Students and residents with disabilities have an important role to play in health care. An AAMC report outlines promising practices for medical schools and teaching hospitals to create a supportive and inclusive learning environment.
Editor's note: The number of medical students who report having a disability rose 69% between 2016 and 2019, according to a new survey published November 26, 2019 in the Journal of the American Medical Association. Lisa Meeks, PhD, co-author of the 2018 AAMC report and the new JAMA article, speculates that the increase in disability prevalence may be due to "more applicants with disabilities being admitted to medical school, more existing students disclosing disability, better reporting of disability data, or increased development of psychological disability while attending medical school."
Medical schools and teaching hospitals are striving to support learners with disabilities, yet they often need more information and resources to help create fully inclusive environments. Furthermore, the quality and extent of supports for these learners vary quite significantly from institution to institution across the country.
Those are among the findings of an AAMC report released in 2018 that captures the insights and lived experiences of learners and physicians with disabilities.
The report, Accessibility, Inclusion, and Action in Medical Education: Lived Experiences of Learners and Physicians With Disabilities, is the product of months of delving into research studies and interviewing administrators and learners at more than 30 institutions. It offers practical considerations and resources to help ensure that people with disabilities have equal access to medical education and the profession of medicine.
“Prior AAMC reports have addressed various issues surrounding disabilities, but this is the first comprehensive examination of the experiences of medical learners with disabilities,” notes Geoffrey Young, PhD, AAMC senior director of student affairs and programs. “This report gives voice to students, residents, and physicians with physical, psychological, sensory, learning, or chronic health disabilities.”
Created in partnership with the University of California, San Francisco (UCSF), School of Medicine, the report covers a broad landscape: physical accessibility, institutional culture, legal requirements, training opportunities, and more.
Report coauthor Lisa Meeks, PhD, former director of medical student disability services at UCSF School of Medicine, notes key takeaways. “Learners certainly need effective structures that sometimes are missing, such as clear policies around disabilities and knowledgeable disability service providers. But that’s not enough,” says Meeks, now a researcher at the University of Michigan Medical School. “They also need a culture that lets them know they are welcome.”
“Prior AAMC reports have addressed various issues surrounding disabilities, but this is the first comprehensive examination of the experiences of medical learners with disabilities.” Geoffrey Young, PhD, AAMC
Young hopes the report will spark some crucial conversations. “I want this publication to encourage all involved in medical education to explore and challenge their implicit biases,” he says. “I want them to appreciate how people with disabilities can enrich medical education and the care of patients.”
Valuing and attracting learners with disabilities
Physicians and learners with disabilities can contribute to health care in many ways, the report notes. For one, research suggests that identifying with one’s physician increases patient compliance. Physicians with disabilities may also be well equipped to provide culturally competent care informed by their own experiences with treatment.
As one medical student interviewed for the report explained: “I can take my experiences and say, ‘Hey, I know what it's like to be a patient. Most recently, I know what it's like to have a really terrible thing that you have to deal with on a daily basis, or a disorder, a disease, illness that you have to deal with, and what I've learned from it. I can help you from what I've learned.’”
In addition, training alongside a fellow student with a disability can help unravel stereotypes.
“I tell medical students that you are going to learn far more from each other than from us,” says Lina Mehta, MD, associate dean for admissions at Case Western Reserve University School of Medicine. “Studying with other students from diverse backgrounds gives you a broader understanding of people’s life experiences and challenges—and even what may be possible for your patients.”
Mehta has focused on ensuring that policies and procedures are supportive of applicants with disabilities. She also partnered with UCSF to create an online training session for admissions officers as part of the UCSF faculty training series.
“We are very cognizant of training admissions interviewers so they don’t make the student feel uncomfortable in discussing relevant issues. Sometimes [a disability is] so obvious that not addressing it probably would make the student feel worse,” says Mehta. “I think we are sometimes so afraid of saying the wrong thing that we don’t set ourselves up to say the right thing.” The training module provides guidance to interviewers to facilitate such sensitive conversations.
The report offers several ideas for admissions office staff to consider, such as:
Include disability in any statements welcoming diverse applicants to the school.
Make clear and accessible all instructions for requesting accommodations.
Devise technical standards—nonacademic criteria for entering and completing medical school—that focus on the ability to achieve key competencies rather than on how students achieve them.
The Americans with Disabilities Act requires schools and employers to provide reasonable accommodations—unless they fundamentally alter a program or pose an undue burden to the institution.
In a medical environment, accommodations might include a powerful magnifying device for a learner with a visual disability, extended test times for a student with a learning disability, and a convertible wheelchair that allows a learner with paraplegia to stand at a surgical table.
To successfully access accommodations, learners need a dedicated contact person well versed in disability law and services, the report notes. They also need to feel comfortable using the accommodations.
“The interviewees [with disabilities] are trusting us with what they’ve been through, and they are trusting us to do the right thing with that information.” Lisa Meeks, PhD University of Michigan Medical School
Sometimes, other students misunderstand accommodations, says Neera Jain, MS, the report’s coauthor and a former disability service provider at UCSF School of Medicine. “They may think accommodations are unfair, having only seen the results—a student thriving in school. What peers aren’t privy to is all the work that students with disabilities need to do to achieve and forces like chronic pain, fatigue, and strict medication schedules that necessitate accommodations.”
Creating a supportive climate
While accommodations and other supportive structures are necessary for learners with disabilities, an institution’s culture around disability—though more nebulous—can be equally impactful.
Interviewees for the report shared complex, sometimes painful experiences: expending significant energy pursuing supports, feeling a need to outperform peers to prove themselves, and being stigmatized at times, even by well-meaning individuals.
A less-than-welcoming environment can breed a reluctance to disclose disabilities, Meeks notes. Then, in an unfortunate cycle, a lack of disclosure can contribute to a less-inclusive environment, which then leads to fewer students disclosing disabilities.
For Kurt Herzer, MD, a graduate of Johns Hopkins University School of Medicine, the decision to disclose his visual disability was easy. “I would disclose it broadly because I wanted people to see this is possible. It’s working. Things are being done a bit differently, but it fits in fine with our clinical workflow.” Herzer notes that his school was extremely responsive and supportive.
Choosing to disclose ADHD, a learning disability, or other “invisible” disability can be harder, though. “With the competitive culture of medical school, admitting you’re having problems of any sort . . . is tension laden,” says one student with invisible disabilities who asked not to be named. “The culture is changing, but too slowly. Any sign of perceived weakness can be taken to mean you’re not fit to be there.
“With my issues, I can’t easily or succinctly point to what’s wrong with me. It’s much hazier,” she adds. “In some people’s eyes, my need for certain accommodations becomes blurred with my personal responsibility and capability—and even sometimes who I am as a person.”
The report describes practices that can foster a positive culture around disability. One key step is ongoing professional development for faculty on how to communicate with and about people with disabilities. Also invaluable: taking a universal design approach, which means that anyone can access both the physical space and all learning experiences.
Meeks and Jain look forward to having such ideas discussed, debated, and, they hope, implemented. Hearing learners’ stories and writing the report was something of a sacred trust, they feel. Meeks points to one particularly compelling interview, which ran much longer than expected.
“We had to stop to allow her to process what she was saying,” explains Meeks, “because she had never said any of this out loud before, and it was causing significant distress to relive it. . . . Yet it also was therapeutic for her to tell her story.”
“It’s for people like her that I feel this report needs to exist,” Meeks adds. “The interviewees are trusting us with what they’ve been through, and they are trusting us to do the right thing with that information.”
This story was originally published on March 13, 2018.