A specific learning difficulty (SpLD) is defined as an impairment within learning that is unexpected given other learning abilities. Areas that may be impaired include, but are not limited to attention, concentration, reasoning, understanding, memory and coordination [
1,
2]. It is challenging, however, to find an international consensus within assessment guidelines or literature, with the condition defined as a specific learning difficulty, disability or disorder depending on national diagnosis guidelines [
1,
3,
4]. To maintain consistency the term SpLD will be used within this paper. In 2009, 4.1% of medical students disclosed a disability, which included SpLDs [
5]. Dyslexia is the most common SpLD affecting 3–10% of the general population in the UK [
1,
6] and 10–15% in the US [
7]. Currently up to 2% of students entering UK medical schools are diagnosed with dyslexia, twice what it was 10 years ago [
8]. SpLD may be associated with differential attainment within medical education. Affected students often receive a reasonable adjustment (or accommodation) within examinations in the form of modified assessment provision (MAP) in order to ‘level the playing field’ [
3,
9]. In the UK, the General Medical Council states that ‘students with a wide range of disabilities or health conditions can achieve the set standards of knowledge, skills, attitudes and behaviour’ [
10]. There is similar guidance from other international medical professional bodies including Australia, United States and Canada [
11‐
13]. In many countries it is unlawful to discriminate against the education of a student because of their disability. This is in line with the Equality Act 2010 within the UK [
14], Disability Discrimination Act 1992 in Australia [
15] and ADA Amendments Act of 2008 in the USA [
16]. Therefore, a student with a disability can be accepted into medical school, as long as they can be provided with reasonable adjustments to support their performance, which do not compromise the assessment of clinical competence standards [
17]. The most common form of MAP is extra time to allow for slower abilities in reading, comprehension and/or writing [
9], but can also include formats facilitating enlarged size, altered font, or colour combinations [
18]. The General Medical Council published a comprehensive list of types of MAP used within medical schools [
19]; however, a survey of UK medical schools demonstrated variation in their implementation [
20]. This may be related to different types of assessment or indicate some confusion between schools on the types of MAP that may be appropriate for different types of assessment [
20]. The General Medical Council guidelines also state ‘only those students who are fit to practice as doctors should be allowed to complete the curriculum and gain provisional registration’ [
10]. This inconsistency in guidelines between ‘fit for study’ and ‘fit for practice’ may make it challenging for a school to reconcile MAP during education, with a desire to empower students towards the workplace, where fewer reasonable adjustments are typically available.
There is currently little research into the performance of students with SpLD in medical education [
21]. Two UK medical schools have examined students with SpLDs as part of a larger study on assessment using multiple choice question (MCQ) based progress testing. They showed that there was no significant difference between students with SpLD who received a MAP and students without disabilities [
9,
22]. These studies examined a snapshot of medical knowledge assessment performances and were limited to suggesting that SpLD students do not perform significantly differently because of their MAP. Given that all SpLD students within these studies received a MAP they cannot identify if students required the MAP or would have performed equally well without it. Furthermore, no considerations were made within these studies regarding the timing of SpLD diagnosis or MAP. Currently, although MAPs are universally applied across assessments, there is little or no evidence that they provide benefit within medical examinations [
21]. Students receiving a diagnosis of SpLD late in the course of their studies provide an opportunity to assess the benefit of a MAP in SpLD students. The study focuses on the impact of a MAP on progress test performance in which students receive extra time. Other forms of assessment including OSCEs were not included because students do not receive additional time. This is consistent with previous studies which reported no difference in OSCE performance in students with or without dyslexia [
9]. The aims of the current study were to further elucidate:
1.whether students with SpLD benefit from a MAP; and
2.whether the timing of a SpLD diagnosis and subsequent implementation of MAP affects summative performance.