Examples of reasonable adjustments for vet students

EPA 1

Gather a history, perform an examination, and create a prioritised differential diagnosis list. 

Description

Perform a history and examination on an individual animal or herd/flock and assimilate the information collected to derive a prioritised differential diagnosis.

Elements (tasks) from Competency-based Veterinary Education (CBVE) EPAs

• Obtain a complete and accurate history in an organised fashion.
• Demonstrate client-centred interview skills (establish rapport, attentive to verbal and nonverbal cues, client culture, socioeconomic factors, demonstrate active listening skills).
• Identify the client complaint.
• Identify pertinent history elements associated with common conditions.
• Demonstrate cultural competence in interactions with clients, recognising the potential for bias.
• Perform exam (individual animal or herd).
• Communicate findings.
• Attend to patient welfare and client safety and comfort.
• Create a problem list.
• Justify prioritised differential diagnosis(es).
• Document findings in the medical record.

Examples of how reasonable adjustments could help someone with the physical disabilities or impairments perform the task.

Please note: the student must be able to perform the exam themselves and interpret what they can see and feel.

Perform exam (individual animal or herd)

• A lay person or member of the vet team (who is only permitted to perform the task a lay person can legally carry out) can be instructed to restrain the animal so it can be safely checked. If reaching the animal is still an issue - for example, to check heat or pulse in horse’s hoof - a lay person can be directed to assist with this. However, the student would need to be able to feel if there was heat or a pulse under the hoof. If a lay person took the pulse or felt for heat and communicated the findings to the student, the student would not be performing the competence standard.
• A student could use technology such as a standing wheelchair to reach the animal and be able to feel the pulse/heat, if safe to do so.
• A lay person could reposition an animal to make it more accessible for the student.

Attend to patient welfare and client safety and comfort

• A lay person can be directed to move, reposition or restrain an animal (for example: placing animal back into a kennel).
• The student can use specialised equipment to be able to reach and attend to the animal, if safe to do so.
• The student must be able to identify potential issues with patient welfare, safety and comfort. The lay person cannot be relied upon to identify or describe potential issues.

Potential reasonable adjustments for someone with a non-physical disability or impairment

Perform a history and examination on an individual animal or herd/flock and assimilate the information collected to derive a prioritised differential diagnosis

• Additional time, the use of a scribe/note taker or other assistive technologies.
• Additional time, ability to take a break before and after the interview. Scribe/assistive technology for any note taking.
• Assistive technology for any reading or note taking necessary.
• Enabling the student to take breaks before and after each activity.
• Enable additional time to consider and process information.

Communicate findings

• If there are verbal communication difficulties, a vet team member would be able to relay instructions, advice or diagnosis to clients, as fully instructed by the student.

Create a problem list; justify prioritised differential diagnosis(es)

• Text-to-speech (TTS) technology could be used for communication if verbal communication was an issue.

EPA 2

Develop a diagnostic plan and interpret results.

Description

Integrate individual animal or herd data to create a prioritised differential diagnostic list and determine a diagnostic plan, obtain consent for diagnostic testing and interpret results.

Elements (tasks) from Competency-based Veterinary Education (CBVE) EPAs

• Use clinical reasoning skills to create a prioritised differential diagnosis list.

• Select initial diagnostic tests/procedures.

• Explain working diagnosis and rationale for further testing.

• Develop a financial estimate and obtain and document informed consent.

• Interpret test results.

• Update working diagnosis, diagnostic plan and client consent as new information is obtained.

• Document diagnostic plan in medical record.

Examples of how reasonable adjustments could help someone with the physical disabilities or impairments perform the task.

General

The student could use technology to communicate the results to them, for example, the use of audio technology to speak test results. The student must be able to interpret the results.

Potential reasonable adjustments for someone with a non-physical disability or impairment

General

• Assistive technology for any reading or note taking necessary.

• Enabling the student to take breaks before and after each activity.

• Enable additional time to consider and process information.

• Text-to-speech (TTS) technology for communication issues.

EPA 3

Utilise working diagnosis and client considerations to formulate a management and treatment plan for an individual animal or herd, including referral or euthanasia when warranted. Implement the plan and adjust based on response.

Description

Utilise working diagnosis and client considerations to formulate a management and treatment plan for an individual animal or herd, including referral or euthanasia when warranted. Implement the plan and adjust based on response.

Elements (tasks) from Competency-based Veterinary Education (CBVE) EPAs

• Use clinical reasoning skills to integrate medical, ethical, legal and economic factors, along with client preferences, to create a management and treatment plan.  

• Act in the face of ambiguity resulting from gaps in available information.

• Explain treatment options to the client and respond to questions.

Examples of how reasonable adjustments could help someone with the physical disabilities or impairments perform the task.

Perform therapeutic interventions, including euthanasia, when warranted

• The student could instruct the lay person to restrain the animal.

• The student could use assisted technology such as a standing wheelchair and a height adjusting table to reach the animal.

• The student would need to be able to carry out all the therapeutic interventions, including euthanasia.

Potential reasonable adjustments for someone with a non-physical disability or impairment

General 

• Assistive technology for any reading or note taking necessary.

• Enabling the student to take breaks before and after each activity.

• Enabling additional time for the student to consider and process information.

• If there are communication issues, the student could fully instruct a vet team member to explain the treatment options to the client. Written communication could be possible. Additional time to answer questions.

• Text-to-speech technology could be used for communication and to answer questions if verbal communication was an issue.

Use clinical reasoning skills to integrate medical, ethical, legal and economic factors along with client preferences to create a management and treatment plan  

• Assistive technology for any reading or note taking necessary.

• Enabling the student to take breaks before and after each activity.

• Providing additional time to consider and process information.

Act in the face of ambiguity resulting from gaps in available information; explain treatment options to the client and respond to questions

• If there are communication issues, the student could fully instruct a vet team member to explain the treatment options to the client. Written communication could be possible.

• Additional time to answer questions.

• Text-to-speech technology could be used for communication and to answer questions if verbal communication was an issue.

Educate the client or team to provide ongoing care for the patient and recognise changes or concerns that trigger additional action; integrate new information as it is available to update management and treatment plan; recognise limitations of personal veterinary skills, team or facilities and arrange for referral based upon client circumstances; follow-up with clients or team to determine change in patient status, compliance with recommendations, and ability to implement the treatment plan

• Assistive technology for any reading or note taking necessary.
• Enabling them to take breaks before and after each activity.
• Enable additional time to consider and process information.
• Communication technology and text-to-speech programmes.

EPA 4

Recognise a patient requiring urgent or emergent care and initiate evaluation and management. 

Description

Recognise a patient/situation that requires urgent or emergent care and triage based on severity. Initial emergency management should include procedures that support vital functions.

Elements (tasks) from Competency-based Veterinary Education (CBVE) EPAs

• Quickly assess a situation to identify patient(s) that might require urgent or emergent treatment.

• In the case of multiple patients, effectively triage patient care according to severity of condition.

• Evaluate patient status to determine and triage urgent problems.

Examples of how reasonable adjustments could help someone with the physical disabilities or impairments perform the task.

As necessary, initiate emergency management to support vital functions such as:

●  Provide oxygen
●  Secure an airway and effective ventilation
●  Establish effective circulation
●  Provide effective pain relief and sedation for safe patient handling
●  Correct life-threatening alterations (e.g. hypoglycemia, hypothermia)
●  Control hemorrhage
●  Stabilise fractures

• The student could instruct a lay person to restrain and position the animal.
• The student could use technology, for example a stand-up wheelchair or height adjusting table, to ensure they are the correct height to reach the animal safely.

Potential reasonable adjustments for someone with a non-physical disability or impairment

General

• Assistive technology for any reading or note taking necessary.
• Enabling the student to take breaks before and after each activity.
• Providing additional time to consider and process information.
• Text-to-speech technology for communication issues.

Update the client on the urgency of the patient’s status and immediate management plans

• As above. 

Identify potential underlying etiologies for the urgent or emergent patient status and determine initial management plan

• Assistive technology for any reading or note taking necessary.

Discuss patient status and initial management plan, including euthanasia when warranted, with the client, and identify client expectations

• Enabling the student to take breaks before and after each activity.
• Providing the student with additional time to consider and process information.

Optimise patient care by engaging with team members, determining when to function as a leader or team member and working within personal limitations

Text-to-speech technology for communication issues.

EPA 5

Formulate relevant questions and retrieve evidence to advance care. 

Description

Identify questions and information resources. Critique the quality of the evidence and assess the applicability to the clinical situation.

Elements (tasks) from Competency-based Veterinary Education (CBVE) EPAs

• Formulate focused pertinent questions based on situation evaluation.

• Appraise sources of information to evaluate the quality of the content.

• Assess applicability and generalisability of published studies to specific clinical situations.

Identify resources and use information technology to assess accurate and reliable online medical information and retrieve animal/herd information.

Examples of how reasonable adjustments could help someone with the physical disabilities or impairments perform the task.

Not applicable. 

Potential reasonable adjustments for someone with a non-physical disability or impairment

Formulate focused and pertinent questions based on situation evaluation

• Assistive technology for any reading or note taking necessary.

Appraise sources of information to evaluate the quality of the content

• Enabling the student to take breaks before and after each activity.

Create a problem list; justify prioritised differential diagnosis(es)

• Text-to-speech (TTS) technology could be used for communication if verbal communication was an issue.

Assess applicability and generalisability of published studies to specific clinical situations

• Provide additional time to consider and process information.

Identify resources and use information technology to assess accurate and reliable online medical information and retrieve animal or herd information

• Text-to-speech technology for communication issues.

Evaluate animal or herd response to interventions and use available evidence to adjust care plan

• As above. 

EPA 6

Perform a common surgical procedure on a stable patient, including pre-operative and post-operative management. 

Description

Perform a surgical procedure, including pre- operative preparation of the patient and the surgeon and post-operative care.

Elements (tasks) from Competency-based Veterinary Education (CBVE) EPAs

• Formulate surgical plan.

• Direct the veterinary team to assist in procedure.

• Prepare self and surgical site to perform procedure.

• Perform surgical procedure.

• Apply principles of tissue handling, haemostasis, asepsis and surgical skills.

Examples of how reasonable adjustments could help someone with the physical disabilities or impairments perform the task.

Prepare self and surgical site to perform procedure

• The student could instruct a lay person to restrain and position the patient.

Perform surgical procedure; apply principles of tissue handling, haemostasis, asepsis and surgical skills

• The student could instruct a lay person to restrain and position the patient.
• The student could have any surgical tables and equipment set to their required height. Can use specialised equipment or technology to assist, for example, a standing wheelchair or robotic technology.
• They could instruct the vet team or lay person to assist them to scrub up where needed, ensuring any assistive technologies they cannot reach are aseptic. The student would issue full instructions on how this should be done.
• If the area where the surgery is to be performed is large, for example, a horse's back, the vet team or lay person can prepare the area for surgery, as directed by the student.
• The vet team or lay person could restrain the animal, such as using a crush or stocks for larger animals, or placing a smaller animal on a surgical table.
• If safe to do so, the student should be able to access the animal to perform minor surgery, such as a lumpectomy or spaying. 
• If the student had access to robotic technology then they can, in principle, use it. However, it could mean anesthetising a large animal unnecessarily in order to use the specialist equipment in a surgical setting. This could pose a welfare issues and it would need to be decided if this would be in the animals’ best interests.
• In cases of disabilities such as blindness, using robotic or haptic technology to assist with surgery would require the integration of multiple advanced technologies. Tools such as 3D audio mapping and AI-based object recognition could also assist; however, it is not known if a combination of these tools would enable the sensitivity or accuracy needed for a student to carry out the task.

Potential reasonable adjustments for someone with a non-physical disability or impairment

Formulate surgical plan; direct the veterinary team to assist in procedure

• Assistive technology for any reading or note taking necessary.
• Allowing the student to take breaks before and after each activity.
• Enabling additional time to consider and process information.
• Text-to-speech technology for communication issues.

Respond to changes in patient status.

• Assistive technology for any reading or note taking necessary.
• Enable additional time to consider and process information.
• Text-to-speech technology for communication issues. 

Formulate analgesic and post-operative care plan

• As above. Use of assistive equipment/technology where necessary.

EPA 7

Perform general anaesthesia and recovery of a stable patient, including monitoring and support.

Description

Induce, maintain and recover a stable anaesthetic patient (ASA 1 or 2), including monitoring vital functions and providing supportive care. Evaluate patient status, and determine a suitable anaesthetic and analgesic protocol.

Elements (tasks) from Competency-based Veterinary Education (CBVE) EPAs

• Evaluate patient based on history, physical examination, results of diagnostic tests and procedure for suitability for anesthesia (ASA status 1 or 2 – a normal, healthy patient or a patient with mild systemic disease that does not result in functional limitations).

• Formulate a general anesthetic and analgesic protocol including premedication, induction, maintenance and recovery. Select drugs and equipment.

• Share plan with team members and answer questions.

• Execute anesthesia and recovery safely. This includes:

●  Select and prepare anesthetic support and monitoring equipment.
●  Prepare patient for anesthesia.
●  Administer premedication to patient.
●  Induce anesthesia and establish airway.
●  Maintain anesthesia.
●  Monitor vital signs including blood pressure and respond to common complications        associated either with anesthesia or the procedure.
●  Recover patient from anesthesia, including assessment of pain and administration
of analgesic drugs if necessary.

Examples of how reasonable adjustments could help someone with the physical disabilities or impairments perform the task.

Execute anesthesia and recovery safely.

• If a student has the ability to reach the animal, a lay person or vet team can be directed to restrain the animal. An adjustable height table and wheelchair may allow the student to perform anesthesia and facilitate recovery.

• If a student is blind, it may be possible for them to perform the hands-on aspects of the task with the aid of haptic technology. Additionally, tools such as 3D audio mapping and AI-based object recognition could assist; however, it is not known if a combination of these tools would enable the sensitivity or accuracy needed for a student to carry out the task without any sight.

Potential reasonable adjustments for someone with a non-physical disability or impairment

General

• Assistive technology for any reading or note taking necessary.
• Enabling the student to take breaks before and after each activity.
• Enable additional time to consider and process information.
• Text-to-speech technology for communication issues.

Collaborate with others to update plan as needed.

• Additional time to collaborate with others.

Follow legal requirements for use of controlled substances

• Assistive technology for any reading or note taking necessary.

Maintain an anaesthetic record including drugs, doses, route and time of administration, vital signs, important anaesthetic and procedure events and complications

• Enabling the student to take breaks before and after each activity.
• Enable additional time to consider and process information.
• Text-to-speech technology for communication issues.

EPA 8

Formulate recommendations for preventive healthcare. 

Description

Create a preventive healthcare plan, considering the animal/herd needs, the client’s capabilities, and the care setting, to optimise health and welfare and prevent spread of disease.

Elements (tasks) from Competency-based Veterinary Education (CBVE) EPAs

• Evaluate individual animal or herd needs, considering age, health status, exposure risk.

• Make recommendations regarding disease screening.

• Educate clients and stakeholders on disease prevention measures.

• Perform preventive healthcare measures.

• Document recommendations and procedures in the record.

Examples of how reasonable adjustments could help someone with the physical disabilities or impairments perform the task.

Perform preventive healthcare measures

• A lay person can be directed to restrain the animal. Technology such as a standing or surgical wheelchair can enable student to reach larger animals to carry out preventative health care measures such as worming or vaccinations. The student would need to be able to administer the injection/worming treatment.

Potential reasonable adjustments for someone with a non-physical disability or impairment

Evaluate individual animal or herd needs, considering age, health status, exposure risk; make recommendations regarding disease screening; educate clients and stakeholders on disease prevention measures.

• Assistive technology for any reading or note taking necessary.

• Enabling the student to take breaks before and after each activity.

• Enable additional time to consider and process information.

• Text-to-speech technology for communication issues.

Document recommendations and procedures in the record

• Assistive technology for any reading or note taking necessary. Use of ergonomic equipment where necessary.

• Enabling the student to take breaks before and after each activity.

Disability or impairment

Student temporarily using crutches. 

Examples of possible reasonable adjustments

• Lay person can hold or restrain an animal. Providing seating for the student when needed and additional rest breaks.

• Postponing assessments or teaching where crutches could be a hinderance or safety risk until they are no longer needed.

• Access to facilities, for example, providing transport to placements or between sites, ramps, access to lifts.

Examples of potential difficulties 

• Missing a barrier assessment or key placement could affect the student's progression.

Disability or impairment

Student with limited mobility (cannot stand for long) or chronic physical condition. 

Examples of possible reasonable adjustments

• Lay person can hold/restrain an animal or assist where appropriate.

• Benches and tables can be adjusted to fit the requirements of the individual during consults, surgeries, practical classes etc. Access to a chair at all times. Access to an adapted car if a wheelchair is required for ambulatory or placements, which could be the student’s own vehicle.

• Diagnostic equipment which can be raised or lowered to fit the requirements of the individual. If student can move for short periods, they could move to a suitable height chair.

• Standing wheelchair to help support the student to stand for longer periods.

• Increased rest breaks.

• Use of ergonomic equipment to mitigate discomfort.

Disability or impairment

Student with no leg mobility (unable to walk or stand, uses a wheelchair exclusively).

Examples of possible reasonable adjustments

• A lay person or team member can hold/restrain an animal or assist where needed to support a student through a reasonable adjustment.

• Benches and tables can be adjusted to fit the height of the person using a wheelchair.

• Diagnostic equipment can be raised or lowered to fit the wheelchair. The provision of ramps and hydraulic doors.

• All-terrain wheelchair, far-reaching wheelchair, standing wheelchair.

• Alternative biosecurity arrangements for wheelchair.

• Voice controlled systems, for example lighting and temperature control in environment.

• Additional time to complete tasks.

Examples of potential difficulties 

• Currently, there are limited reasonable adjustments available for anyone with no use in either their arm or hand, and it may not be possible to make adjustments to some competences. 
• Technology is advancing but may not yet be evolved enough. This may also mean simple surgeries on large animals would need to take place in surgical environments where the technology is housed. This may not be feasible from a welfare point of view. Further research is needed by schools into this area.

Disability or impairment

Student with a severe allergy to a species

Examples of possible reasonable adjustments

• Protective gear such as an anti-allergy suit, face mask and gloves.

• Wash down procedures put in place for changing into normal clothes at the end of a shift.

• Use of models and haptics where the competence standard does not relate to live animals.

• Student may already be familiar with anti-allergy medication.

• Full body covering with filtered air system.

• Air filtered system in buildings.

Disability or impairment

Student who is blind or has low vision. 

Examples of possible reasonable adjustments

• Provision of printed materials, transcripts and reading materials in a format that best suits the student, such as braille, audio recordings, large print, pre-recorded lectures and transcription of visual resources.

• Provision of a Practical Assistant within laboratories or workshops.

• Guide dog.

• Assistive technologies such as tactile diagnostic tools.

• A lay person to assist with animal restraint and positioning.

• Additional time to complete tasks.

Examples of potential difficulties 

• Potential issues using guide dog alongside other animals.
• Would need to consider how the student would be able to assess if an animal was fit to go into the food chain.
• Haptic technologies are evolving, but may not be advanced enough yet.
• The student would need to use technology, which requires the integration of multiple advanced technologies such as haptic technology and robotics. Additionally, while tools like 3D audio mapping and AI-based object recognition could assist, it is not known if a combination of these tools would enable the sensitivity needed for a student to perform hands-on tasks such as minor surgery or anesthetising an animal without any sight. Further research by schools needed. Some competences may not be able to be adjusted for.

Disability or impairment

Student who is deaf or has hearing loss. 

Examples of possible reasonable adjustments

• Hearing aids, use of clear facemasks to facilitate lip-reading, hearing loops in teaching spaces, digital stethoscopes, haptic or sight stethoscope.

• Use of a signer.

• Voice-to-text technology to aid communication from others.

• Teaching notes available in advance of the session.

• Anaesthetic monitoring and other alarms as flashing lights or vibrating buzzers.

• Additional time to complete tasks.

Disability or impairment

Student with communication issues (non-verbal)

Examples of possible reasonable adjustments

• Text-to-speech technology.

• Use of sign language with a signer.

• Written rather than oral assessments.

• Additional time allowed to complete tasks and communicate.

• A lay person or vet team members to help read notes and communicate these to a client.

Disability or impairment

Student with learning difficulty (dyslexia). 

Examples of possible reasonable adjustments

• Text-to-speech and voice recognition assistive technologies. 

• Coloured overlays or tinted glasses. 

• Lay person or vet team members to help read handwritten notes.

• Additional time to complete written or reading tasks.

• Use of a laptop in all settings.

Examples of potential difficulties 

• Reading handwritten notes may cause a problem, especially in the field. While students can take a photo of handwriting and use certain programmes to translate it into speech, it is unclear how well these can decipher veterinary terminology or medication names.

Disability or impairment

Student is neurodivergent, for example, they have autism. 

Examples of possible reasonable adjustments

• Noise-cancelling headphones. 

• Provision of a laptop screen filter.

• Provision of a quiet space. 

• Provision of time management software or apps.

• Text-to-speech aps for anyone who is non-verbal (see also the examples provided above for communication issues).

Disability or impairment

Student with an unseen disability such as Crohn’s disease.

Examples of possible reasonable adjustments

• Allowing time off for medical appointments or treatment without it affecting any attendance requirements.

• Flexible arrangements for placements and EMS, such as shorter or flexible hours.

• Unlimited toilet breaks and easy access to toilet facilities.

• The ability to watch some lectures outside of lecture hall setting.

• Additional time if required for assessments.

Disability or impairment

Student with a mental health issue such as anxiety.

Examples of possible reasonable adjustments

• More frequent breaks. 

• The provision of a quiet space.

• Time off for medical appointments without it affecting any attendance requirements. 

• Flexible hours for placements and EMS. 

• Offering alternative forms of assessment, for example, written tasks instead of verbal presentations, or small group presentations instead of whole class presentations.

• Additional time to complete tasks/assessments.

• Provision of a mental health support worker.