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Medical Schools' Willingness to Accommodate Medical Students with Sensory and Physical Disabilities: Ethical Foundations of a Functional Challenge to "Organic" Technical Standards
Abstract
Students with sensory and physical disabilities are underrepresented in medical schools despite the availability of assistive technologies and accommodations. Unfortunately, many medical schools have adopted restrictive "organic" technical standards based on deficits rather than on the ability to do the work. Compelling ethical considerations of justice and beneficence should prompt change in this arena. Medical schools should instead embrace "functional" technical standards that permit accommodations for disabilities and update their admissions policies to promote applications from qualified students with disabilities. Medical schools thus should focus on what students with disabilities can do, rather than what they cannot do, because these students further diversify the health care profession and improve our ability to care for an expanding population of patients with disabilities.
... One main concern is a deficit in model support programs to support learners with disabilities across the medical education spectrum [4]. Barriers have included structural barriers, including restrictive or outdated policies and procedures [1], a poor understanding of clinical accommodations [1], a gap between disability and wellness support services [1], and a physical environment that limits accessibility, often resulting in very immediate, specific, and practical implications for trainees [4]. ...
... One main concern is a deficit in model support programs to support learners with disabilities across the medical education spectrum [4]. Barriers have included structural barriers, including restrictive or outdated policies and procedures [1], a poor understanding of clinical accommodations [1], a gap between disability and wellness support services [1], and a physical environment that limits accessibility, often resulting in very immediate, specific, and practical implications for trainees [4]. ...
... One main concern is a deficit in model support programs to support learners with disabilities across the medical education spectrum [4]. Barriers have included structural barriers, including restrictive or outdated policies and procedures [1], a poor understanding of clinical accommodations [1], a gap between disability and wellness support services [1], and a physical environment that limits accessibility, often resulting in very immediate, specific, and practical implications for trainees [4]. ...
Many leaders in medical education have called for the inclusion of students with disabilities. Yet, a small number of review articles have been written summarizing the key literature addressing this topic. This review focuses on literature published between 2000 and 2021 that discusses medical education disability-specific barriers, student disability prevalence, and available institutional disability resources. Barriers include lack of procedure for students with disabilities to access services, delays in education to address disability needs, identified institutional disability resource professional (DRP), structural and physical barriers, outdated policies, and lack of understanding of accommodations needed in all educational settings, especially clinical. Medical school stakeholders must clearly understand the published literature on this topic to promote the full inclusion of students with disabilities.
... TS are often categorized as "functional" or "organic" and, to address the aforementioned concerns, researchers have urged schools to adopt functional TS (Argenyi, 2016;Kezar et al., 2019;McKee et al., 2016). Functional TS focus on the skills learners must gain to become effective physicians, without designating a specific manner in which they must achieve these skills. ...
... Under the terms of the licence agreement, an individual user may print out a single article for personal use (for details see Privacy Policy and Legal Notice). Subscriber: OUP-Reference Gratis Access; date: 21 April 2022 the outcome, while organic standards focus on the process which results in the outcome (Argenyi, 2016;Kezar et al., 2019;McKee et al., 2016). Argenyi (2016) notes that inflexible TS are especially problematic for D/deaf and hard-of-hearing learners when they require specific sensory skills. ...
... Argenyi (2016) notes that inflexible TS are especially problematic for D/deaf and hard-of-hearing learners when they require specific sensory skills. Other researchers highlight that TS tend to emphasize sensory and motor function over cognitive abilities (McKee et al., 2016). According to a study conducted in the United States in 2016, full function of vision, hearing, and mobility was required by nearly 30% of MD-granting institutions (Zazove et al., 2016). ...
For two decades, leaders in medical education have emphasized the importance of increasing diversity within the physician workforce to better reflect the general population, including people with disabilities. Historically, the barriers in medical education for the inclusion of learners with disabilities have been many. As we progress through the early 21st century, researchers are seeking to reduce or eliminate these barriers to improve access to medical school education by readily putting forth the value of disability as diversity. Inclusive and accessible learning environments for those with disabilities benefit all learners. Carrying these findings into the healthcare profession brings further evidence to show the concordance between patients and physicians with disabilities through the lived experiences of being a patient with increased empathy and patient-focused care. With the inclusion of learners and practitioners with disabilities, their lived experiences, and allies contributing to the environments and standards in medical education and the medical profession, significant contributions for equitable opportunities and improvements can be made that ultimately benefit all.
... 'organic' technical standards). This poses a major systemic obstacle for some disabled trainees to pursue a medical career (McKee et al. 2016). There is a robust discussion in the literature questioning their importance McKee et al. 2016;DeLisa and Lindenthal 2012;VanMatre et al. 2004;Wainapel 2015). ...
... This poses a major systemic obstacle for some disabled trainees to pursue a medical career (McKee et al. 2016). There is a robust discussion in the literature questioning their importance McKee et al. 2016;DeLisa and Lindenthal 2012;VanMatre et al. 2004;Wainapel 2015). By contrast, functional technical standards allow for each professional to contribute to the delivery of healthcare in their own unique way (McKee et al. 2016;DeLisa and Lindenthal 2012). ...
... There is a robust discussion in the literature questioning their importance McKee et al. 2016;DeLisa and Lindenthal 2012;VanMatre et al. 2004;Wainapel 2015). By contrast, functional technical standards allow for each professional to contribute to the delivery of healthcare in their own unique way (McKee et al. 2016;DeLisa and Lindenthal 2012). Further, technological advances in both accommodations and healthcare devices are starting to change the way healthcare is delivered. ...
Disabled medical learners have unique accommodation needs, given their diverse and changing learning environments and direct contact with patient-care. However, there are very limited policies and resources available in Canada to inform medical learners and educators about what accommodations are available to them, and little is known about the usefulness of existing policies. This study explored the perspectives of disabled medical learners on existing policies in medical schools. We conducted interviews with eight disabled medical learners, focusing on their experiences with their institutions’ disability-related policies. Interviews were thematically analyzed. The analysis demonstrated that there are gaps in services for medical learners. Participants did not feel that pre-existing policies were helpful in addressing the existing barriers. In addition, participants felt that the responsibility for navigating the system falls primarily on them. This study addresses some needed changes to create more inclusive environments in medical education.
• Points of interest
• Disabled medical learners have unique accommodation needs.
• In Canada there are limited policies and resources available to inform medical learners and educators about what accommodations are available.
• This study focuses on what disabled medical learners think about existing policies in medical schools.
• Services and procedures for supporting disabled learners are complex and inconsistent.
• The support system and attitudinal barriers are challenging to navigate.
• Negative perceptions of disability in medicine are persistent.
• Attitudinal changes, simplified services and procedures, and an inclusive learning environment can improve the experiences of disabled medical learners.
... 5 A commentary reflecting on the aforementioned study argued that technical standards should employ "functional" rather than "organic" language. 8 Organic technical standards focus on the "specific physical, cognitive, sensory, or behavioral abilities that a student must demonstrate, without accommodation," placing process-oriented emphasis on sensorimotor skills rather than cognitive abilities. 8 Conversely, functional technical standards focus on competency outcomes without delineating how a student achieves these outcomes and allowing for accommodations including intermediaries and assistive technologies. ...
... 8 Organic technical standards focus on the "specific physical, cognitive, sensory, or behavioral abilities that a student must demonstrate, without accommodation," placing process-oriented emphasis on sensorimotor skills rather than cognitive abilities. 8 Conversely, functional technical standards focus on competency outcomes without delineating how a student achieves these outcomes and allowing for accommodations including intermediaries and assistive technologies. 9 Functional standards are further supported by Kezar and colleagues who offer an exemplar for medical schools seeking to align their technical standards with the aforementioned guidance. ...
... The addition of 15 new US MD and DO medical schools in the last three years provides an opportunity to evaluate newly developed technical standards to assess the adoption of more inclusive standards, as recommended in the literature. 7,8,10,11,13 In this study the authors evaluated technical standards from 15 new medical schools whose inaugural classes matriculated between 2017 and 2020. Using an analytical framework like that used in a previous study, 7 the authors evaluated technical standards for (1) willingness to accommodate, (2) functional level required across hearing, vision, and mobility, and (3) the locus of responsibility for providing accommodations. ...
Introduction
Technical standards document US medical school's nonacademic criteria necessary for admission, persistence, and graduation and communicate the school's commitment to disability inclusion and accommodation but are considered one of the largest barriers for students with disabilities. Calls for more inclusive technical standards have increased in recent years, yet the impact of this work on changing technical standards has not been measured. The establishment of 15 new US MD- and DO-granting medical schools between 2017 to 2020 offered a unique opportunity to evaluate differences in the inclusive nature of newly developed technical standards.
Method
We conducted a document analysis of 15 newly formed medical schools’ technical standards to determine the availability and inclusive nature of the standards as they pertain to students with sensory and mobility disabilities. Technical standards were coded for: ease of obtaining technical standards, the school's stated willingness to provide reasonable accommodations, the origin of responsibility for accommodation request and implementation, and the school's openness to intermediaries or auxiliary aids.
Results
Of the 15 schools, 73% of the technical standards were not easy to locate online. Few (13%) included language that support disability accommodations. Most (73%) used language that was coded as ‘restrictive’ for students with physical or sensory disabilities. Coding of the newly accredited US MD and DO medical schools suggests that newly created technical standards are more restrictive than those in previous studies.
Conclusions
Efforts to create more inclusive technical standards have not yet been realized. Newly formed US MD- and DO-granting medical schools may perpetuate historically restrictive technical standards that serve as barriers to applicants with disabilities. Future research should evaluate the role of medical school accrediting bodies to go beyond simply requiring technical standards to ensuring that the standards are readily available and appropriately convey the availability of reasonable accommodations for students with disabilities.
... 15,16 For example, having hearing loss doctors may benefit patients who also have hearing loss. 17 The value of incorporating individuals with disabilities is underscored by their dual perspective, having experienced both patient and provider roles. 18,19 Consequently, admitting students with physical disabilities to medical schools may lead to better clinical results later. ...
... McKee et al denied this assumption in their article. 17 238 emergency scenarios during clinical simulations at medical school. Additionally, there was uncertainty about whether the typical working hours suit doctors with disabilities. ...
Introduction
Physical disability is seen as a burden in many countries, and it has been a challenge to create a healthy environment and a fair living experience for all people with physical disability. For a long time, the number of students accepted to medical school has been limited, and the number of successful experiences for doctors with disabilities is inadequate worldwide. This study aims to investigate the perception of the public, medical educators, and medical students about the acceptance of students with physical disabilities in medical schools in Saudi Arabia.
Methods
The study uses two methodological strategies: a quantitative cross-sectional survey and a qualitative interview with a young female doctor with a physical disability to discuss her educational experience and work journey in Saudi Arabia and abroad. The study was conducted at the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Results
The perception survey results showed a broad acceptance of the public, medical educators, and medical students regarding the enrollment of students with physical disabilities in medical schools and regarding being treated by doctors with physical disabilities. The participants also believed that students with physical disabilities are compatible with most doctors’ jobs.
Conclusion
Students with physical disabilities should be able to study and practice medicine. Educational and health institutions should apply more effort and commitment to provide the necessary accommodations to accept students and doctors with physical disabilities based on their cognitive ability but not their physical disability.
... These technical standards often create significant barriers to requests for reasonable accommodation from students with disabilities . Moreover, research on student satisfaction with accommodation finds mixed perceptions depending on accommodation needs and the context of the task (McKee et al., 2016). Limited satisfaction with accommodations may be because of the failure to achieve the original intent of the ADA, which was that services be as integrated as possible into the context of academia. ...
... The U.S. Department of Health and Human Services recommends that to reduce health disparities, allied health and medical schools should focus on attending to the demographic makeup of providers in the health care workforce. However, despite these efforts, these programs continue to largely exclude students with disabilities because of the many technical standards for admission and completion of these programs (Brown et al., 2021;Meeks et al., 2018;McKee et al., 2016). Accommodations do not support the full inclusion of students with different learning needs; however, the UDL framework does. ...
... Removing application barriers at health professional schools and training programs, such as restrictive technical standards, can help improve the recruitment and retention of those with disabilities and hearing loss into health care and audiology fields (Meeks & Jain, 2018;Zazove et al., 2016). Restrictive technical standards, unlike functional technical standards, requires that the student be able to display physical, cognitive, and sensory abilities (e.g., "student must be able to hear heart sounds"; McKee et al., 2016;Stauffer et al., 2022). A student with a hearing loss would normally be discouraged from applying even though existing accommodations and assistive technologies can overcome limitations caused by the hearing loss. ...
... A student with a hearing loss would normally be discouraged from applying even though existing accommodations and assistive technologies can overcome limitations caused by the hearing loss. In contrast, a functional technical standard allows students with a hearing loss to incorporate assistive technologies and accommodations to successfully complete the essential tasks in their training and work (McKee et al., 2016;Stauffer et al., 2022). ...
Purpose
Nearly 20% of U.S. Americans report a hearing loss, yet our current health care system is poorly designed and equipped to effectively care for these individuals. Individuals with hearing loss report communication breakdowns, inaccessible health information, reduced awareness and training by health care providers, and decreased satisfaction while struggling with inadequate health literacy. These all contribute to health inequities and increased health care expenditures and inefficiencies. It is time to reframe the health care system for these individuals using existing models of best practices and accessibility to mitigate inequities and improve quality of care.
Method
A review of system-, clinic-, provider-, and patient-level barriers, along with existing and suggested efforts to improve care for individuals with hearing loss, are presented.
Results
These strategies include improving screening and identification of hearing loss, adopting universal design and inclusion principles, implementing effective communication approaches, leveraging assistive technologies and training, and diversifying a team to better care for patients with hearing loss. Patients should also be encouraged to seek social support and resources from hearing loss organizations while leveraging technologies to help facilitate communication.
Conclusions
The strategies described introduce actionable steps that can be made at the system, clinic, provider, and patient levels. With implementation of these steps, significant progress can be made to more proactively meet the needs of patients with hearing loss.
Presentation Video
https://doi.org/10.23641/asha.21215843
... To our knowledge only one article exists that discusses a DHoH student's experiences in an anesthesia rotation. 6 Researchers suggest that the inclusion of DHoH students, residents and physicians in the medical education continuum could offer multiple benefits to peers and patients alike including increasing disability awareness, improving interactions with DHoH patients and family members; 7,8 building empathy for persons with disabilities; 9 and promoting an accessible and supportive environment for patients and physicians, including aging physicians who experience hearing loss as part of natural aging. 8 DHoH patients may benefit from improvements in knowledge, attitudes, and communication that results from teaching medical students how to work with interpreters 9 specifically in emergency department (ED) settings where communication is central to patient outcomes. ...
... 14 It may be that physicians skilled at creatively navigating diverse and alternative forms of communication are able to provide more informed care to DHoH patients. 7,15 While reduced healthcare disparities for patients and a commitment to social justice should drive the inclusion of DHoH students in medicine, recent court decisions have supported qualified DHoH individuals in the healthcare workforce noting that DHoH individuals are appropriate providers when properly accommodated. [16][17][18][19] Despite the courts' support of DHoH students and employees, and the greater focus on diversity and inclusion in medical education, there remains a great deal of stigma for DHoH individuals in medicine. ...
Approximately 23% of Americans over age 12 have some level of hearing loss. 1 Emergency departments can reduce healthcare barriers for deaf and hard-of-hearing (DHoH) patients through improved patient-physician communication. DHoH students, once they become physicians, may provide one mechanism for reducing existing healthcare disparities and communication barriers for DHoH patients, and may be more adept with patients facing other communication barriers. A renewed interest in disability access and a commitment to social justice has increased efforts toward the inclusion of individuals with disabilities in medical education and training. Despite this increased interest and a growing number of DHoH students entering medical education, DHoH students continue to be dissuaded from specialty careers such as emergency medicine (EM) over concerns regarding effective communication and ability. Given the academic medicine communities’ commitment to diversity, a recounting of the successful inclusion of DHoH students in EM can benefit medical education and practice. In this account, the authors reflect on the successful experiences of a visiting DHoH medical student in an academic EM rotation at a Level I trauma hospital that serves a diverse population, and they identify the potential challenges for DHoH students in an EM setting, offer solutions including reasonable accommodations, and provide commentary on the legal requirements for providing full and equal access for DHoH students. We secured permission from the student to share the contents of this article prior to publication.
... The stigmatization of disability within medical education impedes disclosure of disability and accommodation requests (BMA, 2020;Bulk et al., 2017;Meeks et al., 2020c). Policies that construct disability as a threat to medicine and incompatible with the physician role also constrain access (McKee et al., 2016;Shrewsbury et al., 2018;Zazove et al., 2016). Despite the importance of how conceptualizations of disability impact inclusion, few studies have explored this matter in depth beyond its effects on individual disabled student actions (Bulk et al., 2017;Easterbrook et al., 2015). ...
How medical students, their teachers, and school administrators understand disability appears connected to ongoing, unequal access to medical education for disabled people. The stigmatization of disability within medical education affects students’ disability disclosures, yet few studies have explored how understandings of disability influence inclusion practices beyond individual student actions. This paper develops the concept of legibility, derived from a constructivist grounded theory study that examined disability inclusion at four U.S. medical schools through interviews with 19 disabled students and 27 school officials (faculty and administrators). With two dimensions (recognition and assessment of possibility), legibility demonstrates that knowing disability is relational, contextual, and equivocal. Drawing from the field of disability studies, the paper argues that the current paradigm of disability inclusion demands that students’ disability experiences be highly legible to themselves and others, yet increased legibility comes with potential risk due to prevalent ableism. While individual interactions can shift understandings of disability towards greater inclusivity, systemic action that embeds liberating discourses of disability into medical education is needed.
... a. Embrace "functional" technical standards that focus on students' abilities with or without the use of accommodations or assistive technologies. 4,11 b. Include disability in any statements welcoming diverse applicants to the medical school. ...
When physicians have a disability or chronic condition, they can offer deeper insight and ability into managing the needs of patients with similar conditions. Yet an alarming 2021 survey found that only 40.7% of physicians feel confident that they provide the same level of care to people with disabilities (PWD) as those without. This may contribute to troubling health care disparities for the over 61 million Americans living with disabilities. In a recent report, The American Medical Association (AMA) recognized that increased concordance between patients and physicians with disabilities is key to resolving health care inequities for PWD, yet although 1 in 5 patients reports a disability, only 1 in 33 physicians identifies as such. This is because prospective medical students with disabilities face many barriers in medical education and practice. We call for specific changes to medical school admission processes and curricula to promote a more just and diverse workforce which includes more physicians with disabilities.
... 15 Revising restrictive and organic technical standards into inclusive and functional ones, with annual updates to honor improvements in accommodative technology would remove unnecessary barriers. 16,17 We should work to focus on the end goal of skill mastery, not on how such skills are mastered, mirroring universal design. Within medical training, related changes should rebuild a stronger, more inclusive foundation where what is "normal" is learning about how to combat ableism to provide equitable care to all. ...
There currently exists an exciting impetus for increased diversity among medical trainees and improved equity in medical care received by patients. Yet, inclusion of disability within these efforts is often forgotten, allowing the current cultural narrative of ableism to shape medical training. National structural challenges as early as medical school admissions and ableist barriers throughout the educational pipeline have yielded 1) a concerningly low prevalence of medical students and physicians in the US who identify as disabled and 2) propagation of systemic misunderstandings on disability in our healthcare system. This perspective addresses the need for a re-evaluation of diversity in medicine which includes ability status and a commitment to anti-ableism as a critical part of the conversation. We propose reforms and important considerations that could have meaningful implications necessary for improving the culture of disability inclusion in medical education.
... 17 While these guidelines were developed with the aim of protecting service user safety, they were vague, did not offer evidential support, and were not completely prescriptive, which led to heterogeneity among the technical standards developed and followed by individual medical schools. 18,19 Anecdotally, from our collective experience, the resultant variability in language, concepts, and presentation in online admissions materials has also led to confusion and frustration among applicants with disabilities. ...
Individuals living with disabilities are underrepresented in the physician workforce, despite benefits of inclusion. This article describes how both ableism in admissions processes and expectations set by technical standards can perpetuate harm. The authors advocate for active attention to disability diversity and equity in medical school admissions.
... Working with the student, site, experiential team, college, and the disability resource center is key to identifying what is reasonable. 6 Large-font text and other visual or auditory modifications greatly assist with accurate information transmission but may introduce potential risks to patient privacy. Thus, it may be necessary to "modify the modifications" such as using computer privacy screens or asking students to use headphones and exercise additional discretion to protect patient information. ...
Accommodating pharmacy students with physical disabilities during the experiential learning portion of the Doctor of Pharmacy (PharmD) curriculum can present unique challenges for pharmacy schools. The available literature regarding accommodations for pharmacy students in the experiential learning environment is sparse, leaving programs with little guidance. This commentary from the Big Ten Academic Alliance calls on the Academy to create a community of shared resources and best practice examples and offers practical suggestions for accommodating pharmacy students with mobility, vision, and auditory disabilities during introductory pharmacy practice experiences (IPPEs) and advanced pharmacy practice experiences (APPEs).
... It is incumbent upon a mentor and host institution to understand the regulations (Berry et al., 2011;Schwartz, 2012;Zazove et al., 2016) that pertain to the successful securing and deployment of access services such as sign language interpreting, captioning, and notetaking. Although there are laws that mandate the provisioning of access services for D/HH persons, establishing a workplace in which communication diversity is valued, encouraged, and promoted is vital (McKee et al., 2016). Section 504 of the Rehabilitation Act of 1973 (U.S. ...
Diversification of the scientific workforce usually focuses on recruitment and retention of women and underrepresented racial and ethnic minorities but often overlooks deaf and hard-of-hearing (D/HH) persons. Usually classified as a disability group, such persons are often members of their own sociocultural linguistic minority and deserve unique support. For them, access to technical and social information is often hindered by communication- and/or language-centered barriers, but securing and using communication access services is just a start. Critical aspects of training D/HH scientists as part of a diversified workforce necessitates: (a) educating hearing persons in cross-cultural dynamics pertaining to deafness, sign language, and Deaf culture; (b) ensuring access to formal and incidental information to support development of professional soft skills; and (c) understanding that institutional infrastructure change may be necessary to ensure success. Mentorship and training programs that implement these criteria are now creating a new generation of D/HH scientists.
... Health professions programmes could reassess the criteria by which they evaluate applicants for admission to focus on the core skills and perspectives that are vital for competent care. 14,15 Medical schools and their affiliated clinical institutions must be able to determine and provide, with appropriate support, the optimal reasonable accommodations or adjustments for equal access to the curriculum, while ensuring competence for health professions practice. Changes to institutional culture are needed to ensure that all students and health-care providers are able to practise in inclusive environments. ...
... Some see these standards as an outdated concept that hinders diversity (Schwartz, 2009). The technical standards often limit the use of appropriate accommodations to meet the standards and are seen as overly restrictive, limiting the access of those with vision, hearing, mobility, and neurological impairments (Argenyi, 2016;Bagenstos, 2016;McKee, 2016;Schwartz, 2009;Zazove et al., 2016). While these technical standards are an obvious impediment to access in some areas of the medical professions, there is still a need to see if disparities in enrolment in the health-related fields more broadly may be grounded in earlier factors at the culmination of a bachelor's degree. ...
People with disabilities have been historically marginalised and consistently underrepresented at all levels of education. In the U.S., the Individuals with Disabilities Act (IDEA) in the 1970s changed the landscape for primary and secondary education, increasing access for many students. In 1990, the Americans with Disabilities Act (ADA) was passed, and since that time students with disabilities have entered postsecondary institutions at greater rates. While in 2001, only about 5% of college students identified as having a disability, more recent estimates put the proportion of undergraduate students with disabilities at approximately 11%. Despite this growth, only 5% of post-baccalaureate students report having a disability relative to undergraduate students. This raises the question of how accessible graduate and professional education is for students with disabilities.
... 6 During 2014 to 2016, 1,547 students at 89 US allopathic medical schools had disabilities, representing 2.7% of total enrollment. 7 Barriers to entry into the medical profession faced by students with disabilities include narrow interpretations of medical school technical standards (ie, descriptions of motor, sensory, and cognitive capacities required to matriculate, advance, and graduate), 8 denial of accommodations, 9 and the courts' interpretation of disability. 10 Other challenges are unique to medical students with specific disabilities, including deafness or hard of hearing 11 and dyslexia. ...
... A 2016 prevalence study found that 2.7% of US MD candidates disclosed disabilities, most having nonapparent disabilities (eg, attention deficit/ hyperactivity disorder, learning difficulties, or psychological disabilities). 2 This represents a larger cohort of students with disabilities entering GME than previously imagined [3][4][5] and suggests potential increases in requests for accommodation. Numerous resources exist to aid undergraduate medical education programs in disability-related recruitment and retention efforts, [6][7][8][9][10][11][12][13] including guidance on technical standards, 14,15 clinical accommodations, 16 and inclusive assessment. 17,18 The GME guidance is less robust. ...
... LGBTQ + -inclusive evidence-based educational materials 188,190 LGBTQ + -inclusive forms and decision-making tools 188,190 Physicians with disabilities Recruitment and workforce culture Include disability in discussions of diversity 4,191,192 Increase recruitment 193 Remove pressure on students and physicians to disclose the full nature of their disability 4 Improve and standardize medical school technical standards 194 addressing unclear, inconsistent, and lengthy policies and processes 4 Define responsibility for accommodations 4,194 Provide access to appropriate accommodations, personal and professional networks, peer support, and mentorship 4 Expand study of barriers and accommodations supportive of physicians [194][195][196] Patient comfort, communication, and outcomes Improve access, provider awareness, and communication, and address attitudinal barriers [45][46][47][48][49]195,[197][198][199] anxiety, low perceived self-health, harassment, and isolation. 130 Burnout in physicians with disabilities and intersectional identities Unfortunately, we were unable to find any study specifically aimed at examining burnout in physicians with disabilities or with intersectional identities, making these important areas for future research. ...
Background: Ensuring the strength of the physician workforce is essential to optimizing patient care. Challenges that undermine the profession include inequities in advancement, high levels of burnout, reduced career duration, and elevated risk for mental health problems, including suicide. This narrative review explores whether physicians within four subpopulations represented in the workforce at levels lower than predicted from their numbers in the general population—women, racial and ethnic minorities in medicine, sexual and gender minorities, and people with disabilities—are at elevated risk for these problems, and if present, how these problems might be addressed to support patient care. In essence, the underlying question this narrative review explores is as follows: Do physician workforce disparities affect patient care? While numerous articles and high-profile reports have examined the relationship between workforce diversity and patient care, to our knowledge, this is the first review to examine the important relationship between diversity-related workforce disparities and patient care.
Methods: Five databases (PubMed, the Cochrane Library of Systematic Reviews, EMBASE, Web of Knowledge, and EBSCO Discovery Service) were searched by a librarian. Additional resources were included by authors, as deemed relevant to the investigation.
Results: The initial database searches identified 440 potentially relevant articles. Articles were categorized according to subtopics, including (1) underrepresented physicians and support for vulnerable patient populations; (2) factors that could exacerbate the projected physician deficit; (3) methods of addressing disparities among underrepresented physicians to support patient care; or (4) excluded (n=155). The authors identified another 220 potentially relevant articles. Of 505 potentially relevant articles, 199 (39.4%) were included in this review.
Conclusions: This report demonstrates an important gap in the literature regarding the impact of physician workforce disparities and their effect on patient care. This is a critical public health issue and should be urgently addressed in future research and considered in clinical practice and policy decision-making.
Accounting for approximately 1 in 4 community-dwelling adults in the United States (US), people with disabilities (PWD) experience significant disparities in health care quality, access, and outcomes. At the same time, US physicians have reported feeling unprepared to care for PWD and have revealed significant negative bias about this population.
To understand how physicians are trained to care for PWD in US medical schools.
Qualitative, critical theory paradigm.
US medical school faculty (n = 8) and students (n = 9) were purposively sampled for knowledge of disability-related training based on known engagement in activities to advance disability-related medical education. Inclusion was limited to English language proficiency.
n/a.
Data were collected through focus groups, hosted virtually with separate groups for faculty and medical students between September 2021 and February 2022. Each meeting was recorded, transcribed, and de-identified. Deductive and inductive coding schemes were applied by multiple coders until reaching thematic saturation.
Prominent themes revealed critical shortfalls in medical education, including (1) disability being omitted from standard curricula; (2) disability being framed as a problem within individuals; (3) pervasive discrimination against PWD in medicine; and (4) over-reliance on ad hoc faculty and student-led efforts to cultivate curricular change. Data also revealed multifactorial barriers to including disability training as part of US medical education, such as avoidance of personal and institutional responsibility, and permeations of ableism across social and training contexts.
Medical education may perpetuate negative bias about disability through a hidden curriculum. Insufficient support from institutional and licensing authorities has stymied efforts to expand and improve disability-related training such that disability is not included in existing curricula focused on mitigating health care disparities — despite known vulnerabilities for PWD. Without improvements to disability-related curricular content, physicians will remain ill-equipped to care for the nation’s largest minority group.
This chapter explores the integration and impact of adaptive learning technologies in healthcare education, specifically for students with disabilities. By leveraging experiential technologies such as virtual reality (VR), mixed reality (MR), and augmented reality (AR), healthcare education can foster more immersive, interactive, and inclusive learning experiences. This narrative review identifies the unique challenges faced by students with disabilities, including accessibility issues, gaps in disability competency training, and inequities in educational opportunities. The chapter examines how adaptive learning, supported by artificial intelligence (AI) and machine learning (ML), can create personalized learning paths that enhance student engagement, confidence, and skill development. Additionally, it highlights the role of assistive technologies in improving accessibility and fostering inclusive educational practices.
Purpose
Students with disabilities have inequitable access to medical education, despite widespread attention to their inclusion. Although systemic barriers and their adverse effects on medical student performance are well documented, few studies include disabled students’ first-person accounts. Existing first-person accounts are limited by their focus predominantly on students who used accommodations. This study bridged these gaps by analyzing a national dataset of medical students with disabilities to understand their perceptions of disability inclusion in U.S. medical education.
Method
The authors analyzed 674 open-text responses by students with disabilities from the 2019 and 2020 Association of American Medical Colleges Year Two Questionnaire responding to the prompt, “Use the space below if you would like to share anything about your experiences regarding disability and medical school.” Following reflexive thematic analysis principles, the authors coded the data using an inductive semantic approach to develop and refine themes. The authors used the political-relational model of disability to interpret themes.
Results
Student responses were wide-ranging in experience. The authors identified key dimensions of the medical education system that influenced student experiences: program structure, processes, people, and culture. These dimensions informed the changes students perceived as possible to support their access to education and whether pursuing such change would be acceptable. In turn, students took action to navigate the system, using administrative, social, and internal mechanisms to manage disability.
Conclusions
Key dimensions of medical school affect student experiences of and interactions with disability inclusion, demonstrating the political-relational production of disability. Findings confirm earlier studies on disability inclusion that suggest systemic change is necessary, while adding depth to understand how and why students do not pursue accommodations. On the basis of student accounts, the authors identify existing resources to help medical schools remedy deficits in their systems to improve their disability inclusion practice.
Medical education programs profess commitments to justice, equity, and inclusion, seeking to diversify the profession and better serve patient populations. Although disability has more recently joined recognized categories of valued diversity, significant barriers remain for disabled learners in medicine. This paper develops the concept of the capability imperative, derived from a constructivist grounded theory study examining disability inclusion at four U.S. medical schools that analyzed technical standards policies and interviews with 19 disabled students and 27 school officials (faculty and administrators). Through three motifs (the selfless superhuman; the “real world” of medicine; and the malleable student), the capability imperative enforces the characteristics of a good physician, justifies institutional arrangements, and seeks to produce a learner who can conform to these expectations. Drawing on critical disability theories of ableism and crip theory, the paper argues that the capability imperative represents a context-specific manifestation of ableism that upholds a cultural logic of compulsory hyper-ablebodiedness and mindedness. This logic is antithetical to inclusive goals. Exploration of what constitutes a physician and whom this vision serves may help to shift the professional culture towards justice and unroot disabled peoples’ ongoing marginalization in the medical profession.
Many leaders in medical education have called for the inclusion of students with disabilities. Yet, a small number of review articles have been written summarizing the key literature addressing this topic. This review focuses on literature published between 2000-2021 that discusses medical education disability-specific barriers, student disability prevalence, and available institutional disability resources. Barriers include lack of procedure for students with disabilities to access services, delays in education to address disability needs, identified institutional disability resource professional (DRP), structural and physical barriers, outdated policies, and lack of understanding of accommodations needed in all educational settings, especially clinical. Medical school stakeholders must clearly understand the published literature on this topic to promote the full inclusion of students with disabilities.
The current approach to clinical placement training for nurses excludes students with disabilities. The purpose of this article is to introduce a four-step model for nursing programs to identify clinical essential requirements – specific skills and competencies students must gain during placement. Engaging this four-step model will allow educators to identify how essential requirements can be achieved in a variety of ways, and thus can involve accommodations. It will also allow for the identification of which essential requirements cannot be accommodated and must be demonstrated in a prescribed manner due to impacting the nature or integrity of the task. Analyzing clinical essential requirements using this framework will create a consistent and defensible method to determine the flexibility or inflexibility of clinical tasks. The framework provided requires a collaborative process including key experts, nursing students and nurses with disabilities to comprehensively address the challenges clinical environments pose to inclusiveness.
In this commentary, the author briefly reviews 3 articles from this issue of Academic Medicine that serve as a welcome addition to the literature in the quest to reduce the significant health inequities experienced by the Deaf and hard of hearing (DHoH) community. The author connects these articles to his own story as a DHoH medical student navigating the medical education system and also to his perspective as a practicing family medicine physician in a rural community health center. The path to bridging these health inequities is multifactorial. This includes identifying and eliminating barriers to increasing DHoH physician representation in the workforce, enhancing DHoH cultural competency in medical education, and using advances in technology through the creation of communication access plans and language access teams in hospitals and medical clinics for DHoH patients.
Purpose
There is an increase in medical students with long term conditions applying for accommodations in assessment. Medical school responses to such applications appear inconsistent, possibly reflecting insufficient guidance for policy. We aimed to inform an approach by developing guidance.
Methods
Within a New Zealand and Australian context, we used a four-stage action research methodology: discussion with medical educators and survey of all 21 medical schools, including responding to 22 hypothetical scenarios; developing an approach; applying the approach to the hypothetical scenarios; and seeking feedback from stakeholders on the proposed approach.
Results
Current practice varied among the 13 responding medical schools. Medical schools were consistent in their responses for 10 hypothetical scenarios but inconsistent in 12. An approach based on a matrix of authenticity to practice, including regulatory and employment factors, and feasibility to educational institutions was developed. This was applied to the hypothetical scenarios and highlighted how consistency could be better achieved, and where further discussion between regulators and employers might be needed.
Conclusion
This approach and the matrix based on authenticity and feasibility provides guidance to consider assessment accommodation applications. It highlights the need for discussions among regulators, employers, educational institutions and the disability sector.
The population of people with physical or sensory disabilities is growing, yet they are underrepresented in the medical and other health professions. At the same time, there is a clear need to enhance didactic curricular content and clinical training experiences that explicitly address the full scope of medical needs that individuals with disabilities have. These gaps represent missed opportunities to advance the health of an important, underserved, and growing population. Based on the authors' experience, the inclusion of people with physical or sensory disabilities in medical education greatly enhances the education of all learners and the professional development of faculty and staff, providing invaluable perspectives on the significant abilities of individuals with diverse physical or sensory disabilities. There are additional efforts and costs associated with the education of a medical student who is blind, is deaf, uses a wheelchair, or has another disability. But based on the authors' experience, it is clear that the societal return on investment is enormous, and the costs associated with a failure to embrace full inclusivity are much greater. Medical education institutions should recognize the population of people with disabilities as a vital component of their commitment to diversity, equity, and inclusion and strive to provide inclusive education for learners with disabilities.
Medical educators and leaders have called for greater diversity among the physician workforce, including those with disabilities. However, many students with disabilities are precluded from entering and completing medical training due to historically restrictive technical standards and poor internal practices to protect student privacy. This limits the possibilities for growing this part of the workforce and making progress toward the ultimate goal of having a physician workforce that better represents the patients it serves. To achieve diversity among the physician workforce, medical education must create environments that allow students with disabilities to apply to, flourish in, and feel well supported in medical school.
Recent additions to Accreditation Council for Graduate Medical Education requirements have helped to catalyze work in the area of disability inclusion by incorporating disability-focused mandates into graduate medical education accreditation standards. However, similar mandates for undergraduate medical education have not yet materialized. In this article, the authors call for the Liaison Committee on Medical Education (LCME) to elevate disability as a valued part of medical school diversity in its accreditation standards and to include protections for disabled students. The authors propose that the LCME can take 5 actions to promote institutional accountability toward students with disabilities: (1) define disability as diversity, (2) mandate disability support, (3) protect from conflicts of interest, (4) protect privacy, and (5) verify schools’ technical standards comply with the Americans with Disabilities Act. By adopting these recommendations, the LCME would send the powerful message that students with disabilities bring welcome expertise and value to the medical community.
Healthcare students with hearing loss require special consideration, as healthcare training may present new challenges compared to conventional didactic education. The degree and impact of hearing loss varies from person to person, and each student should receive a tailored assessment, with attention to unique challenges such as the operating room, highly formalized vocabulary, and incidental learning opportunities. This case follows a rising third-year medical student advocating for novel accommodations during clinical rotations in a medical school that has never had a deaf matriculant before. This case follows each stakeholder as they navigate establishing clinical rotations and accommodations, including a surgical rotation, that take into consideration the learner’s communication access needs and medical school requirements.
Efforts to include people with disability as students and practitioners in the health professions have gained momentum in recent years. However, prevailing technical standards at U.S. medical schools have biases that can prevent or impede their admission, promotion, and graduation. These standards derive from an approach first promulgated in 1979 and have since remained largely unaltered. Current technical standards at most medical schools are now at odds with changes occurring since the 1990 enactment of broad civil rights protections for people with disability and current aspirations for diversity, equity, and inclusion in the medical profession. It is time to replace the technical standards construct with an approach more consistent with current medical practices, and with societal imperatives of equity and social justice. Such an approach should assess candidates' demonstrable skills and merits, rather than relying on a preconceived construct defining the presence or absence of defined levels of ability. The maturation of competency-based approaches to curricular design and assessment provides an opportunity to reconceptualize the abilities required to practice medicine, foster the appropriate inclusion of physicians with disability, and better align medical education and training with broader societal needs and goals.
This chapter describes three frameworks for disability inclusion in health science education, the “strict compliance” approach, the “spirit of the law” approach, and the transformative approach. The first two represent “ideal types” of existing approaches, informed by legal standards. The third is a philosophical possibility for inclusion that moves beyond existing legal parameters. Adopting a “restless reflexive” stance, the author analyzes the central features and major implications of each approach to unearth their philosophical roots. Through this discussion, the reader is encouraged to continuously (re)consider their approach to determine its alignment with their aspirations for disability inclusion.
Technical standards have historically been identified as a barrier to entry in the health professions for many individuals with disabilities. Restrictive organic-based technical standards and the inappropriate use of “essential functions” restrict access into these programs. Accommodations including assistive technologies now provide a growing number of avenues for individuals with disabilities and their schools to consider when determining whether a student can meet the technical standards. The life experiences of students and professionals with disabilities provide a rich and unique element that often improves the care of patients with disabilities and improves the understanding and attitudes of health professions in general. Programs can increase the inclusion of these individuals into their educational programs through careful review of technical standards, clarity and transparency regarding the accommodation process, awareness of the varied accommodation options, and clear messaging to applicants about programs’ commitments to diversity. The chapter discusses the history of the use of technical standards in medicine and nursing, provides examples of inclusive (“functional”) standards that reflect the needs of a twenty-first century healthcare professionals, and offers guidance to programs seeking to amend practices to align with current standards.
Federal laws call for non-discrimination of persons with disabilities and require institutions to create thoughtful and informed processes to determine reasonable accommodations. The law, however, does not give guidance as to how an institution should create and implement disability inclusion processes; these processes include removing barriers in the admissions process, using language that communicates inclusion, and processing student requests for accommodations. This chapter aims to assist health science institutions and programs in developing robust and thoughtful approaches to equal access for qualified students with disabilities. The chapter also provides resources for evaluating existing programs, identifying gaps in service, improving forward facing messaging, and hiring staff.
It has been suggested that “the most dramatic learning can come when it is a peer who is disabled, rather than a patient.1” The sentiment of Shakespeare, Iezzoni, and Groce are evident in Jauregui and colleagues' innovations report. In this Invited Commentary, the authors discuss how the team at The University of Washington moved beyond the legal mandates of the ADA to capture the spirit of inclusion. We examine the benefits of training doctors and clinical researchers with disabilities and the potential impact on the health care system. We build on Jauregui’s work, applying their educational approach to an employment model and demonstrate, through our own case report, how these models can be scaled in clinical practice providing benefit to the medical education pipeline. We conclude with a review of the promising practices and contemplate the promise of “crowd‐sourcing” shared experiences toward creative approaches to the inclusion of medical students with disabilities.
The number of students with a disability matriculating into institutions of medical education, including physician assistant programs, is increasing. Educational institutions must develop procedures with regard to the Americans with Disabilities Act (ADA) including the provision of reasonable accommodations to provide equal opportunities for all. These procedures must be compliant with federal and state laws while protecting academic integrity, maintaining technical standards, and successfully navigating the institutional and individual faculty barriers. Knowledge of the ADA and the ADA Amendments Act of 2008 as well as some familiarity with the legal precedent regarding these laws will facilitate planning and decision-making for students with disabilities. This is imperative for educating not just those with specific disabilities but also the evolving learners of today. Such knowledge, coupled with the continued prioritization of technical standards and student outcomes, will assist in the curricular development of the future.
In this chapter, we will explore a case involving patients with multiple sclerosis (MS). The case focuses on topics related to disability including defining disability, characterizing some aspects of the Americans with Disabilities Act (ADA), and noting how environment and disability interact. There is also consideration of issues related to treating physician-patients and of physicians with disability practicing medicine. At the conclusion of the case, learners will be able to describe the healthcare system as it relates to disability and appreciate that people with disability should not be identified by their limitations. Learners will also be able to recognize skills needed to provide high-quality care for people with disability and how those skills apply to all patients. Finally, they will be able to analyze the role of the ADA and the issues of access to care for people with disability.
National Report with Association of American Medical Colleges and The University of California, San Francisco
The medical profession first addressed the need for technical standards (TS), defining the nonacademic requirements deemed essential for participation in an educational program, in guidelines published by the Association of American Medical Colleges in 1979. Despite many changes in the practice of medicine and legal, cultural, and technological advances that afford greater opportunities for people with disabilities, the profession’s approach to TS largely has not changed over the ensuing four decades. Although physicians with disabilities bring unique perspectives to medicine and contribute to a diverse physician workforce of culturally competent practitioners, they remain underrepresented in the profession.
As part of an initiative sponsored by the Association of Academic Physiatrists, the authors describe the need for an updated TS framework, outlining interval changes in the legal and regulatory climate, medical practice, and medical education since the initial TS guidelines were put forth. They conclude by offering eight recommendations and two functional approaches to TS that are consistent with now-prevalent competency-based medical education constructs.
The profession’s commitment to diversity and inclusion should extend explicitly to people with disabilities, and this stance should be clearly communicated through medical schools’ TS and procedures for requesting accommodations. To this end, schools should consider the principles of universal design to create policies and assessments that work for all learners, to the greatest extent possible, without the need for after-the-fact accommodations. A thoughtful and concerted effort along these lines is long overdue in medical education.
As curricula to improve medical students' attitudes toward people with disabilities are developed, instruments are needed to guide the process and evaluate effectiveness. The authors developed an instrument to measure medical students' attitudes toward people with disabilities. A pilot instrument with 30 items in four sections was administered to 342 medical students. Internal consistency reliability and factor analysis were conducted. The Cronbach's alpha coefficient was 0.857, indicating very good internal consistency. Five components were identified: comfort interacting with people with disabilities, working with people with disabilities in a clinical setting, negative impressions of self-concepts of people with disabilities, positive impressions of self-concepts of people with disabilities, and conditional comfort with people with disabilities. The instrument appears to have good psychometric properties and requires further validation.
Purpose:
Physician diversity improves care for underserved populations, yet there are few physicians with disabilities. The authors examined the availability of technical standards (TSs) from U.S. medical schools (MD- and DO-granting) and evaluated these relative to intent to comply with the Americans with Disabilities Act (ADA).
Method:
Document analysis was conducted (2012-2014) on U.S. medical schools' TSs for hearing, visual, and mobility disabilities. Primary outcome measures were ease of obtaining TSs, willingness to provide reasonable accommodations, responsibility for accommodations, and acceptability of intermediaries or auxiliary aids.
Results:
TSs were available for 161/173 (93%) schools. While 146 (84%) posted these on their Web sites, 100 (58%) were located easily. Few schools, 53 (33%), had TSs specifically supporting accommodating disabilities; 79 (49%) did not clearly state policies, 6 (4%) were unsupportive, and 23 (14%) provided no information. Most schools, 98 (61%), lacked information on responsibility for providing accommodations, 33 (27%) provided accommodations, and 10 (6%) had students assume some responsibility. Approximately 40% allowed auxiliary aids (e.g., motorized scooter), but < 10% allowed intermediaries (e.g., sign language interpreter). Supportive schools were more likely to allow accommodations (P < .001), assume responsibility for accommodations (P < .001), and accept intermediaries (P < .002). DO-granting schools were more supportive for students with mobility disabilities.
Conclusions:
Most medical school TSs do not support provision of reasonable accommodations for students with disabilities as intended by the ADA. Further study is needed to understand how schools operationalize TSs and barriers to achieving ADA standards.
Etiologies of hearing loss vary. When hearing loss is diagnosed, referral to an otology subspecialist, audiology subspecialist, or hearing aid dispenser to discuss treatment options is appropriate. Conventional hearing aids provide increased sound pressure in the ear canal for detection of sounds that might otherwise be soft or inaudible. Hearing aids can be used for sensorineural, conductive, or mixed hearing loss by patients with a wide range of hearing loss severity. The most common type of hearing loss is high-frequency, which affects audibility and perception of speech consonants, but not vowels. As the severity of hearing loss increases, the benefit of hearing aids for speech perception decreases. Implantable devices such as cochlear implants, middle ear implants, and bone-anchored implants can benefit specific patient groups. Hearing assistive technology devices provide auditory, visual, or tactile information to augment hearing and increase environmental awareness of sounds. Hearing assistive devices include wireless assistive listening device systems, closed captioning, hearing aid-compatible telephones, and other devices. For some patients, financial barriers and health insurance issues limit acquisition of hearing aids, implantable devices, and hearing assistive devices. Physicians should be aware that for some patients and families, hearing augmentation may not be desired for cultural reasons.
Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.
Medical schools utilize a set of technical standards used to screen applicants with disabilities, and one of the standards, which deals with communication, requires the applicant to be capable of speech and hearing. To the extent that medical schools exclude an applicant with a hearing impairment on the ground that the applicant cannot hear and speak, such exclusion would be (and should be) a violation of federal law. Schools must engage in an individualized assessment of how a Deaf medical candidate would satisfy the communication standard. The notion of an “undifferentiated graduate,” where all graduates qualify for practice in any field of medical practice and research, is outdated. Providing the Deaf candidate with an appropriate auxiliary aid such as a sign language interpreter would not constitute a fundamental alteration of the medical school’s program, nor would the interpreter serve as an intermediary substituting his judgment for that of the candidate. This Article is structured as a memorandum of law arguing for a construction of the technical standard of communication that is open to the different ways – via appropriate auxiliary aids – Deaf students communicate. Ends matter, not means.
Deaf and hard-of-hearing (DHoH) individuals are underrepresented among physicians and physicians-in-training, yet this group is frequently overlooked in the diversity efforts of many medical training programs. The inclusion of DHoH individuals, with their diverse backgrounds, experiences, and struggles, contributes to medical education and health care systems in a variety of ways, including (1) a richer medical education experience for students and faculty resulting in greater disability awareness and knowledge about how to interact with and care for DHoH individuals and their families, (2) the provision of empathetic care desired by many patients and their families, including individuals who have a disability or chronic condition, and (3) the promotion of a more supportive and accessible professional environment for physicians, including older physicians in practice and as educators, who are experiencing age-associated decreased hearing acuity or other acquired disabilities.Today, many qualified DHoH individuals face barriers to pursuing medical careers even while physicians who become DHoH can continue to practice medicine. These barriers still exist two decades after the implementation of the Americans with Disabilities Act of 1990 and despite technological advancements and changing attitudes. In light of the findings by Moreland and colleagues, the authors of this commentary discuss reasons to include DHoH individuals in the physician workforce, explain why this group remains underrepresented among physicians, and suggest ways that medical schools and training programs can ensure fair application processes and inclusive educational opportunities for work with DHoH students who are interested in health care careers.
Purpose:
To describe the characteristics of and accommodations used by the deaf and hard-of-hearing (DHoH) physician and trainee population and examine whether these individuals are more likely to care for DHoH patients.
Method:
Multipronged snowball sampling identified 86 potential DHoH physician and trainee participants. In July to September 2010, a Web-based survey investigated accommodations used by survey respondents. The authors analyzed participants' demographics, accommodation and career satisfaction, sense of institutional support, likelihood of recommending medicine as a career, and current/anticipated DHoH patient population size.
Results:
The response rate was 65% (56 respondents; 31 trainees and 25 practicing physicians). Modified stethoscopes were the most frequently used accommodation (n = 50; 89%); other accommodations included auditory equipment, note-taking, computer-assisted real-time captioning, signed interpretation, and oral interpretation. Most respondents reported that their accommodations met their needs well, although 2 spent up to 10 hours weekly arranging accommodations. Of 25 physicians, 17 reported primary care specialties; 7 of 31 trainees planned to enter primary care specialties. Over 20% of trainees anticipated working with DHoH patients, whereas physicians on average spent 10% of their time with DHoH patients. Physicians' accommodation satisfaction was positively associated with career satisfaction and recommending medicine as a career.
Conclusions:
DHoH physicians and trainees seemed satisfied with frequent, multimodal accommodations from employers and educators. These results may assist organizations in planning accommodation provisions. Because DHoH physicians and trainees seem interested in primary care and serving DHoH patients, recruiting and training DHoH physicians has implications for the care of this underserved population.
The authors discuss how the strategy of fostering greater diversity and inclusion regarding minorities can help decrease health disparities and improve health outcomes. They propose that examining admission to medical school of qualified individuals with physical disabilities and fostering better communication with these individuals should be part of that strategy. Whereas people with disabilities constitute about 20% of the population, only between 2% and 10% are practicing physicians. The two major barriers to having more persons with disabilities as medical students are the cost of accommodating these persons and medical schools' technical standards. The authors offer suggestions for overcoming these barriers, and the additional barrier of communication with persons with various disabilities, such as deafness or visual impairment.The authors also discuss some of the issues involved in having greater representation of minorities in medicine. In addition, they stress the need for more training in cultural awareness for students and residents and for physicians well along in their careers. Medical educators will be increasingly called on to create new models designed to sensitize students and faculty to racial, ethnic, and other types of diversity, while documenting the efficacy and costs of extant ones, from the standpoint of both practitioner and consumer.The authors hope that the moves toward greater diversity and more training in cultural awareness will increase the efficacy of health care while reducing its cost. The demands of these efforts will require the commitment of diverse, intellectually capable, and compassionate people at many levels of academic medicine.
To determine the nature and frequency of impairments and related underlying conditions of medical students with physical and sensory disabilities (PSDs), and to assess medical schools' use of relevant publications in setting admission criteria and developing appropriate accommodations.
A 25-item survey addressed schools' experiences with students known to have PSDs and their related policies and practices. The survey instrument was directed to student affairs deans at all 163 accredited American and Canadian medical schools. The authors limited the survey to consideration of PSDs, excluding psychiatric, cognitive, and learning disabilities.
Eighty-six schools (52.8%) responded, representing an estimated 83,327 students enrolled between 2001 and 2010. Of these students, 0.56% had PSDs at matriculation and 0.42% at graduation. Although 81% of respondents were familiar with published guidelines for technical standards, 71% used locally derived institutional guidelines for the admission of disabled applicants. The most commonly reported accommodations for students with PSDs included extra time to complete tasks/exams (n = 62), ramps, lifts, or accessible entrances (n = 43), and dictated/audio-recorded lectures (n = 40). All responding schools required students' demonstration of physical examination skills; requirements for other technical skills, with or without accommodations, varied considerably.
The matriculation and graduation rates of medical students with PSDs remain low. The most frequent accommodations reported were among those required of any academic or clinical setting by the Americans with Disabilities Act. There is a lack of consensus regarding technical standards for admission, suggesting a need to reexamine this critical issue.
Deaf American Sign Language (ASL) users face communication and language barriers that limit healthcare communication with their providers. Prior research has not examined preventive services with ASL-skilled clinicians.
The goal of this study was to determine whether provider language concordance is associated with improved receipt of preventive services among deaf respondents.
This cross-sectional study included 89 deaf respondents aged 50-75 years from the Deaf Health Survey (2008), a Behavioral Risk Factor Surveillance System survey adapted for use with deaf ASL users. Association between the respondent's communication method with the provider (i.e., categorized as either concordant-doctor signs or discordant-other) and preventive services use was assessed using logistic regression adjusting for race, gender, income, health status, health insurance, and education. Analyses were conducted in 2010.
Deaf respondents who reported having a concordant provider were more likely to report a greater number of preventive services (OR=3.42, 95% CI=1.31, 8.93, p=0.0122) when compared to deaf respondents who reported having a discordant provider even after adjusting for race, gender, income, health status, health insurance, and education. In unadjusted analyses, deaf respondents who reported having a concordant provider were more likely to receive an influenza vaccination in the past year (OR=4.55, p=0.016) when compared to respondents who had a discordant provider.
Language-concordant patient-provider communication is associated with higher appropriate use of preventive services by deaf ASL users.
In 2008, Congress amended the Americans with Disabilities Act (ADA) to relax court-imposed limitations on evidence required to warrant protection under the ADA. Since passage of the ADA in 1990, medicine has focused not on evaluating the types of accommodations that would best balance the interests of individuals with disabilities, institutions, and patients but, rather, on the question of whether individuals seeking protection under the law qualify for disability accommodations at all. The medical profession should refocus on the nature of accommodations provided to those with disabilities. In doing so, the intent to support disabled persons seeking careers in medicine must be balanced with ethical obligations to protect patient welfare. Medical schools, graduate medical education programs, licensing and certifying authorities, and assessment organizations should work together to establish evidence-based minimum criteria for the physical and cognitive capabilities required of every physician.
The Americans With Disabilities Act (ADA) promotes social justice by protecting disabled persons from discrimination and prejudice. It seeks equality of opportunity for them and protects their well being by giving them fair access to goods, services and benefits. These rights are circumscribed in the ADA, however, by constraints of cost, efficiency, utility, and certain social mores. The ADA offers little direction about how to set priorities when these values come into conflict, or about whether equality or opportunity favors equivalent or preferential treatment for disadvantaged people. Until these ambiguities and potential value conflicts are resolved, a central moral and social problem remains unresolved: How can we demonstrate commitment to the rights and welfare of those with severe disabilities while placing fair limits upon their claims? Five special concerns are discussed: (1) eligibility and the allocation of health care; (2) the meaning of 'qualified but disabled' in employing people with mental disabilities; (3) equal opportunity and problems of envy and malingering; (4) ADA accommodation and public protection through testing and licensure; and (5) ADA protection and problems of backlash. Rather than simply wait to see what courts and administrative agencies decide, we should evaluate the moral conflicts, articulate criteria, and help make some difficult choices on morally defensible grounds.
The predicted increase in the prevalence of chronic and disabling diseases in the population over the next 30 years calls for a more effective approach to educating medical students about the assessment and management of disability. The introduction of a new postgraduate medical course at Flinders University of South Australia in 1996 allowed the development of a new topic on disability and rehabilitation. Over a 4-week period, students undertake four activities. First, they follow a particular patient in an inpatient rehabilitation setting and learn about the multidisciplinary approach to rehabilitation. Secondly, they each visit two people with a disability living in the community and assess their physical, mental, functional and social status. Thirdly, they each visit a service which supports those people in the community. Finally, they simulate having a disability which is randomly allocated to them. During these 4 weeks, students also participate in problem-based learning (PBL) and have 27 h of associated sessions or lectures. The PBL cases and associated sessions have a 'chronic disease' theme. We developed a questionnaire to obtain student feedback on this new topic in the first 2 years of its delivery. A 69% response rate has been obtained. Overall, the topic was well-received, and as a result most students felt more comfortable in dealing with disabled people. They were enthusiastic about ward work, and enjoyed learning about aspects of multidisciplinary team care. Exercises involving simulation of disability were largely acceptable. We believe that this topic helps our students to deal better with the problems of disabled people.
This pilot study assessed the opinions of medical students, residents, and attending physicians regarding the technical standards for medical school admission and the competencies required of graduates in the context of physical disability issues.
Students, residents, and faculty from all specialties at a major academic medical center were surveyed regarding the concept of the "undifferentiated graduate;" the relative importance of motor, sensory, observation, and communication skills; the importance of specific technical skills; and the use of physician extenders and other accommodations to fulfill technical standards.
Respondents placed higher importance on observation and communication skills compared with motor skills. Of respondents, 69.8% either disagree or strongly disagree with the idea that a medical student should be an undifferentiated candidate possessing all the technical skills necessary to enter any specialty.
Technical skills used in interpretation and observation were more important to respondents than those technical skills that are purely procedural. Respondents largely rejected the concept of the undifferentiated graduate. Although statistical analyses are of limited reliability because of low response rates, this study represents the most extensive sampling to date of medical professionals' opinions on these issues. Respondents' narrative comments also provided valuable perspectives.
People with disabilities make up about 20% of the population, yet only a tiny fraction of matriculants to medical school have disabilities. Attempts to define core technical standards and competencies have not kept pace with technological changes, diverse specialization, and changing practice options. This has resulted in the inappropriate exclusion of some people with disabilities. Medical schools determine how any qualified applicant, regardless of physical or cognitive ability, can be effectively accommodated and counseled in achieving the most appropriate medical career. A serious effort to redefine the technical standards and core competencies of the 21st century medical education at the undergraduate and graduate levels would likely resolve many of the troubling questions regarding medical students with disabilities. We have made some recommendations to organized medicine for constructing an agenda to address these issues.
Disability teaching is a core theme in undergraduate medical education. Medical students bring a range of experiences of disability to their medical training.
The principal aim of this study was to explore the words that medical students associate with the term "disability" and to consider how the resulting information could inform teaching. A secondary aim was to see if a short disability course changed the word associations.
Students were asked to write down 2 words that came to mind when they heard the word "disability", before and after a 4-day course in disability. Words from 4 cohorts were analysed by frequency and the following word dichotomies: visual icons/personal attributes; loss/enabling, and medical model/social model. A random sample of students took part in focus groups at the beginning and end of the course.
A total of 381 students provided 667 before-course words and 189 students provided 336 after-course words. Before the course, words denoting visual icons of disability, and loss were prominent, accounting for 85% of the words, and 74% of the words describing personal attributes were negative. Focus group responses at this stage reflected an eagerness to help but patronising terms were prominent, along with concern about political correctness. Students also expressed nervousness about encountering disabled people. In response, teaching was adapted to make it more learner-focused, to offer a safe environment in which students can test out their language, to build on the positive associations and to develop a range of pre-course creative activities with disabled people. After the course a considerable and significant shift in emphasis was observed, with a reduction in the use of visual icon words, an increase in words denoting enablement, and an increase in words relating to the social model of disability and to positive personal attributes (P < 0.001). Focus group participants at this stage reported greater confidence in approaching disabled people but continued to question political correctness.
Medical students associate disability predominantly with depersonalised or negative words. A short disability course appears to change these associations. Reasons for this and implications for teaching are discussed.
s impossible dream to be doctor comes true. Pittsburgh Post-Gazette
- D Meghan Templeton
- Wilson
Templeton D. Meghan Wilson's impossible dream to be doctor comes true.
Pittsburgh Post-Gazette. May 19, 2013. http://www.postgazette.com/local/region/2013/05/19/Meghan-Wilson-s-impossible-dreamto-be-doctor-comes-true/stories/201305190253. Accessed June 24, 2016.
Deaf doctor makes patients feel heard. CNN
- P Zazove
Zazove P. Deaf doctor makes patients feel heard. CNN. May 20, 2015.
http://www.cnn.com/2015/05/20/health/human-factor-philip-zazove/.
Federal judge orders Creighton medical school to provide specific accomodations-different from those it offered-to hearing impaired student. Inside Higher Edus-judge-orderscreighton-medical-school-provide-specific-services-deafstudent#sthash
- S Jaschik
Jaschik S. Federal judge orders Creighton medical school to provide specific
accomodations-different from those it offered-to hearing impaired student.
Inside Higher Ed. December 23, 2013.
https://www.insidehighered.com/news/2013/12/23/us-judge-orderscreighton-medical-school-provide-specific-services-deafstudent#sthash.oI00Ok9F.dpbs. Accessed June 24, 2016.
Fighting their way into medical school. Inside Higher Ed
New J. Fighting their way into medical school. Inside Higher Ed. July 28, 2014.
https://www.insidehighered.com/news/2014/07/28/judge-orders-medicalcollege-accommodate-deaf-student. Accessed June 24, 2016.
Iowa Supreme Court rules that chiropratic college cannot reject a student's request to meet requirements for analyzing X-rays. Inside Higher Ed
- S Jaschik
Jaschik S. Iowa Supreme Court rules that chiropratic college cannot reject a
student's request to meet requirements for analyzing X-rays. Inside Higher Ed.
June 30, 2014. https://www.insidehighered.com/news/2014/06/30/iowasupreme-court-says-chiropractic-college-discriminated-against-blind-student#sthash.J1XuRrSV.dpbs. Accessed June 24, 2016.
Medical students with disabilities: a generation of practice. Wilkerson DJ, ed. Association of Medical Colleges
- J E Watson
- S H Hutchens
Watson JE, Hutchens SH. Medical students with disabilities: a generation of
practice. Wilkerson DJ, ed. Association of Medical Colleges; 2005.
https://members.aamc.org/eweb/upload/Medical%20Students%20with%20Disa
bilities%20A%20Generation%202005.pdf. Accessed June 24, 2016.
Learning objectives for medical student education-guidelines for medical schools: report I of the Medical School Objectives Project
Learning objectives for medical student education-guidelines for medical
schools: report I of the Medical School Objectives Project. Acad Med.
1999;74(1):13-18.
gov's guide to assistive and accessible technologies
- Gov Disability
- Disability
Disability.gov. Disability.gov's guide to assistive and accessible technologies.
https://www.disability.gov/resource/disability-govs-guide-assistivetechnology/. Accessed June 24, 2016.
A word from the president: reconsidering "disabled
- J Cohen
Cohen J. A word from the president: reconsidering "disabled" applicants. AAMC
Reporter. 2004;13(9):2.
Institute of Medicine Committee on Institutional and Policy-Level Strategies for Increasing the Diversity of the US Health Care Workforce. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce
- B D Smedley
- A S Butler
- L R Bristow
Smedley BD, Butler AS, Bristow LR, eds; Institute of Medicine Committee on
Institutional and Policy-Level Strategies for Increasing the Diversity of the US
Health Care Workforce. In the Nation's Compelling Interest: Ensuring Diversity in the
Health-Care Workforce. Washington, DC: National Academies Press; 2004.
Deaf hospitalist focuses on teaching, co-management, patientcentered care
- G Henkel
Henkel G. Deaf hospitalist focuses on teaching, co-management, patientcentered care. Hospitalist. August 1, 2014. http://www.thehospitalist.org/article/deaf-hospitalist-focuses-on-teaching-co-managementpatient-centered-care/. Accessed June 24, 2016.
Federal judge orders Creighton medical school to provide specific accomodations-different from those it offered-to hearing impaired student. Inside Higher Ed
- S Jaschik
Jaschik S. Federal judge orders Creighton medical school to provide specific
accomodations-different from those it offered-to hearing impaired student.
Inside Higher Ed. December 23, 2013.
https://www.insidehighered.com/news/2013/12/23/us-judge-orderscreighton-medical-school-provide-specific-services-deaf-student#sthash.oI00Ok9F.dpbs. Accessed June 24, 2016.