A mature student* enrolled in Warwick Medical School (WMS) has just lost a formal appeal after being denied the opportunity to resit an exam.

The events that led to this outcome indicate that WMS provides poorly for trans students undergoing a physical transition, and suggest that other students with access needs are likely to face similar problems. The student in question argued that these oversights amount to indirect discrimination: a claim rejected by a committee of senior academics from the wider University.

This message this sends is that discrimination against trans people and others is acceptable at the University of Warwick.

An inappropriate request

The first sign of trouble came in September 2011 (at the start of the WMS course) when the student (who I shall henceforth refer to as “B”) was asked to attend an Occupational Health doctor at the University Hospital of Coventry and Warwickshire.

This is not a standard procedure for all students on the course, and instead related to information B had provided to WMS upon enrolment. She was informed by a secretary in WMS that: “You are not being asked to attend on the grounds of being transgender […] I can only assume that you have ticked one of the health issues boxes and the Occupational Health team are required to assess your fitness to cope with the course.”

B sought an explanation, writing: “I’m concerned that I am actually being asked to attended simply because I am TG. Under the strictest definition, transexualism is still classified as a ‘severe mental illness’ and consequently it was necessary for me to tick the corresponding box (9? – mental health).” B had commented on the form that was was trans, believing this action to be private disclosure.

Upon further enquiry, Occupational Health confirmed B’s suspicion, explaining that she was asked to attend the meeting because she had ticked the “mental health” box. The meeting was compulsory, with B being told that: “Failure to attend will result in us not being able to clear you health wise for the course“.

Conflicting messages

Ahead of the meeting, B attempted to clarify the situation in an email to an Occupational Health Nurse based in the hospital: “Just so that I’m completely clear, am I being asked to attend due to declaring that I have dysphoria of gender identity?”

The nurse’s response was:  “No – it is connected with the health question you replyed yes to on the form.  It has nothing to do with your gender.  We work in accordance with the equality act 2010.”

B describes the eventual meeting as follows:

When the OH appointment occurred the doctor walked in, checked the notes, and then said, “Oh, you’re trans”.

At which point I said, “Oh, you’re breaching the Equality Act then,” and proceeded to lecture them on how they were breaking my rights. At which point they asserted the party like about OH being a positive thing. And I pointed out, “then in that case I could have the right to decline your invitation”.

And the appointment ended. Nothing else was discussed.

 

A limited window of opportunity

Medical degrees are typically very intense. Students on B’s course are expected to take no more than three week’s sick leave per year during their four year course and subsequent two years as a foundation doctor. The maximum holiday period available is four weeks. The only exception to this is the summer holiday period between students’ first and second years.

As of autumn 2011, B was undergoing a physical transition, funded by the NHS and overseen by Charing Cross gender identity clinic. She intended to take a brief break in order to undergo genital surgery during her time as a medical student. However, the long recovery time (patients are typically recommended to take off at least eight weeks post-op; B was recommended to take off twelve weeks because of the physical nature of her course) and short breaks permitted during the six years of medical training meant that it would be difficult for her to find time to do so.

B was informed by the Senior Tutor at WMS that the only time she could realistically take off for surgery was her first summer holiday period. As a consequence of this, she was likely to forgo any chance to resit exams failed during her first year.

Private surgery

B then approached Charing Cross about the possibility of scheduling genital surgery for the summer of 2012. At this point, she would have completed the year of “real life experience” required by the current World Professional Association of Transgender Health Standards of Care. However, her request was rejected by Charing Cross on the grounds that she would have been attending the gender clinic for less than two years at the time of surgery.

B then faced a difficult dilemma: to wait six years for surgery, or pay for a private operation in order to complete her physical transition within the timeframe effectively demanded by WMS. She eventually took the decision to spend her savings on private treatment in order to minimise disruption to her study.

The possibility of failure

Whilst considering her options, B approached a couple of tutors for advice. She was particularly concerned about the possibility of failing her exam and then missing the resit during her time in hospital. This was a valid concern: not because B is a poor student, but because resits are not exactly uncommon within medical schools. As one academic within WMS commented in email correspondence to B:

As I am sure that you are becoming aware, medical exams can be a bit of a lottery and do not necessary relate to the candidate’s ability.

B was, however, informed that she was unlikely to fail any of her modules, and decided to go ahead with the surgery.

The exam

As it turned out, B failed her exam – along with 35% of her cohort.

An investigation by WMS formally dismissed any possibility of responsibility for this on the part of course conveners and school policy. However, B’s failure is arguably down in part to the complexities of the system as much as her own work. The manner in which the exam was marked meant that B got a higher percentage of marks than some students who passed, but failed the exam after doing poorly on a couple of very particular sections.

The exam results were announced the day that B regained consciousness in hospital following her operation. She spent the next few days in email contact with WMS from her hospital bed in an attempt to safeguard her second year of university.

The response

B requested that she be allowed (like the rest of her cohort) the opportunity to resit her exam. Unfortunately, the resit was to take place whilst she was still in hospital. WMS refused to provide any means for B to take her exam remotely, and insisted that it would not be possible for her to re-take her exam individually.

It later emerged that WMS were not prepared for any student to resit an exam individually under exceptional circumstances. Their argument is that it takes 60 working hours over the course of six months to prepare an individual exam, and that it is therefore too much work to prepare more than one paper.

B was reminded that she had been made aware that she would have to re-take the year in the event of failing any exam. WMS was not prepared to make any accommodation for her exceptional circumstances.

This would seem to imply that any student at WMS who is forced to miss an exam because of transition, disability or emergency surgery would be placed in a similar position to B.

The appeal

After pursuing the case within WMS for several weeks, B eventually decided to make a formal appeal within the wider University. The appeal entailed the preparation of a case, to be scrutinised by a committee of senior academics (including several faculty heads) before a recommendation was made to the Vice-Chancellor.

B argued that the approach of WMS amounted to indirect discrimination. The Equality Act and Disability Discrimination Act (which is applicable to individuals recovering from major surgery) both insist that suitable provisions are made for individuals with a legitimate need. The inability of WMS to provide a resit for students who have a legitimate medical reason for missing the standard resit effectively makes it difficult for anyone requiring surgery to undertake particular courses.

She therefore requested the opportunity to resit her exam, or (failing that) financial support for her re-take of the first year.

After a lengthy process of assessment (including an hour-and-a-half meeting with B in which she was able to direct present her case and answer questions) the committee rejected B’s appeal.

Some particularly telling extracts from the appeal documents follow (emphasis mine).

From the minutes of the committee’s meeting with B:

(i)  It was noted that [B] believed she required surgery as a matter of medical need;

(ii)  [B] was aware that she intended to undergo surgery at the time she applied for, and subsequently enrolled on, her degree and would also have been aware of the structure of the academic year (through the School’s Code of Practice 2011) and the fact that this would limit her opportunities to undergo elective surgery

(ii) [B’s] decision to undergo private, rather than NHS, surgery was a result of her own rational choice and was not forced by the Medical School;

(iii) The Committee accepted that the structure of the academic year for the MB ChB, in which resit exams are scheduled during the long vacation, did not allow sufficient time for students requiring long-term elective medical treatment, including transgender students requiringtransition surgery;

(iv) The Committee considered that the imposition of a structured academic year applicable to students generally is proportionate to the legitimate aim of providing education and therefore does not constitute indirect discrimination against students requiring gender re-assignment under s.19 Equality Act 2010;

(v) It was noted that the University has a duty to make reasonable adjustments under s.92(6) Equality Act 2010 where a rule or practice impacts adversely on a student with a protected characteristic;

(vi) As such, the Committee deemed temporary withdrawal for an academic year a reasonable adjustment, as it is always available for students requiring long-term treatment, including students undergoing gender re-assignment;

(vii) In relation to the question whether the Medical School should prepare a special resit paper to be taken at a time convenient to [B], it was noted that it is not uncommon in other Faculties for special arrangements to be made to enable students with disabilities to take scheduled resit examinations;

(viii) Nevertheless, it was noted that in this instance, the process of setting, marking and moderating a special exam would take the equivalent of 60 staff hours and if it were required that special resit papers for individual students with particular characteristics (i.e. transgender students) should be set, to be taken outside the calendared exam periods, it would be necessary as a matter of fairness to offer this service to other students with disabilities, protected characteristics or general illness who were unable to take scheduled resits

[…]

In relation to the supplementary ground of complaint:

(i) That there would be no reason for any member of Warwick Medical School staff to anticipate this level of failure;

(ii) That advice given to [B] by the Senior Tutor made clear that early scheduling of treatment would incur a risk and that [B] should consider her degree of confidence in passing the exams, before scheduling her elective treatment;

(iii) The Committee was therefore satisfied that the advice given by the Senior Tutor was appropriate.

Particularly unimpressive is the assumption that students such as B can afford (in financial as well as emotional terms) an entire year out from study, and the implication that a decision in her favour would set an awful precedent in which the University would have to appropriately support disabled students.

Concluding thoughts

I find the handling of this whole affair by WMS and the wider University of Warwick to be quite disturbing.

Of course medical courses should be difficult, and of course exams should be stringent. But everyone should have an equal chance to pass (and fail!) them.

Of course University departments have limited time, resources and money, particularly at this time of financial crisis. But they’ve had to spend a whole lot of time and money on this appeal, and they’re going to have to spend more on dealing with the fallout from this case.

I’ve tried to keep this post relatively succinct. It’s inevitably ended up being pretty long, but there’s so much background to this, and so much I haven’t been able to cover. The general impression I get is that WMS (and the University of Warwick) were keen to bury this case underneath a mountain of bureaucracy. The fact that it even reached the appeal stage is a minor miracle.

My concern now is not just for B, but for future students at WMS. I’ve seen a lot of evidence that suggests they don’t take discrimination seriously enough. Let’s hope that in the wake of this we might see policy change to ensure otherwise.

If you wish to contact WMS about this affair, please do. But please do not send any hate mail or threats!

* The student in question wishes to remain anonymous at the time of writing.

Edit: for a more personal take on this story, see No More Lost. There is also now a discussion up at Trans Medic.