Text only versionAHEAD 2017
Learners and Physicians with Disabilities: Accessibility, Action, and Inclusion in Medical Education
Slide 1:
Learners and Physicians with Disabilities:
Accessibility, Action, and Inclusion in Medical Education
Slide 2:
LISA M. MEEKS, PHD
UNIVERSITY OF MICHIGAN
MEDICAL SCHOOL
NEERA R. JAIN, MS, CRC
UNIVERSITY OF AUCKLAND
FACULTY OF EDUCATION & SOCIAL WORK
Slide 3:
1. WHAT WE KNEW
Slide 4:
ACROSS SCHOOLS
Inconsistent policies and procedures
Inconsistent support
Lack of ADA understanding
Slide 5:
AD/HD 33.7%
Learning 21.5%
Psychological 20%
Chronic Health 13.1%
Visual 3%
Mobility 2.5%
Deaf or hard of hearing 2.2%
Other functional 3.9%
Overall 2.7% (0-12%)
Meeks & Herzer, 2016
Slide 6:
DRIVERS
Rights of STUDENTS
Benefit to PATIENTS
Near PEER learning
UNIVERSITY process
Image description: Black and white photo of a smiling young, white, male doctor. The camera angle is at his eye level. He wears scrubs and has a stethoscope around his neck. He is sitting and looking up at several doctors who stand, slightly out of frame wearing white coats.
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2.WHAT WE DID
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RESEARCH QUESTION
What are the lived experiences of students, trainees, and practicing physicians with disabilities through training?
Barriers
Supports
Recommendations
Image description: A young Latina woman sits at a table in front of a microphone. She is wearing glasses and has a chunky necklace and long wavy hair. Her hands are gesturing upwards and she is smiling.
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METHODOLOGY
Modified grounded theory
Semi-structured interviews
Open coding
Themes: Barriers, Supports, Recommendations
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3.WHO PARTICIPATED
Slide 11:
47 participants
17 Men
40 Women
17 Students, 15 Medical Residents, 15 Physicians
Slide 12:
Pie Graph depicting the number of participants who reported various types of disability:
Mobility: 10
DHOH: 9
ADHD: 8
Learning: 5
Chronic Health: 4
Psychological: 3
Visual: 2
Co-occurring
Psychological: 14
Learning disability: 5
Slide 13:
4.WHAT WE FOUND
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STRUCTURAL BARRIERS
Disability Services
Appropriate accommodations
Access to health and wellness support
Technical Standards
Access to accommodations for the USMLE
Access to community and support
Slide 15:
Disability Services
Knowledge
Collaboration
Clear policies
Nuance: Clinic & AT
Image description: Image of a young man with spiky hair wearing glasses. He is smiling and holding a sign above his head that reads: Today a #CreightonGrad tomorrow a #DeafDoctor
Slide 16:
“I remember citing the ADA and I was like, ‘I have a 504 plan,’ and she said, ‘What's the ADA?’ I thought, ‘How do you work in the disability office when you don't know what the ADA is?’ I felt like I gave up on that office immediately.”
Slide 17:
Access to Health & Wellness
Cost, distance, & time
Confidentiality
Image description: A young woman sits at a table in front of a microphone. Her hair is pulled back and she is gesturing with her hands. Behind her is a projection of live captioning.
Slide 18:
“[The mental health outpatient services] are on the same floor as one of the main rotations for all 3rd and 4th year medical students. . . I think the breaking point for me in terms of not wanting to go there for services was sitting in the waiting room and [a classmate] thought it was okay to just sit in the waiting room with me and try to have a conversation.”
Slide 19:
Technical Standards
Unnecessary organic TS
Lack of ADA compliance
Impact of bias of confusing language
Image description: A diverse group of people wearing white coats surround a patient on a table. Some are using stethoscopes and some have placed their hands on the patient’s body.
Slide 20:
“I was very concerned about disclosing any disabilities, or that I had accommodations for testing always, and that I did things a little bit differently. . . I know that many schools are very strict about the technical standards . . . there should be a disclaimer saying, ‘We have accommodations,’ or something, but there [were] no schools that put that [guidance about disability accommodations] in their program out there.”
Slide 21:
USMLE
Unnecessary wait time
Lack of communication
Time commitment
Lack of guidance
DS Knowledge
Image description: White text on a black background with an image of a crown at the top, reads: “Keep calm study really hard and get 278 USMLE Step 1-3”
Slide 22:
“I spent so much time on [my Step 1 personal statement] . . . The whole document at the end, I think it was 130 pages of documentation. . .The process is so involved. It actively detracts from. . . your ability to progress through school. If you’re dealing with disabilities, things are already harder for you. . . In addition to it, you have a whole 130 pages to write and collate and put together and organize, and send forth, etc. You’re putting yourself at an even greater disadvantage. Forget the disability. It’s like a double disability. I had a very negative experience.”
Slide 23:
Effect of Culture and Climate
Role of program climate
Impact of attitude on lived experience
Knowledge of disability
Role of interpersonal relationships
Impact of supportive administration
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“In most hospitals, there's a lot of talk and people will find out [about the disability], but you are just hoping to prove yourself enough that they can say, ‘Okay, well, she's very smart. She's very good with patients. She knows her stuff. She works well. We don't care if she has whatever.’ It almost feels like you have to prove yourself extra to get to that point where people accept you.”
Slide 25:
Attitudinal Barriers
Stigma
Disclosure
Clinicalized culture
Twice as good
Peers
Specialties
Image description: Image of a young white man wearing a suit and tie and glasses. He holds his left hand up to emphasize a point.
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Stigma in admissions
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Needing to be twice as good
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SUPPORTS
Program culture
Mentors
Knowledge of disability
Supportive administration
Appropriate accommodations
Shared experiences
Slide 29:
Program Culture
Climate
Attitudes
Evaluation of supports
Reputation
Image description: A young, white woman wearing glasses with long brown hair sits behind a microphone. Her left hand is pointing towards the ceiling. She sits in front of a projected PowerPoint slide on which we can read the words “importance of self care and a supportive team”
Slide 30:
“The admissions dean, the dean who interviewed me . . . she is a big reason why I loved [the school] right away. Her attitude about everything and really the whole admissions office, their whole attitude…Everybody was just very supportive, and very much, ‘Whatever we have to do to help you, we’ll do and it’s not a big deal.’ I think it was a part of it…the attitude about the disability, and it wasn’t a big deal to anybody…in the program.”
Slide 31:
Mentors
Physicians
Peers
Medical school personnel
Image description: Image of Dr. Philip Zazove examining a patient. He wears a shirt, tie, and white coat, and his stethoscope is seen around his neck withsmall stuffed animals clipped to it. He is pointing an opthalmascope towards the patient, whose back is to us.
Slide 32:
“I was advised by a number of people that medicine was a very unreasonable occupation for me… I sought out a network and tried to find other people like myself that were successful in their careers… it was helpful to me to see people who were succeeding. I started to think more seriously about medicine…I started shadowing patients to see if it was doable and reached out to other deaf doctors. Phillip Zazove was one, I read his book, When the phone rings my bed shakes and reached out to him early on.”
Slide 33:
Knowledge of Disability
Admissions
Open dialogue
In support roles
Image description: A doctor using a standing wheelchair wearing a surgical mask and cap is seen in the process of donning a surgical gown with assistance from two people who are also wearing scrubs and other protective surgical gear.
Slide 34:
“Applying for a career in medicine—especially surgery—with an [apparent] disability, it’s obviously a part of the discussion. It’s obviously something that’s going to come up. And if it doesn’t come up, then it almost feels that—that the whole process is disingenuous. There are places I would go where people were obviously trying to dance around the issue and would have wanted to ask about it, but didn’t ask about it. And that, to me, does both of us a disservice, because I know it’s there, you know it’s there, and you might as well talk about it. . .”
Slide 35:
Supportive Administration
From the top down
Positive interactions with DS
Image description: Image of Dr. Christopher Moreland wearing a white coat, shirt and tie. He stands in front of a white board and he is gesturing towards it.
Slide 36:
“[The DS provider] was just so kind and welcoming, and he made it easy. He was so nice, so cheery, even in his email, and just welcoming. I had to fill out a one-page form or something, that was it. I was like really? Are you sure? I had to forward him whatever documents I had. There weren't even requirements for which documents. He asked what accommodations did I think I needed, and there was no question of my motives.”
Slide 37:
Knowledge and Support of DSPs
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Appropriate Accommodations
Innovative & effective
Simple solutions
Ease of access
Knowledge of clinical accommodations & medicine
Meaningful access
Image description: Image of a ThinkLabs amplified stethoscope
Slide 39:
“There was no question in either of our minds, I was not going to be an anesthesiologist…but he set out, and spent the entire rotation, trying to give me the richest experience possible. It was amazing. Before they had all those monitors, the anesthesiologists all wore a little earplug with a tube down to basically a stethoscope that they would tape on to the patient's chest. They would just listen to them breathe and listen to their heartbeat throughout the whole surgery…. He dug one of those things up and it's like this is how we used to do it. You do it this way.”
Slide 40:
Shared Experiences
A network
Student organizations
Image descriptions: two young women wearing glasses and dresses are smiling, mid-conversation. One is taller and leaning against a podium. The other is shorter and has one hand on her hip, the other rests on the podium.
Slide 41:
“One thing that I was talking about last week with the Dean for Diversity and Inclusion was how there is a lack of a national organization for students with disabilities, similar to how there are for underrepresented groups in medicine. . . We thought that would be something to explore to try to normalize the culture a bit more, towards including people with disabilities.”
Slide 42:
4.WHERE TO FROM HERE?
Slide 43:
Training the next generation of DSPs in health science
Image description: a group of 26 people stand holding copies of the book “The guide to assisting students with disabilities: Equal access in health science and professional education”
Slide 44:
Amplifying student voices
Image description: A group of 6 young men and women sit at a long table with microphones in front of them. A sign language interpreter is seated with them, interpreting the conversation. Projected above their heads is a PowerPoint slide titled “Physical and sensory disabilities in the clinic: A panel discussion”
Slide 45:
INSTITUTIONS
Culture
Program assessment
Training
Disability in diversity
DS Providers
Image description: close up image of a stack of books with a stethoscope draped over them.
Slide 46:
With thanks to:
RESEARCH TEAM
Stacy C. Jones, Harvard Medical School
Mijiza M. Sanchez, EdD, Stanford University School of Medicine
Alice Wong, MS University of California, San Francisco
FUNDERS
Association of American Medical Colleges
UCSF School of Medicine
RESEARCH PARTICIPANTS
Slide 47:
Image credits:
CNN. (2015). [Untitled image of Philip Zazove]. Retrieved from:
Hearing and Vision Center. (n.d.). Retrieved from:
Hospitalist. (2014). [Untitled image of Christopher Moreland]. Retrieved from:
Kartushka. (2016). Keep calm…USMLE. Retrieved from:
Richards, E. (2014). [Untitled image of Chris McCullough]. Retrieved from:
[Untitled image of Michael Argenyi]. Retrieved from:
Various images and video material by University of Central Florida, College of Medicine (2017). Used with permission. Do not duplicate.
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