Dyslexia and the surgical trainee – How it impacts training and what you can do to help

Jamie A Nicholson, Jennifer Dunn and Maria Boland on behalf of the RCSEd Trainee Committee

Jamie Nicholson is an ST8 Trauma and Orthopaedic trainee at the Royal Infirmary of Edinburgh. He previously undertook two years out of programme serving as a clinical teaching fellow and was responsible for the Undergraduate Trauma & Orthopaedic block for Edinburgh University whilst undertaking a clinical PhD in Clavicle fractures. For the past five years he has organised the Trauma & Orthopaedic teaching day for Scottish Core Surgical Trainees and was recently appointed as a Member of the Faculty of Surgical Trainers of RCSEd.

Jennifer Dunn is an ST5 Trauma and Orthopaedic surgical trainee living with her husband and son in Dundee. She was diagnosed with dyslexia during surgical training and aims to increase awareness of this issue as part of her role as a Royal College of Surgeons of Edinburgh Trainees Committee member. She enjoys writing, paddle boarding and gaming.

Maria Boland is a general surgical ST5 trainee in South East Scotland. Maria has always had a keen interest in teaching since medical school and has recently joined the Committee to support the work they do and also to work towards improving recruitment to surgery and making it a more attractive career to medical students.

The RCSEd Trainee Committee consists of a group of surgical trainees from a diverse range of backgrounds working together to address contemporary matters affecting all surgeons in training. There has been a previous focus on bullying and undermining in surgery, flexible working, promoting surgery to undergraduates and a recent drive towards practical aspects of wellbeing for surgeons (see further reading section for recent webinars and the RCSEd website).

The impact of dyslexia on surgical training is poorly understood and has the potential to negatively affect training and a surgeon’s working life. It is often under diagnosed and associated with intense stigma. We hope this article highlights some essential knowledge in this area to assist and better understand colleagues with the condition.

What is dyslexia?

Dyslexia is a diverse condition which primarily impacts an individual’s ability to process information. It is common, affecting approximately ten percent of the population and just under two percent of doctors [1-3]. It is worth stressing that dyslexia can affect any trainee irrespective of their intellectual ability and may not be predictive of performance in other areas.

Dyslexia is now considered as a neurodiverse condition where differences in neurological function between individuals are considered a natural variation rather than a pathological entity. Indeed, those who have such a condition (including but not limited to autism, ADHD, and dyspraxia) often exhibit advantageous traits such as attention to detail, creativity, integrity, team workers, empathy, spatial awareness and practical skills [4].

How can it impact surgical trainees?

The condition can affect surgical trainees with their personal studies and day to day work environment as summarised in Table 1.

Foundation years doctors with dyslexia have reported challenges with communication, time management and anxiety [5]. Doctors who have a self-reported learning disability have a significantly lower pass rate in postgraduate exams, most notably MRCS Part A [6]. Interestingly this is not observed for the part B element. It is also a phenomenon that is observed in the written exit Fellowship exams, most likely due to the challenges around multiple choice questions which require rapid reading and assimilation of complex text in a stressful environment.

There has been a recognition of the lack of understanding of dyslexia with regards to the general stigma and disabling clinical environments which doctors work within [7]. Further work is needed to understand this complex issue.

Current views on dyslexia from RCSEd members

The RCSEd Trainee Committee recently undertook a survey to gather further information on the impact of dyslexia in surgery and invited all RCSEd members to take part (n=249 responses). There was a breadth of representation from all specialities with just over half of the responses coming from consultants.

From the responders, 28% had been formally diagnosed with dyslexia but only two thirds had disclosed their diagnosis to a colleague. Overall, 41% of those with dyslexia felt it impacted their workload negatively and 53% felt there is inadequate workplace support for doctors with dyslexia. Interestingly approximately one third of surgeons were diagnosed at school, one third as undergraduates and the remainder as a postgraduate.

Using the free text comments from the survey, a thematic analysis was carried out in order to identify core themes of the issues facing surgeons with dyslexia. This is summarised in table 2.

Aiding trainees and colleagues with dyslexia

Being aware of the potential for undiagnosed dyslexia is important in trainees given a substantial portion will be detected in postgraduate environments. Unexpected failure of postgraduate exams, mismatch between written and verbal communication, challenges with spelling and time pressured information digestion are typical although not exclusive suggestions.

Day-to-day advice

• Be aware dyslexia can manifest in many ways.

• A patient, understanding approach to training to allow trainees the extra time and space to process suggestions without embarrassment, for example in theatre or trauma meetings.

• Avoid information overload – short emails or correspondence, both in speech and written material, can be helpful.

• Vary teaching or feedback with diagrams, videos or other non-written communication.

• Clear assignment of clinical tasks and avoid overloading trainees.

• Foster and enable creativity.

• Use of dictation for clinics and theatre documentation for time efficiency.

• Employ use of mind mapping memory aids for teaching.

• Extra time when appropriate for clinical work or assessments.

• Offer honest support and assistance to adapt aspects of the workplace for the individual where possible.

Formal help

• Self or TPD referral to local Performance- Support-Unit.

• Education psychologist assessment for formal diagnosis (the PSU can often offer financial support with this).

• Access to work (Department of Work and Pensions) assessment can offer input on technological aids such as speech-totext software, organisational devices for clinical work and study.

Resources available to help

• Self-assessment dyslexia tool For more information about dyslexia, the International Dyslexia Association website and their self-assessment tool can be found here: https://dyslexiaida.org/dyslexia-test

• RCSEd wellbeing resources and recent webinars www.rcsed.ac.uk/professional-support-development-resources/learning-resources/webinars/wellbeing-week

• Orthopodcast on dyslexia from the BOA www.boa.ac.uk/resources/orthopodcasts/ orthopodcast-15-struggling-to-pass-mcqs.html

• British Orthopaedic Trainees Association (BOTA) resource www.bota.org.uk/neurodiversity

References

1. Dyslexia Scotland. Scottish Gov Cross Party Group on Dyslexia. January 2009. Available at: www.dyslexiascotland.org.uk/sites/ default/files/page_content/09-01-27-CPG-minutes.pdf

2. GOV.UK [2017] ‘Statistics about dyslexia. Available at: www.gov.uk/government/ publications/understanding-disabilities-and-impairments-user-profiles/simone-dyslexic-user

3. Kinsella M, Waduud MA and Biddlestone J. Dyslexic doctors, an observation on current United Kingdom practice. MedEdPublish 2017,6:60.

4. Shaw SCK, Anderson JL. Doctors with dyslexia: a world of stigma, stonewalling and silence, still? MedEdPublish 2017;6(1):29.

5. Newlands F, Shrewsbury D, Robson J. Foundation doctors and dyslexia: a qualitative study of their experiences and coping strategies. Postgrad Med J. 2015;91(1073):121-6.

6. Ellis R, Cleland J, Scrimgeour D, A J Lee AJ, Brennan PA. The impact of disability on performance in a high-stakes postgraduate surgical examination: a retrospective cohort study. J R Soc Med. 2022;115(2):58-68.

7. Locke R, Scallan S, Mann R, Alexander G. Clinicians with dyslexia: a systematic review of effects and strategies. Clin Teach. 2015;12(6):394-8.