Doctors with disabilities are rapidly changing stigmas, peer-to-peer learning, and outcomes for patients, yet remain underrepresented in the medical profession. Up to 10 percent of the U.S. population aged 18-24 has some type of disability, whereas only 2.7 percent of U.S. medical students have disclosed a disability. In a recent article published in Academic Medicine, an expert task force convened by the Association of Academic Physiatrists (AAP) recommend legal, cultural and technological advances to facilitate the inclusion of students with disabilities.
“It is abundantly clear that a more diverse physician workforce, one which reflects the demographics of the general population, is necessary to optimize health care outcomes,” explains Dr. Laura Kezar, lead author for the article. “Today, almost three decades after passage of the ADA, most medical schools do not provide a warm welcome to students with disabilities and such students are not typically included in their schools' diversity and inclusion efforts. These new Technical Standards guidelines update the critical first link in a process to promote inclusion of people with disabilities in medical education. As the leader of this task force, I am humbled to work alongside passionate educators to shine a bright light on an issue that has remained in the shadows for far too long.”
While medical students must meet academic standards for admission, they must also meet nonacademic requirements (called Technical Standards or TS) such as observation, communication, motor function and more. TS guidelines were first issued by the Association of American Medical Colleges (AAMC) in 1979, and, while they vary considerably by school, they remain the primary reference for medical school policies. These outdated TS can serve as a barrier to entry to the medical profession, causing bias and discrimination in the admissions process, lack of access to or knowledge of reasonable accommodations, and misconceptions about the ability of people with disabilities to function as physicians.
Co-author of the paper and the George A. Dean, M.D. Chair of Family Medicine, Philip Zazove, M.D. noted:
“The first year I applied for medical school, my grades were better than my peers and my MCAT scores were competitive. I was rejected and the admittance committee told me 100% it was because I was deaf. Updating technical standards is just the right thing to do. Why prevent someone who is very capable just because they have a disability? The more of us there are, the more people with disabilities think ‘I can do this too!’”
The task force proposes new language for the five TS categories and/or updating the content of each category to promote a functional approach. In addition, they advocate that medical schools monitor admission and retention of students with disabilities, ensure the accessibility of their TS to applicants and the public, clearly define procedures and decisions for accommodations, implement the principles of universal design in education, and other recommendations.
People with disabilities bring unique perspectives to medicine and help create a diverse workforce made up of culturally-competent practitioners that benefits their patients and their peers. Twenty-first century medicine must place a greater emphasis on competency-based skills that allow students to demonstrate their mastery of skills through alternative methods.
Article citation: Kezar LB, Kirschner KL, Clinchot DM, Laird-Metke E, Zazove P, Curry RH. Leading Practices and Future Directions for Technical Standards in Medical Education. Academic Medicine. 2018:1. doi:10.1097/acm.0000000000002517.
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