Call to action: Medical schools must eliminate barriers for students with disabilities

Key takeaways:

• Medical students with disabilities face many barriers.
• A diverse workforce is critical to build empathy, combat bias and address attitudinal barriers.
• The authors call on medical schools to take five steps to be more inclusive.

To achieve a more diverse workforce, the medical community must acknowledge and eradicate the barriers that medical students with disabilities face, according to a call to action published in Annals of Family Medicine.

Brianna A. Marzolf, DO, of the department of family medicine at the University of Michigan, and colleagues wrote that physicians who have a chronic condition or disability are able to “offer deeper insight and ability into managing the needs of patients with similar conditions.” However, despite the fact that disability affects one in five patients, just one in 33 physicians identify as a person with a disability, according to the authors.

“Diversity among physicians is essential to address attitudinal barriers, combat bias and build empathy. When people with disabilities are viewed only as subjects to be studied and treated, negative attitudes and false stereotypes will likely continue,” Marzolf and colleagues wrote. “One way to counter bias against outsiders (ie, what many consider [people with disabilities]), is to make them insiders (physicians).”

Part of the reason why these gaps exist might be because, historically, the medical community has “viewed disability as a pathology and an impairment,” the authors wrote.

Ableism can help shape how physicians think about people with disabilities, they added. In fact, 82% of physicians said they believe people with disabilities have a quality of life that is either “a little worse” or “a lot worse” than those without, Marzolf and colleagues wrote, noting that only 18% of physicians said they “would be glad to be alive after a severe Spinal Cord Injury/Disorder (SCI/D) vs 92% of people with SCI/D.”

Although people with disabilities “face persistent gaps in screening and preventative services, reproductive and pregnancy care, and communication with clinicians,” just a fraction of physicians — 18% — “strongly agreed that people with disabilities are treated unfairly in the health care system,” the authors wrote. Additionally, although 80% of physicians “strongly agree it is very valuable to understand their patients with disabilities,” Marzolf and colleagues cited a recent survey that showed that less than half — 40.7% — of physicians were “confident that they provide the same level of care to people with disabilities as those without.”

“This may contribute to troubling health care disparities for the over 61 million Americans living with disabilities,” the authors wrote.

One of the factors contributing to why so few physicians report living with a disability is that “prospective medical students with disabilities face many barriers in medical education and practice,” Marzolf and colleagues wrote.

Because of the high-stakes “grind culture” of medical school, disabilities may go underreported, and those needing accommodations go unsupported, according to the authors. They found that just 2.7% of medical students in the U.S. self-reported a disability, with ADHD, psychological and learning being the most common, but “a 2009 study found that two-thirds of students with disabilities had not sought support despite experiencing disability-related difficulties in their training,” Marzolf and colleagues wrote.

To further illustrate the barriers that physicians with disabilities face, the authors shared the story of Oluwaferanmi O. Okanlami, MD, MS, a practicing physician who was paralyzed after a spinal cord injury while he was a resident. Okanlami said there are so few physicians with disabilities “not because we’re not qualified,” but “because we’re waiting outside, without a ramp, just to get a seat at the table.”

The specific barriers that medical students with disabilities face, according to the authors, are:

• technical standards — the criteria institutions require for medical school admission that can “require applicants to ‘demonstrate certain physical, cognitive, behavioral and sensory abilities without assistance’” — are exclusionary;

• a “lack of standardization” in both the processes for students to disclose disability and receive accommodations; and

• the inconsistency of disability support systems and “a lack of specialized knowledge about accommodations among disability resource professionals”

To help address these issues, the authors called for changes to medical school curricula and the admission processes that focus on “a more just and diverse workforce.”

“To provide equitable health care for people with disabilities we must heed the rallying cry of the disability rights movement: ‘Nothing about us without us,’” they wrote.

The authors issued the call to action to allies of patients with disabilities, health care institutions and physicians to “advocate that the AMA and AAMC require all medical schools” do the following:

1. Shift the technical standards that medical schools use for admission “to allow for a focus on results rather than process.” Welcome “‘functional’ technical standards” focusing on a student’s capabilities with or without the use of assistive technologies or accommodations, and incorporate disability in statements that welcome applicants who are diverse to the school.
2. Create a culture supportive of “universal design” in physical workspaces and hiring practices. The authors wrote that “everyone benefits” from universal design — for example, wheelchair accessible curbs also benefit bikers, pedestrians, parents pushing strollers, etc.
3. Supply “clear and accessible instructions” so people with disabilities know how to request accommodations with “qualified disability resource professionals” who would “serve as a confidential resource for students and faculty and support the implementation of accommodations.” Further, both the Association of American Medical Colleges (AAMC) and AMA should “provide guidance on disability disclosure” and ensure schools follow the recommended protocols.
4. Work to foster a culture that “facilitates access to wellness services to eliminate stigma” in the profession.
5. Integrate training into medical school curriculum that is about people with disabilities “within the context of human diversity.”

Alison Whelan, MD, chief academic officer at AAMC, told Healio that the organization is “committed to fostering a diverse, equitable and inclusive physician workforce, and that includes people with disabilities.”

“One way in which we’re doing that is through our support of the DocsWithDisabilities initiative to address and remove common barriers in training and to provide a platform for improving disability inclusion,” she said. “The AAMC is reviewing the call to action to determine how we can best support the recommendations and further encourage medical schools to provide an inclusive learning environment for students with disabilities.”

In response to the call to action, a media coordinator at the AMA told Healio that the AMA cannot require all medical schools to take any action, just encourage it. A 2021 AMA policy, D-90-990, urged medical schools to revise technical standards and disseminate information about requesting accommodations for disabilities in easy-to-find locations.

References:

• AMA policy. Evaluate Barriers to Medical Education for Trainees with Disabilities D-90.990. https://policysearch.ama-assn.org/policyfinder/detail/D-90-990%20?uri=%2FAMADoc%2Fdirectives.xml-D-90.990.xml Accessed Aug. 12, 2022.
• Marzolf BA, et al. Ann Fam Med. 2022;doi:10.1370/afm.2824.