions for compliance for medical schools. Academic Medicine, 69(7), 525–535.