LAUSR

We read the article, ‘Delivering a learning disability OSCE station – challenges and solutions’with great interest and agree that it is an important topic to cover [1]. During our medical school training, our cohort has received inconsistent exposure to working with people with learning disabilities (LDs). We therefore wanted to reflect on the points made in the article and suggest ways to further increase exposure during our training. In their research, the authors intended the OSCE station to be a source of education for students. Although OSCEs could be a useful learning tool, in our experience, a medical student’s primary focus during these examinations is passing each station. We wanted to highlight the value of learning how to communicate effectively with LD patients in a more relaxed environment. Our experience of working with these patients has been predominantly in a community setting. We have spent time with a variety of patients. In doing so we gained an insight into how their conditions influenced their family life, schooling and healthcare. The severity of their conditions meant that practising communication skills proved difficult and sometimes required a collaborative history from the patients’ caregivers. This experience encouraged us to identify novel ways of communicating. It helped us understand the need to learn how to advocate for patients with LDs to avoid perpetuating health inequalities, especially for those with communication difficulties [2,p.81]. From our experience in the community, we found that patients with LDs are a heterogenous group with great variability. It could consequently be argued that their use during exams would be unfair to students. Indeed, Ciaran et al refer to variability in delivery of the station across OSCE sites. To reduce this, we wondered about including patients with LDs in at least one mandatory long case. The inherent variable nature of long cases would allow the patients to be themselves rather than act. This would reduce the amount of preparation required of them and make it easier for more patients with learning disabilities to take part. General practice placements could provide opportunities for exposure to patients with LDs. Our GP block involves several teaching days where sessions with simulated patients cover various clinical scenarios, such as dealing with aggressive patients or breaking bad news. Here, we can practise communication skills and receive invaluable feedback from peers, observing clinicians and the ‘patients’ themselves. We feel that sessions covering communicating with LD patients using genuine people with LDs would be of great benefit. It would be easy to implement as it is already an established method of teaching communication skills. Perhaps the most noteworthy finding from the study was the positive experiences of the LDpatients and actors. They reported feeling important and understood. It is significant that the authors were able to provide a platform for this neglected patient group so that their voices could be heard. Importantly, the authors have identified a dual benefit to both student and patient. Medical educators should therefore actively encourage the use of people with LDs, and other neglected patient groups, in all suitable teaching and assessment settings.