Equity and access in rural medicine - Identifying Neurodivergence in Australian Medical SchoolAdmissions
Suttie, JJ, Suttie E, Cheon S, Suttie C, Suttie I
Introduction
Neurodivergence is an umbrella term to position neurodevelopmental differences as natural variations in human neurology rather than deficits to be fixed. There is significant debate concerning the definition of neurodivergence (Melbourne, 2024). There is a division between the medical-diagnostic model that identifies neurodivergence as a range of conditions defined in part by their psychosocial dysfunction. The social-activist model initiated by Judith Singer in 1997 identifies neurodivergence as a social-activist model to advocate against exclusion by the neurotypical neuromajority (Singer, 1999).
Categorising neurodivergence
ICD-10, ICD-11 and DSM-5 all differ in how they diagnose and specify autism spectrum disorder. Some neurodivergent conditions such as Central Processing Disorder are not recognised by any of the recognised disease classifications.
Results
There are 42 universities in Australia, including 37 publicly funded, three private and two private international universities (n=42). All universities have disability and inclusion departments to support students in their studies. Typical assistance includes tuition, increased examination times or calming
examination conditions. All universities have special access or consideration schemes that accept conditions (e.g. neurodivergence) provided that there is certification by an approved medical practitioner. Nine of the 42 universities have special access or consideration programs that do not rely on a medical
practitioner to diagnose a condition, however all of these have exclusions for applications to medicine(n=9/42, 21%). There were no pathways identified for students requesting harder entry pathways due to neurodivergent advantage (e.g. exceptional memory or creativity).
Discussion
Admissions to medical school are highly competitive. There is a recognised need for admissions to be fair and merit based. Increasingly, however, this has been balanced against several social factors. It remains controversial whether some disabilities might prevent a student from meeting the minimal essential requirements for professional medical practice. In recent years, some medical students and practitioners have been registered while overcoming severe deafness, blindness or paraplegia. However, dyslexia, intellectual impairment or other conditions might also be deemed as limiting essential minimal
requirements for medical practice.Particular issues arise in rural areas where medical schools may not have the same standard of access to services in mental health and subspecialty cognitive expertise. There is also a well recognised ‘mismatch’ phenomenon in which people with additional study needs are
more likely to fail if they are accepted based on lower entry standards without adequate supports.
Conclusion
It remains controversial whether medicine should be more understanding of the diverse complexities of medical and social disadvantage, or whether there are higher standards required for medical practitioners to meet the minimum requirements for professional medical practice.
References
- Melbourne University, Neurodiversity Project, 2024 accessed at https://www.unimelb.edu.au/ neurodiversity.
- Singer, J. (1999). Why can’t you be normal for once in your life? From a problem with no name to the emergence of a new category of difference. Disability Discourse, 59-70.