1. Reasonable Accommodation for Students with Special Needs Karen Gabriele Biomedical Laboratory Technology May 29, 2014 Canadian Association of Allied Health Programs

2. Biomedical Laboratory Technology 2 3 year program leading to a diploma Entering class of about 32-35 students Graduating approximately 22-24 students 26 weeks of internship completed in the third year of the program About us

3. Biomedical Laboratory Technology 3 Program is designed locally to address: o competencies from the Québec Ministry of Education o national competencies defined by the Canadian Society for Medical Laboratory Science (CSMLS) Accredited by the Canadian Medical Association (CMA) About us

4. Biomedical Laboratory Technology 4 Entry into the Profession in Québec Graduates receive their license from the professional order (OPTMQ*) to practice as medical technologists upon completion of the program Graduates can also become nationally certified by passing the CSMLS examination * l’Ordre professionnel des technologistes médicaux du Québec About us

5. Dawson as a Centre of Expertise The Research Centre for the Educational and Professional Inclusion of Students with Disabilities (CRISPESH) Recognized by the Ministry of Education, Recreation and Sports (MELS) in October 2010. Partnership between the Cégep du Vieux Montréal and Dawson College College Technology Transfer Centre in Innovative Social Practices (CCTT- PSN) CRISPESH Mission To promote the educational, social and professional inclusion of people living with disabilities through advancement of knowledge development and promotion of social practices 5 CRISPESH

6. AccessAbility Centre AccessAbility Centre provides support mechanisms for students with diagnosed disabilities (hearing, visual, or motor/coordination impairments, learning disabilities, mental health issues, or chronic medical conditions) Note takers Shadowing the students Specialized equipment and software Alternative formats of textbooks and documents Pre-registration and course selection; reduced course loads Extended time for exams and access to exam services (invigilation in an environment with no distractions) 6 DAWSON

7. AccessAbility Centre Increasing number of special needs students every year at Dawson: 7 DAWSON

8. Legal Responsibilities Quebec General and Vocational Colleges Act No provisions obliging colleges to provide special services to disabled students Quebec Charter of Human Rights and Freedoms Recognizes the rights of the disabled and establishes the legal framework of the responsibility that colleges have in this regard S.10 prohibits discrimination founded on a handicap or the use of any means to palliate a handicap The Commission des droits de la personne et des droits de la jeunesse responded to many requests for clarification at the College level. A report was produced in March 2012: “l’Accommodement des étudiants et étudiantes en situation de handicap dans les établissements d’enseingement collégial”* 8 Quebec * Daniel Ducharme (Ph.D. sociologie) and Me. Karina Montminy (conseillère juridique), Cat. 2.120-12.58

9. Legal Responsibilities Educational institutions cannot refuse to admit any disabled student who meets the established admission conditions cannot refuse to provide educational services are required to show that all possible and reasonable measures have been taken to accommodate such individuals Regarding the conditions of the Accommodation : Standards and objectives are the same as for other students; standards should be as inclusive as possible. Accommodation should not affect the quality of the diploma of studies to preserve the credibility of the certification process. Accommodation measures should support learning and learning assessment a change in the context in which the competencies are evaluated or the way in which they are evaluated without compromising the competencies. The accommodation must be reasonable (i.e., the student can not choose the time for an evaluation according to his/her own convenience) The accommodation should not place an undue hardship on the college 9 Quebec

10. Legal Responsibilities Undue hardship (contrainte excessive) Organization of services accommodation becomes excessive over time, availability of human resources required, flexibility of schedule, availability and adaptability of the facilities, number of students involved, respecting the Règlement sur le régime des études collégiales Financial resources cost of the accommodation vs. the capacity to pay, available grants, external financing Security and rights of other people increase risk for the health and security of other people or the disabled student, state of vulnerability of those exposed to the risk, level of interference, morale and motivation of other students, evaluation criteria 10 Quebec

11. Common request for extra time for theory exams to process information Allowed to take the exams in the AccessAbility Centre Program 11 Emerging populations: students with an anxiety disorder are requesting additional time for practical laboratory exams as well as theory Anxiety disorders have been found to occur more commonly in the ADHD population. The actual medical diagnosis is not communicated to us. Accommodation requests

12. Laboratory Examinations Practical laboratory component of most didactic concentration courses Requirement that the laboratory component and theory component must be passed separately to pass the course Evaluation of students in the laboratory component o weekly laboratory exercises (formative) o midterm laboratory exam (some courses) o comprehensive practical examination at the end of the term Laboratory exams are designed to evaluate the students’ attainment of the competencies. o perform a series of analyses that are set up at a work station o to rotate through a number of stations at which certain demonstrations are set up or single tasks are performed 12 Program

13. Laboratory Examinations 13 Program Transfusion perform all of the required tests to find a compatible donor unit Microbiology inoculate, perform gram stains and other biochemical tests to identify pathogens in a specimen interpret a set of prepared tests to identify a pathogen Histotechniques embed tissue specimens, cut the embedded blocks into thin sections, stain the sections according to a given staining procedure and evaluate quality of sections and stains under the microscope Biochemistry perform some manual tests and operate automated analyzers including the quality control) on patient specimens Hematology identify cells and cell morphology through microscopic examination perform manual and automated tests DisciplineLaboratory Exam Activities (Performance Requirements)

14. Laboratory Examinations Questions may be asked that involve the application of theory understand the underlying principles of laboratory tests evaluate and interpret results troubleshoot technical errors validate results according to quality control measures make calculations as part of a lab protocol make decisions as to any follow up Laboratory exams are timed if the exam is comprised of different stations, each station is timed and students would rotate from station to station. Laboratory exams are designed so that complexity and content increase from first year to third year. 14 Program

15. Preparation for internship and workplace The goal of the didactic component of the program is to ensure that students are prepared for the internship in the third year at a level which is expected by the clinical sites at a level which would lead to successful completion of the program. Terminal competencies from the CSMLS: 7.02Demonstrates the ability to adapt to rapidly changing situations, e.g., responds appropriately to critical situations, retains composure in stressful situation, applies existing skills to new situations 9.02 Demonstrates acceptance of the need for change and anticipates, contributes to, responds to and effectively works in a changing environment (e.g., external forces, instrumentation, workplace organization, etc.) 15 Program

16. Lab Exam Accommodation Our initial feeling about extending the time for laboratory exams was negative: Students are being prepared for a clinical lab with challenging working conditions: o High volume of workload o Stress, noise, distractions, constantly changing demands o Multi-tasking o Critical thinking, judgment o Time-sensitive workflow (includes STAT requests that are of critical importance) o Teamwork – everyone depends on all members of the team to complete their portion of the tasks quickly, efficiently and accurately o Reality of evening, night and weekend shifts - work alone 16 Program

17. Steps taken by the Program Consultation to ascertain the nature and extent of an appropriate accommodation in the context of the MLT profession Consulted with other Biomedical Laboratory Technology Programs in Quebec Consulted with our Advisory Committee and clinical sites Consulted with the OPTMQ (professional order) Attended a presentation by the Quebec Human Rights Commission 17 Program

18. Resources and Pedagogy Scheduling difficulties in extending the timing of a laboratory exam for one or two students Redesigning laboratory exams to accommodate extra time o Reconfigure the logistics and organizational aspects of the lab exam o May compromise the competencies that are being evaluating o Limits the number of competencies that can be examined o Access to the equipment is a limiting factor o May require extra time on the part of the technician to prepare the specimens and materials o Requires extra time to invigilate (can not be run at the same time as the other students); financial implications, availability of faculty and staff after hours 18 Program

19. Final Accommodation Decision: Compromise Gradual decrease of the additional time in the laboratory exams so that by the third year the student is able to work at the same pace as the other students and is ready for the internship First year:Time + ¼ Second year:Time + ⅛ Third year:No additional time 19 Program

20. Additional Steps… Provide information on the website to prospective students Non-academic standards that students are expected to meet o Physical (motor dexterity, color differentiation, endurance) o Intellectual and behavioral (manage time, prioritize work, work under pressure, exercise judgment and make decisions, adaptability to change) o Interpersonal (work with different people in different situations, work in a team, communication skills) o Professionalism (professional conduct and dress, ethical, honesty, manage stress) 20 Program

21. Additional Steps… Provide information on the website to prospective students Expectations of employers regarding o Ability to work in different sectors and willingness to work different shifts o Open minded o Good interpersonal skills, work in teams and autonomously o Show initiative o Attention to detail, careful, vigilant o Good critical thinking skills and judgment o Manage time, prioritize work, work quickly and accurately in stressful situations, manage a typical workload 21 Program

22. Success Rate? 1 student is a practicing MLT (CSMLS certified) and clinical instructor (with extra time for theory examinations) 1 student was given additional time for both theory and laboratory examinations in the first and second years but did not return to complete the program 2 students are currently in their first year 22 Success of the measures? Inconclusive Program

23. Future Challenges… Autistic student has been accepted for Fall 2014 (high performing, dispractic) Hearing impairment Wheelchair access 23 Program

24. The Challenge Delicate problem to balance the rights of individuals with professional requirements Rights must be examined in the context in which the accommodation is requested (i.e., the profession) College’s mandate is to provide an education Diploma also certifies that graduates meet the entry level requirements for the profession As health care educators, how do we balance our role to educate with our professional responsibility to safeguard the public and the rights of patients to timely and quality health care? 24 Overview

25. Questions? 25