Guidance for Medical Students with dependents
BMA Medical Students Committee
December 2006
1. Introduction
The BMA Medical Students Committee (MSC) has produced this guidance, based on current best practice, with the intention that students may use it as a source of information on support available and so that medical schools can consider the suggestions made in light of any developments in local policy. All comments and questions on the guidance will be gratefully received.
The MSC has conducted a national review of the content and quality of support services provided to students with dependents across the country, and the experience of students with dependents. This guidance is based on responses received from more than half of the UK`s medical schools.
Medical Students with Dependents (MSWD) include those students who become parents during their undergraduate medical education, and those with children or other members of their family who are dependent on them.
The MSC has also consulted with a large group of students who have dependents. This guidance has been developed with the aim of identifying good practice and making further recommendations.
The MSC believes that pregnancy or caring for dependents should not be a barrier to pursuing a career in medicine. Students without dependents should not be disadvantaged by support mechanisms put in place for those with dependents.
2. Legal Responsibilities of the Medical School and the Student
Maternity Rights
In general
By way of background, we summarise the position where pregnant or new mothers are employees. These rights operate to ensure that pregnant or new mothers are provided with paid time off for ante natal care, 26 weeks ordinary maternity leave, protection from dismissal and protection from detriment by reason of their pregnancy, maternity pay and a right to return to work. The entitlement to statutory maternity pay is outlined in the Social Security Contributions and Benefits Act 1996, however, and as such is slightly separate from other maternity related legislation .
Students
Most female medical students will not qualify as an “employee” or as a “worker” – this is because they are not engaged in an employment relationship or in the context of a contract for services. Therefore they cannot benefit from the employment related rights outlined above. Even where a medical student is engaged in clinical placements she might not necessarily qualify for employment related rights because there is no direct legal or financial relationship between the hospital and the student. Hospitals do not select the students, instead the students are allocated places by the medical school. There are no express contracts of employment between the hospitals and students and the hospitals do not fund or administer payment of financial support to the students.
The medical school will therefore have overall responsibility. The Sex Discrimination Act (“SDA”) makes it unlawful for a university or further education establishment to discriminate against a woman in the provision of educational facilities. There are two potentially helpful sections in the SDA: Section14 (vocational trainees) and Section 22 (students). Section 22 of the SDA outlines discrimination against academic students and requires that universities do not discriminate against a woman in a way that it affords her access to any benefits, facilities or services, or by refusing or deliberately omitting to afford her access to them; or by excluding her from the establishment or subjecting her to any other detriment. Under section 22, any less favourable treatment, however well intentioned will amount to direct discrimination. There is also a prohibition of indirect discrimination.
Vocational trainees (not academic students)
Vocational trainees are protected from sexual discrimination by all those who provide, or make facilities for the provision of, facilities for training, whereas students are only as above protected in relation to bodies in charge of their educational establishments. So, for example, vocational trainees are entitled to receive NHS Bursaries provided by the DH, without sex discrimination, whereas no such protection is afforded to students since the DH/DfES is not as such in charge of their establishments.
Under the SDA claimants only have 3 months (from the date of the event relied upon) to bring an action for discrimination and therefore students should approach their local representatives quickly.
Both students and vocational trainees
However, the medical school will be required under Health and Safety legislation to ensure the safety of the student and the child. If action taken by the medical school is potentially discriminatory then it may be possible (depending upon the particular circumstances) that the medical school may be able to defend itself on the grounds that the action was necessary to comply with the legislation and to protect the student and/or child.
Medical students generally however remain outside of the usual protective codes and there is no real comparable set of legal rights open to students in the same way as is open to employees or workers.
3. Formal and Informal Processes for Students with Dependents
Our review of medical school policy and the provision of support for MSWD found that no medical schools appeared to have a written policy on this topic. In order to maximise their ability to be flexible, most medical schools have adopted a case-by-case approach to the issue of supporting MSWD and those who become pregnant during their studies.
The BMA recognises and welcomes a flexible approach from the medical schools with a view to being able to address the student’s individual circumstances. However, a written statement or policy can be useful and informative, especially in light of the changing demographics of medical school where more and more students are planning families during their time at university.
The following guidelines should be considered when dealing with MSWD and when compiling a relevant framework:
- It should be recognised that the best outcome is likely to require patience, co-operation and compromise from both parties.
- MSWD have as much potential to make excellent doctors as students without dependents. It should be recognised that the additional support these students may require during their studies is not a sign of weakness or poor commitment; seeking and making use of available support should be seen as common sense.
- Medical schools should always strive to see the positive aspects of having dependents or becoming pregnant.
- In order to build trust, medical schools should ensure that any information exchanged occurs in a confidential and non-judgemental manner.
- MSWD and those who become parents may experience increased financial and emotional pressures. The medical school should always consider the students well-being when attempting to accommodate their needs, and be particularly patient in allowing them time to make important decisions.
- Students should be prepared to keep their schools fully informed of any changes in their personal circumstances that are relevant.
- Students should seek to clarify, and medical schools should be in a position to provide; details of any options offered to students, the implications of taking any particular option and further advice and information on where to access support related to their situation.
- Students should be aware that medical schools have a legal responsibility to ensure that any person graduating from their institution has received a competent medical education.
- Students should recognise that becoming a parent during their undergraduate education may delay graduation by up to twelve months depending on the structure of the course and timing of the birth.
A clear framework for communication between the medical school and the student is important:
3.1.1 Many medical schools have appointed a member of staff who facilitates liaison between students and staff. This support aims to ensure that any problems are dealt with in a clearly defined, transparent and timely manner. This structure of support is useful for MSWD.
3.1.2 All communication should be bound by the usual practise of confidentiality, students should be made aware of who will have access to information that they discuss with the medical school.
3.1.3 The student should always feel confidence in their point of contact at the medical school and that they can be easily reached when a problem arises.
3.2 Flexible support network
There are a number of useful organisations, departments and individuals that can provide support to MSWD. It is important that students are directed to these sources of support as soon as possible. These may include:
- Medical school welfare officers/tutors
- University student union welfare and education services
- University medical staff or medical centre
- The students own General Practioner
- Counselling services
- BMA Regional Services
- BMA Counselling service
Several medical schools have adopted systems or initiatives aimed at supporting MSWD during the course of their studies. This section highlights some of those that the MSC deems as good practice.
4.1 Timetables and Assessed Deadlines
Both students and medical schools report that adopting short-term flexibility with regard to attendance and assessed work deadline is helpful. It is important that the student fulfils their course requirements and have adequate knowledge, a flexible approach enables students to handle challenges as they arise.
4.1.1 A number of schools have found it pragmatic to agree or outline a set of ground rules with the student at the outset of the situation. Covering for example, how long deadlines can be extended for written work, or in the case of absences, who should be informed.
4.1.2 Consideration of the examination timetable at the earliest opportunity has been found to be helpful to those students who are pregnant.
4.1.3 Some schools have found it possible to arrange for MSWD to sit examinations outside of the published timetable in circumstances of mitigation such as illness of dependent, or giving birth.
4.1.4 Advising students in advance of the timetabling of taught classes has benefit as it enables childcare/care for other dependents to be arranged in advance.
4.2 Classroom Support and Study
Several schools have adopted schemes to help MSWD with classroom-based activities:
4.2.1 A “student buddy” who provides additional support (e.g. taking lecture notes, collecting handout material) to the MSWD if they are unable to attend lectures or group work. If a MSWD has a student buddy it is useful for this student to be identified to the medical school.
4.2.2 Lecture notes and course information provided in advance of teaching sessions has been found to be useful to MSWD.
4.2.3 Early release of module information and mandatory reading lists was reported by students to be helpful in assisting with time management and planning.
4.3 Support Networks
Both students and medical schools have recommended that necessary support networks are utilised quickly for the benefit of both parties. Highlighting that it is important that support remains sustained, responsive and adaptable, with both sides using dialogue to amend, extend or improve the services in response to altering demands.
4.4 Peripheral Placements
Attachments to peripheral hospitals might involve travelling further distances than usual, increased financial outlay, and time away from home. This applies to all students. It is recognised that MSWD may have particular concerns and difficulties when on peripheral attachments. Outlined below are two key issues that medical students and MSWD have considered:
4.4.1 Placement Location
The BMA/CHMS Medical School Charter states that details of placements should be provided to the student at least one month prior to their commencement.
- Where possible and appropriate MSWD should be given consideration to suit their circumstances. It is recognised by both medical schools and students that this is not always possible, and that the medical school must ensure that students without dependents are not disadvantaged in placement allocations.
- MSWD should be informed of how to formally make a request to change a peripheral placement, including how far in advance the request needs to be, and to whom it should be made.
- Informal systems allow some students to swap placements if they find someone willing to swap with them. Where applicable these schemes should be identified to MSWD by medical schools. This has been found to be useful, particularly for male medical students who have recently become fathers.
- Where relevant students should be referred to the Occupational Health services at peripheral placements.
A number of medical schools have suggested that placement content should be approached with the following considerations:
We also stress that medical schools should have regard to the rights of students and vocational trainees under the SDA (Sex Discrimination Act), and should also ensure that they make provision for the safety of pregnant women (and their children (in utero)) so that they comply with Health and Safety legislation.
4.4.3 A review of the content of the placement in co-operation with the University’s Occupational Health Services may be necessary.
- Student co-operation with Occupational Health Services is key in addressing the concerns of MSWD and medical schools with regard to physical or mental stresses/problems that may arise while a student in away from home.
- Schools and students have found it useful to meet with Occupational Health at the same time so that all parties are clear of the demands and requirements of the placement.
5.1 Special Arrangements for Parents
5.1.1 Maternity/Paternity Leave
Medical schools should publish details of maternity/paternity leave allowed to students who become parents so that they can forward plan.
The MSC takes the position that a degree of flexibility should be incorporated into the medical curriculum. It is recognised that medical schools often have rigid curricula that does not always allow for flexible studying.
When recommending extensive periods of leave from university, careful consideration must be given to the effect on a students education. With a view to be as flexible as possible so that there is minimum disruption to their studies.
5.1.2 Provision of Childcare
Childcare is expensive and can be time consuming to arrange. The BMA recommends that medical schools:
- have information available for students about local childcare provision.
- advocate the rights of medical students to access facilities provided by the university and/or the NHS trusts to which students undertake placements.
- investigate the possibility and feasibility of setting up specific childcare for medical students.
Other Legal Rights
The rights set out below apply only to employees (and therefore not to non-employed students) but they have been included in this guidance for clarification and information.
1. Paternity leave
Eligible employee fathers (adoptive parents, same-sex co-parents) are entitled to either one or two weeks’ (their choice) paternity leave. This leave will be paid provided the employee is earning over a certain amount. Minimum pay is the lesser of about £108 per week and 90% of the employee’s average weekly earnings if less than £100.
In addition, the Government plans to increase statutory maternity pay (and the maternity allowance) to 52 weeks by the end of the Parliament (see plans to increase it to 39 weeks at footnote 2 above) and at the same time mothers will be able to transfer up to six months of their entitlement to additional maternity leave (i.e. the second 26 weeks of maternity leave) to fathers, the first three months of which will be paid at the statutory rate.
2. Parental leave
Eligible employee parents are entitled to up to a maximum of 13 weeks parental leave in respect of each child for whom they have responsibility or a maximum of 18 weeks if their child is disabled. This leave is unpaid. It can be taken at any time (on notice) and must (except in the case of disabled children) be taken in blocks of at least one week, and no more than four weeks in any one year can be taken. Usually the right to take leave (whether actually taken or not) expires on the child’s 5th birthday, but in the case of disabled child the leave can be taken until the child’s 18 birthday.
3. Flexible working – carers as well as parents from April 2007
At present, there is only a statutory right for the eligible employee parents of young and disabled children to apply to work flexibly. It places a duty on employers to give serious consideration to such requests from employees. There is a statutory right to apply if one is the biological parent, guardian, adopter or foster carer of a child under the age of six or under the age of eighteen if they are disabled. One also has the right to apply if one is married to, or one is the partner of such a person. One must also have responsibility or expect to have responsibility for the upbringing of the child.
From April 2007 this right is to be extended so that requests for flexible working can be made by those caring for those persons who are either (a) one’s spouse or partner or one’s relatives or (b) other adults living at the same address.