Episode 34: Dr. Laura Bulk

In this podcast, Dr. Meeks and Bulk discuss the experiences of disabled learners in health professions, how to create a more inclusive environment in health professions education, and the emerging research on the value of #DocsWithDisabilities in healthcare professions. Dr. Bulk also recounts her own stories and struggles as a blind individual in Occupational Therapy.


Laura Bulk, PhD, Accessibility Advisor for students in health professional programs at The University of British Columbia (UBC).

Bio: Laura is a scholar, advocate, friend, learner, woman, teacher, mentor, daughter, accessibility advisor, mentee, disabled person, occupational therapist (OT), Christian, artist, and activist. A self-described ‘hat rack,’ Laura wears many hats, playing numerous roles in her academic, spiritual, recreational, professional, and familial communities. Often found preparing food for a small gathering, a meeting with colleagues, or a community event, Laura aims to contribute to shaping a more hospitable world for everyone wherever she can. Her heart for hospitality and belonging is reflected in her academic and advocacy work with the disability, higher education, and health professional communities. As the Accessibility Advisor for students in health professional programs at The University of British Columbia (UBC), she has the privilege of coming alongside learners and programs to explore how health professions education can be more hospitable and accessible to learners with disabilities. As a scholar, Laura is a Visiting Postdoctoral Fellow with the AcTinSite project exploring access in clinical education; she is the Principal Investigator on a justice, equity, diversity, and inclusion action-research project focused on Vancouver Community College's BScN program; and she is a collaborator on a series of projects pushing toward great access for health professional students with disabilities based at UBC, which includes the use of research-based theatre. She obtained a Bachelor's of anti-oppressive Social Work from the University of Victoria, and her Master of Occupational Therapy from UBC. Her doctorate focused on sense of belonging in higher education spaces - for staff, faculty, and students, and for disabled and non-disabled people. Laura is passionate about public scholarship, and as such her dissertation (Being Blind and Belonging in Academia) includes a workshop that she continues to facilitate in various institutions and settings, as well as research-based audio theatre collaboratively created with other members of the disability community. Laura also serves as a board member on the Coalition for Disability Access in Health Science Education’s Board. She is grateful to the Indigenous Peoples who have cared for the lands on which much of her living and working happens, including the Sḵwx̱wú7mesh (Squamish), Stó:lō and Səl̓ílwətaʔ/Selilwitulh (Tsleil-Waututh), xʷməθkʷəy̓əm (Musqueam), and W̱SÁNEĆ Nations. Some keywords that describe her work include belonging, #HigherEd, health professions education, teaching and learning, accessibility, palliative care, occupational science, #DisabilityAsDiversity, allyship, and solidarity. 


Audio transcript

Lisa Meeks:
Doctors with disabilities exist in small but measurable numbers. How did they navigate their journey? What were the challenges? What are the benefits to patients and to their peers? What can we learn from their experiences? My name is Lisa Meeks, and I am thrilled to bring you the DocsWithDisabilities podcast. Join me as I interview Docs, Nurses, Psychologists, OT’s, PT’s, Pharmacists, Dentists, and the list goes on. I’ll also be interviewing the researchers and policymakers that ensure medicine remains an equal opportunity profession.
Sofia Schlozman:
Hello, and welcome back to the Docs with Disabilities podcast. My name is Sofia Schlozman, one of the show’s co-producers, and I’m so excited to introduce this episode’s guest: Laura Bulk. Dr. Bulk is an occupational therapist, a researcher, and an outspoken advocate for greater inclusion and diversity in clinical and academic communities.
In this episode, Dr. Bulk and Dr. Meeks engage in a rich discussion on a multitude of topics, from the value of diverse perspectives in healthcare professions to a discussion of professional identity and Dr. Bulk’s own professional journey.
Listen or read along as we begin with Dr. Bulk’s introduction and a conversation about why it is so important to view disability as a valuable component of diversity in healthcare communities.
Laura Bulk:
I am Laura Bulk, and I'm an occupational therapist. I have been for only about six years. I also have my bachelor's in social work, so kind of have a combined background of different professions. I also identify as a blind person I'm partially blind, um, and, uh, I use identity-first language, um, because being blind is a positive part of who I am and it's part of what makes me-I think- a good OT.

I’m basically a hat rack. I wear a lot of different hats, so I am also doing my PhD, hopefully finishing up soon, and I focus in that work on sense of belonging. And I also work as the accessibility advisor for students with disabilities in health programs at the University of British Columbia, so that’s one of the hats I wear. And I also have been involved in research and advocacy around the inclusion of disabled people in health professions for almost a decade.
Lisa Meeks:
I just know the listener is going to absolutely love everything that you have to share with them. In your introduction, you really laid out your approach. You endorse making sure that disability is seen as this positive addition to diversity. But Can you tell us a little bit more about your philosophy to that and in particular, how that applies to the health professions?

Laura Bulk:
I very much am trying to convey to people, whether it's people I'm working with who are disabled people, themselves, or other colleagues, and that kind of thing that really disability is diversity, not deficit. And I find in my work I need to respect the perspectives of all the disabled people I work with, or who are out there in the world. And so, I try to balance respecting their perspective and where they're coming from with sharing my perspective and how I have felt empowered and emancipated by this idea that disability is a positive part of my diversity. And particularly in the health professions, evidence is showing us more and more that diversity, so important diversity of thought and perspective and approach to solving the challenges that we encounter in healthcare professions. And so, disability is one of those perspectives.

As disabled people, a lot of us have grown up and been socialized in a world that was not designed for the widest possible variation of the human body-mind experience. And so, we've had to problem solve, we've had to make accommodations for the world that was not designed for us, and we take often that same perspective and approach and creativity and innovation to the work that we do as health professionals.

And then I also think about, uh, the folks out there who might be accessing the services of a health professional and how it increases this comfort level of talking with someone who, “Oh, yeah, okay, so you also have some of this same experience of needing to move through a world that is not necessarily designed for me.”

It's something I think that cuts across disability categories, so to speak, we like to categorize things and people, but it's, it's that shared experience of resilience and adaptation. I talk about blindness as it's not, I'm not a sighted person missing my sight; I'm a blind person, and that is a different thing. And that is a unique perspective that isn't just lacking sight.
Lisa Meeks:
I think there's something that's very sacred and trust-building when your provider has been through similar types of learned experience of disability, even when it’s not the same category of disability.
Laura Bulk:
Yeah, absolutely. There's that, that trust. And I think also, I often think of the humor and the jokes that I do with people that is different. I think if you are not a disabled person. I think of some of the work I've got to do in my Ph.D. research even and thinking about sitting around a room with a bunch of blind people and the, the jokes we make and the humor and the kind of that shared understanding that sometimes doesn't even need to be spoken or laughing at “Oh, goodness, I've encountered that same thing.” And of course, it's different when you're a healthcare provider. There is a different relationship than when you're just sitting around and talking with friends. But there is still an opportunity to have this connection on a very human level that is maybe more difficult to get with someone when you don't have something like that in common. I mean, we can find something in common with anyone. We can always, almost always find a point of commonality, but I think it's just maybe easier and faster, and sometimes may be more powerful when you connect on something like being a disabled person. And there's something about having that shared difficult experience that makes it easier to jump to that trusting connection that is so valuable in an interaction with a client or a patient.
Lisa Meeks:
You know, I think in health provider professions people are often seen as these superhumans and that in and of itself removes them from the patient. But having this shared experience of disability, perhaps it builds some trust and encourages the patient to be more open in their communication and in expressing symptoms or concerns. I honestly believe that in the end, we’re going to be able to show empirically that this trusting relationship is going to lead to better care. And if it leads to better care, more accurate care, because of the patient’s willingness to trust the provider, we’re going to see better health outcomes.
Laura Bulk:
Yeah, absolutely. And that research is happening and it's coming out and it's becoming more widely known by people beyond this group that health outcomes are improved when we have a more diverse healthcare workforce and particularly diverse in terms of disability. So, it's exciting that finally the scientific evidence is catching up and it's interesting that we place value on that way of knowing.

Sofia Schlozman:
Dr. Bulk and Dr. Meeks now shift to a discussion about how to increase accessibility to healthcare professions and encourage a sense of belonging within these spaces for individuals with disabilities. Listen or read along as they discuss changes at an institutional and a cultural level, the voices and perspectives that are important to include in these conversations, and how increasing one’s own awareness about accessibility and inclusivity can positively impact how one views the world.

Lisa Meeks:
So, Laura, you write about the barriers, even within the institution. This idea that, coming into the health professions, that a student might not be able to navigate it as easily as, you know, announcing that they have a disability, and they’re going to come into the program, they’ll disclose, and get the accommodations and support that they need, and that everything is going to be wonderful and accessible.

In your paper, you actually shine quite a light on the dysfunction that is present in the system and the accompanying systematic barriers. Would you like to speak to that a little bit more?
Laura Bulk:
Those systems pieces are definitely so important to be thinking about. Systems of making accommodations for systems that are not accessible, for example, I like to think of accommodations as you're accommodating an inaccessible system. We're not making an accommodation for the person, we're making the accommodation for the system because the systems and the thing that's, that's broken. But I always, and I always go back to this idea that while systems are very important and we need to be shifting those, if we don't change people's hearts, we'll never create a place where all of us can belong and can have opportunity to serve as healthcare professionals or health and human service professionals.

I feel like the work needs to happen from so many different angles. And one of those is working on those systems. but systems so often represent the hearts of the people who create and maintain those systems. So, we also need to be working on shifting people's perceptions, their hearts toward, toward other humans, trying to move toward a system where I, as a disabled person or the disabled learner, is not always having to ask. It reminds me of some of the stories from my dissertation research where we talked a lot about belonging and these ideas came out to about if I'm always having to ask for something, always having to remind them to send me the slides ahead of time. Then it starts to make me think “Maybe I am too much trouble. Maybe I am a bit of a hassle. Maybe I don't really belong here”. So, when we're always having to ask for these things and starts to really wear down on you. And, and so I think, yes, it's important for us to think about how can we design things so they are open to a wider range of, of human body-mind experiences, balancing that with the idea that accommodating isn't having accommodations, isn't a bad thing.

Lisa Meeks:
Absolutely. And I think so often the systems that we have in place, depending on your institution, it could be very empowering to be a person with a disability and allow them to flourish and have complete access and accommodations are not a big deal.

And then, of course, there are systems where this isn’t normalized, and students have poorer experiences. You really need to start to change the culture and make help-seeking an active part and a normative part of the culture, but also to infuse as much accessibility into the system as possible.
Laura Bulk:
I think of one strategy I use with introductions for workshops that I do, we go around and we each share our name, our pronouns for the space, our traditional territory that we are from. Um, and if our access needs are being met, and often we'll go around the circle and a lot of people will say, I don't have any access needs. and then at the end I hand out pieces of paper and say, okay, we're going to go around. And each of us will read a sentence. And then I turn off all the lights. Um, and I ask the first person to read the sentence and they can't because it's 2-D print and they don't know how to read braille. And then I say, “are your access needs being met?” And so creative things like that, I think can be really helpful in those spaces where it is really compliance, driven, to start to make the shift. And I really recognize that the people working in the institution, it's not their fault. A lot of people working in those compliance-driven institutions, their hearts maybe have shifted or are shifting. So, I think another piece that we can work on is finding creative ways for folks working in those compliance-driven systems to do more than compliance.

Lisa Meeks:
One of the things I feel like you’re getting at is the concept of ableism, and when you talk about it, people will always say, “I'm not ableist, I don’t do ableist things, I care about and am aware of the barriers in place for my friends or my colleagues”, but the reality is, we all come to the place from our particular experiences, our exposure to individuals with disabilities, what that looked like, our knowledge of disability, and how we experience the world every day. And we’re not going to necessarily think about disability in the way that we need to, to remove barriers. So, reframing and getting people to reshift their focus and think about how barriers work with other people and how it impacts other people is important. We need for people to have enough awareness that they start to have these ‘lightbulb moments’ where all of a sudden they’re thinking about systemic barriers as they’re planning curriculum or as they’re planning an event or planning a clinical experience. And they need to understand why some other ways of thinking would be considered ableist in nature.

Do you have any other thoughts about this?

Laura Bulk:
Yeah, you're trying to belong somewhere where your space was already taken before you even arrived. And then how do you then carve out a space of belonging in a place where they just can't imagine you being there and where you're this anomaly?

We need to be expanding our imagination. And you've talked to those times when friends of yours will start to notice inaccessibility, and I've had some experiences like that as well. That's another reason it's important to have us as a people with diverse experiences on things like boards or policy committees or whatever that may be because it'll catch on, it's contagious people around us, on those boards and committees will start to notice the inaccessibility.

And then I think also that representation piece. I, just as me as a disabled person with my individual experience, I am definitely the expert in my experience. And I think it's also important to think about, um, the other expertise that people gain. So, someone who's a disabled person and they're involved in disabled community, um, and get to know other people and they start to maybe notice different kinds of accessibility and inaccessibility because they're hanging out with other disabled people who have other experiences. And I think that's, that's kind of important to think about too when we think about representation at those decision-making levels. Whereas if I am a disabled person with my experience, but I don’t learn from other disabled people, I think that's a loss for that disabled person because they are not getting to engage in disability culture in the same way and they're not getting to, I guess, notice those different aspects of accessibility.

I always say like as a disabled person, I’ve grown up in a world that is ableist, that promotes the able-bodied mind as the ideal. And I've grown up in a world where disablism exists. So, the thinking that disabled people are inferior. So, I've grown up with these things and I don't always know how they exist within me. So, I will say something that is ableist or disablist in nature. That'll happen because I only have my experience to go on. And hopefully more and more I'm learning from the expertise of other people and building my own expertise. And so more and more, I will not say those disablist things or ableist things or think them. As disabled people, we are not immune to having those perspectives either.
Lisa Meeks:
Laura, you know I am a super fan, and I really appreciate and respect that you are speaking so freely about this experience and how you situate ableism. I think this is really going to encourage people to consider that just because they’re a person with a disability, it doesn’t mean that they know everything about disability or that they can assume that the experiences are similar.

I certainly have learned a lot, and one of the mechanisms that I employ that I think has allowed me to grow in this space is actively inviting people to provide feedback to me. So not only am I inviting feedback, but I also have a core group of people that are coming from different experiences that I actively invite to call me out when I’m missing the mark. And I often will also go to them for advice or direction as I am thinking through the issues of access and inclusion in health professions education.

Even within the disabilities space, we need to make sure that we’re not missing something, that we’re not misrepresenting something among individuals that are in this population. I work so diligently to try to make space in this area, and it’s important to me that, as I’m doing this work that I’m including multiple people with disabilities, that these individuals are at the table, making policy, making procedure, informing all the work that is being done. I think that is the only way that we’re going to move forward in a meaningful, informed manner.

Sofia Schlozman:
In this next section, Dr. Meeks and Dr. Bulk explore the concept of allyship. Listen or read along as they consider the relationship between one’s identity and their role as an ally and the question of what it means to be a good ally.

Laura Bulk:
I've been part recently of starting a network of health professionals and their allies who have disabilities. And we kind of had this conversation and it's an ongoing one about allyship. And the question was, well, if I'm checking off a box, if I'm an ally or a disabled person, but I can't check both. And I thought, “Oh yeah, I guess that's true.” For me, I think this relates again to that representation conversation and thinking about being a disabled person or not disabled person. I think that's an important conversation to have. And I think it's important to think about if the individual who is coming in as a representative is an ally or not, because I could be a disabled person who only thinks about my own experience, um, who maybe thinks disability is a deficit in need of a cure. And that disabled person is not an ally, and I would not want them there representing disabled people. Whereas us, someone like yourself who doesn't identify as a disabled person, but comes with, the perspective that disability is part of diversity and who is kind of an open receptacle of stories and knowledge from disabled people and to see disability community, that person is an ally, and I would want them there representing disabled people. So that representation conversation is that it's not just about identity in terms of disabled non-disabled, it's about being an ally, and do you embody that identity of an ally? And I think that's more important in so many ways.
Sofia Schlozman:
In this next section, Dr. Meeks references one of Dr. Bulk’s recent articles: a 2019 publication in Advances in Health Sciences Education titled “Disabled healthcare professionals’ diverse, embodied, and socially embedded experiences”.
Lisa Meeks:
Laura, your 2019 article in Advances in Health Sciences Education is amazing. I love it, I suggest everyone read it. It tells us the story of what people are experiencing, and in this article, you talk about something that is becoming increasingly important in medical education for all students, those that are disabled and those who do not identify as having a disability, and that is professional identity. So, you talk about this idea that you become, or you start to embody, the elements of the profession, whether that be being a physician, or a nurse, a physical therapist, an occupational therapist, and how that might be different if you’re a person with a disability.

Can you talk about that a little bit more?

Laura Bulk:
Yeah. Okay. So, professionalism, professional identity, these, these concepts are talked about an awful lot, whether we understand what they mean is another question or have a shared understanding of, of what they mean. I think part of that identity formation, their professional identity formation, relates to belonging and I want to belong to this community of occupational therapists. And so, I want to embody the ideal occupational therapist I want to, I want to be that so that I can belong to this community. And so often in the professions, there are sort of antiquated ideas of what that professional looks like. And we can just use a search engine and look for images of various professionals. And often we get those, those stereotypes, or those antiquated notions of what it means to be a healthcare professional. And so often those things are incongruent or perceived as incongruent with being a disabled person. So, if I am someone who perhaps uses some assistance with my self-care activities, does that mean, I can't also be a person who assists others with some of their health and wellness? Well, no, but so often it that's, that's how it seems. And it goes again, back to this idea of imagination.

We can't imagine certain bodies and minds fitting into the professional mold of, of these healthcare professions and, and we need to be expanding our imagination beyond what those molds currently are or have been for too long. And I think that's happening. And I think part of doing that is, is kind of breaking the walls, so to speak and is, is having disabled body-minds in those spaces and helping to recreate and reimagine what this professional identity is.

But that's hard work. and as the pioneers, so to speak that that's really hard work, and I acknowledged that. And, for those learners and professionals out there who are doing that work, I really, I commend you and I encourage you to keep doing it, to take a break when you need to take a break as well. and I also encourage you that you're not alone in that there are more people and it could be the person sitting in the office next to yours, and you just don't know, which, which also kind of breaks my heart a little bit, that we keep silent about our experiences and in that way we reify or, or make real that, that old antiquated notion of what the healthcare professional is when we take our disability, but kind of squished it into, um, that old mold, um, rather than breaking it and, and creating something new.
Lisa Meeks:
Thank you so much for that explanation. You know, I think when students with disabilities don’t see people like them or know that there are people of similar experiences in the profession, it makes it hard. I think you can absolutely say that it’s about belonging. You know, if you don’t feel like you belong, if you can’t situate yourself, or put yourself into this construct of the profession, it can make it very difficult. And I think often, these students feel like outsiders, and that’s hard, and it’s especially hard for those individuals who are multiply marginalized, whether you are disabled or your part of an underrepresented group because of your ethnicity or gender identity or sexual orientation. I think it can make it difficult to feel like your part of this profession when there are not many people who look like you or are similarly represented in the profession.

Sofia Schlozman:
Dr. Meeks and Dr. Bulk now shift to a conversation of Dr. Bulk’s own experiences. Listen or read along as they discuss Dr. Bulk’s journey to occupational therapy and research, with a focus on specific moments that have been particularly impactful to how she views her work.

Lisa Meeks:
So, I guess the question that makes the most sense is, how do you embody the idea of an OT, how did you come to this professional identity and how did you form that identity as a person who is blind and someone who is doing occupational therapy?

Laura Bulk:
Yeah, that's a great question. I think I didn't think about it when I was going into it. I didn't even know OT existed when I first started pursuing that journey. I, back in high school, said, you know, I want to help other disabled people in skills and the confidence that they need to thrive. Because I had met so many people throughout my life who had disabilities and were not thriving or not living the lives they desired, and communities that were missing out on these incredible people because they just weren't given the chance to be part of their wider communities. So, I thought I'm going to invent a profession, I got to figure something out so that I can, I can do this work. And someone introduced me to OT, and he was like, Oh, that's what it is.

I’m very blessed to be surrounded by people throughout my life. I give so much credit. I always want to say, I thank my mom and my dad, they, I think always expected me to amount, to something, so to speak so often disabled people are not expected to amount to much. You know, of course you can wash dishes just because you can't see if they're clean doesn’t mean you can't do that too. And, you know, you fell occasionally. Well, you learned, and you got back up again. So even from my childhood and then into all the way into OT school, I also was blessed to be in a space where there were allies around. And, so I think that's, that was part of it for me. and I acknowledged that there are folks who've tried to be part of the OT profession as disabled people and have not had as positive experiences. So, I do acknowledge that.

For me, it was also about imagining different ways of doing things. And so, it was never, Oh, I can't do that. It's always just been, “well, how am I going to do that?” Because, you know, just figuring it out. and I think that is something that was ingrained in me from childhood and perhaps as one of those gifts of being a disabled person is that creativity and that kind of, well, I'll just figure out how to do it. Perhaps also a combination you have nature and nurture, I, again from, from childhood never kind of felt phased by the stigma I did encounter or the low expectations some people did have. I've always just been able to look past them so to speak or, you know, I don't see that well, I just didn't see those stereotypes standing in my way, so perhaps that's part of it.

I think having a well-established identity, I think is, is, is part of it too, my identity as a disabled person, but my whole identity, I think having that foundation was helpful for me going into OT school and then being able to just kind of build on the identity that I already have and add this other hat or other piece to my identity.
I went to the University of British Columbia on Muskegon territory. And I think that I had an overall positive experience. I talked about there being allies there already which was very positive for me. thinking about accommodations. I think some of them we figured out as we went along, what was needed, which is, is sort of to be expected because I didn't know what field work would be like, so it's kind of hard to set up all the different accommodations, so there's that piece of it.
I think there was a lot of flexibility and conversation, and that was a very positive part of my experience. I had some challenging experiences too. I had one particular field work experience that was very challenging. This was my second to last placement. and I was just in my last week of that placement and I woke up Monday morning and my vision was like half of what it usually is. My eyes were just so blurry. And so, I called my eye specialist and made an appointment for later that morning I went to placement and I was just sort of trying to make it through the morning and adapting as I went and that morning, I was going to shadow someone on another unit, and I went over to the unit and I put myself down next to their clients. And we started chatting and I said to him, “I know my eyes are red, but it's not contagious. It's normal. I just have a flare-up of this condition that I have.” And he's, you know, laughs, and says, “yeah, they're like the color of my shirt.” And I was like,” yeah, don't worry It's not pink eye.” And so, we kind of laughed about it and kept having a conversation. And at one point, I kind of said, “yeah, I'm just kind of trying to adapt to do things differently today because the methods I usually use are not working because of this flare-up.” And this individual who'd had a spinal cord injury, he kind of pauses. And he says, “huh, me too.” And it was this powerful moment of connection. We both had this, this experience of adapting, and, and completely different experiences, but, that shared experience.

Going through the rest of that week at the placement, because of this flare-up I was having, which was worse than anything I'd ever had before I was experiencing fatigue, which I had a little bit, but not to that extent. And by 10 o'clock in the morning, like usually I get up, I exercise, I do a bit of work. I go to placement over lunch break. Maybe I do a little bit of work on my research and then I go back to work and then I get home, I make dinner and then I do some more work and then I go to bed and get up and do it again.

This time by 10 o'clock in the morning, I was just like, I just need to lay down, close my eyes. I was just exhausted. And it was kind of ironic, but it was, it was great because at the time, the place where I was working, a lot of what I was doing was working with folks who live with fatigue for various reasons and doing like fatigue management and things like that. And so, it was so valuable to me to have just the taste--It only lasted six weeks--but I had a taste of that, that fatigue. Then I did finish out that placement, which was my second to last, which was great. And then I had a week off and I thought, okay, maybe the infection will get a little bit better during the week. It wasn't gone by the time my final placement started that it was, it was on its way to getting better. So, I was working on the placement and there were some challenges for sure because I was adapting. I was in a new placement setting that was quite a challenging type of setting for someone who's personally blind, plus I was adapting and managing this flare-up. But we did kind of find some ways to make things work. and my condition, the infection was getting better and better. And, then I went on a week away from the placement to present at our conference. And when I got back, the infection had flared up again and it was just really, bad. long story, not very short, the decision ended up being made that I would stop the placement then and do another week or two in the summer.

I ended up in the summer needing to do an entirely new placement in a different setting, which in the end was a good thing. I've thrived in this other setting and looking back, I think, given the flare up or not, I should not have been in that particular practice setting that I had been placed in for my final placement. It just really was extremely challenging, for me as someone with a different way of navigating in the world that involves being partially blind.

It was a really challenging experience. I was very upset that I had to do a whole other placement and wouldn't, you know, get to, um, have kind of that time off in the summer to work on my research and do all the other things I needed to do. But then I went to this other practice setting and it fit like a glove. I wouldn't trade the challenging experience. I don't think I would do things differently perhaps, because I think all things work out for the good in the end. but that's, I think a place where different kinds of accommodation could have been made had we had the understanding beforehand.

Sofia Schlozman:
In this final section, Dr. Meeks and Dr. Bulk transition to a discussion about how to encourage positive changes to improve accessibility. Listen or read along as they discuss the responsibilities of institutions, how to appropriately honor the work of disabled individuals, and Dr. Bulk’s advice for listeners.

Lisa Meeks:
So, do you think in this instance, it’s the responsibility of the program to learn from that engagement and to have this experience inform future placements and the way that students are placed, or the thought process or the procedure that is employed to determine where students should be placed?

I always feel like this is newer for some programs, so they almost have a two-fold responsibility. First, they have a responsibility to connect with other programs across the country and actively seek information about best practices. And I say actively because some people tend to default to perhaps their near peer institutions, and I think that when you cast a wider net, so actively seeking information, in looking in multiple different places across the country, whether this be about a modification or an accommodation or even just an approach for a learner, that to truly investigate it fully will help inform the program in a way that minimizes bumps in the road for the learner. And then, certainly, they also need to do a root cause analysis of when things go wrong and make sure that they’ve changed things in the system so that this can be, the barrier can be removed completely to avoid those “bumps in the road” for future students. So, the goal should always be, kind of, quality improvement, and quality improvement is certainly part of what we do in the health professions. So, it should be looking and actively seeking opportunities to improve the mechanisms by which you offer access to students with disabilities, but also looking actively, again, at ways to change the system so that we’re less reliant on accommodations so that the system itself is more accessible.

Laura Bulk:
I agree with you that it's, the program has a responsibility to seek out knowledge that has already been created. I think another responsibility of the institution and individuals within it is to be flexible and creative. I think I want to acknowledge that everyone is under constraints, whether it's the licensing body has not yet changed its policies and still puts up barriers to disabled people and the schools feel like they need to satisfy those things or time barriers and constraints, especially thinking of non-tenured faculty and instructors and the pressures that they face.

So, I acknowledge those things. and I think the institution's responsibility is to recognize and, and, um, value the work that people do to make their teaching practices more inclusive, um, or more welcoming of diversity and of diverse people. So, we're kind of in a, in a challenging place where the institution doesn't often live up to that responsibility, they don't value or remunerate or recognize the work that is involved in, in trying to find those resources in being creative and flexible and, and, and doing those pieces of being an ally that is not currently recognized I don't think anywhere by the institution in a tangible way. And I think there's also responsibility of peers and individuals to be flexible in our thinking and to be open to different ways of going about doing things.

As disabled people, we always sort of pay this minority tax and so to speak, or bear this burden of, um, may need to educate people around us, needing to try to think creatively about how we can do certain things, what kinds of accommodations might be possible. And so, I think there's another tension there in that I, as the disabled learner, want to be involved in figuring out the accommodations that are going to make this possible, but the work that I'm doing to do that, that's not recognized. And so, I thought, I wonder if there are creative ways that we can recognize the work that disabled learners do to figure out accommodations, in some way, give them that institutional recognition for the work that they do.


Lisa Meeks:
So, Laura, I close all my podcasts with the same question. I ask every interviewee if they can provide some sort of guidance, food for thought, on what they would consider the most important elements about entering a health professions degree program and for your audience, occupational therapy specifically, as a person with a disability. We love to get those nice little nuggets for mentoring.
Laura Bulk:
Well listeners, in thinking about my experience and learners that I work with I think it's important to remember our priorities and to really have those priorities and values set before we go down this path. And I think I say that because so often we can get lost in the struggle that it often is and the challenges and the joys that we find in learning and in becoming a healthcare professional. I think it's important to have those priorities and values in place so that you can go back to that and to have a support system in place.

So, for example, thinking about my own journey and having already an idea of who I am and what my identity is, and that I have been given unique value, whether I become an OT I am valuable. And the experience that I have and the gifts I must bring to the world are valuable, whether I become an OT and being able to keep falling back on that and keep going back to that and having people in my life who will say that to me, or who will reinforce my value was really, important. For me, the priority was never, I have to become an OT. I really wanted to, and, and that was the goal, but it was, you know, what, I am going to make a positive contribution, whether this path is the path. So, I encourage you to, to know your value, and keep coming back to that throughout your journey.
Lisa Meeks:
Laura, I love that. I don't think that sentiment has been expressed. And it's interesting. You thanked your squad, including your mom and dad and your family earlier for being your support system and, in listening to you give the listeners advice about your value as a person outside of anything that you’ve accomplished professionally, I just want to say, it really warms my heart. And, certainly, this idea that you were brought up with the unconditional belief that you are valuable, outside of anything that you accomplish, just for being you. You are a valuable human who will make a valuable contribution. I think that’s so important.

And I’m going to second your recommendation. I think that life is interesting. It has a way of taking us on a ride that we don’t necessarily plan. And sometimes learners come to the programs through a prescribed path, or a rigid path. This is something they’ve always planned to do their whole lives, but other times people get to us through circuitous pathways, and almost always they come with the most interesting stories about what brought them to health professions. And so, with so much hinged on completing this program, life has a funny way of taking out plans and tossing them up in the air, and sometimes things fall out differently but beautifully. And I think it’s really good advice that you’re giving the listener, to just keep perspective as you go through the program and that this doesn’t define you.

I just want to thank you so much for your time and for coming on the podcast and for sharing your experiences with our audience. I know that everyone listening today is going to benefit from reading or hearing about your story, which would have been enough reason to listen. But your unbelievable perspective as a person with a disability, as a researcher, as a disability resource provider, you just have such a wealth of experience and such diverse perspectives, and such a good heart. I’ve just really enjoyed talking to you and I know that our audience is going to enjoy you as much. I am very, very blessed to have gotten to know you better and to now be part of your circle, and I cannot wait to see all the wonderful things that you accomplish more professionally and personally, and I just really want to thank you for giving your time and sharing your talents with us today.
Laura Bulk:
Thank you so much, Lisa. I don't have a bucket list, but if I did, I would have just checked off one of the top items. It has been such a pleasure to talk with you, Lisa, and I want to thank you for being such a great ally to me as a disabled person and researcher and clinician, and an ally to the disabled community.

Sofia Schlozman:
To Dr. Bulk: thank you! Thank you for this rich and engaging conversation, thank you for so candidly sharing insights from your own experiences, and thank you for all the important work you are doing in this field.

You brought many fresh and important ideas to this episode that I have no doubt will be extremely valuable and impactful for our listeners.

To our audience, thank you for joining us. We hope you will subscribe to our podcast and join us next time.

This podcast is a production of the University of Colorado Anschutz Medical Campus SUMMIT program, the Stanford Medicine-Stanford Medical Abilities Coalition, and the University of Michigan Medical School Department of Family Medicine - M-Disability initiative. The opinions on this podcast do not necessarily reflect those of the respective institutions. It is released under creative commons, attribution non-commercial, non-derivative license. This podcast was produced by Dr. Lisa Meeks and Sofia Schlozman.

- “Aspire” by Scott Holmes
- “Donnalee” by Blue Dot Sessions
- “Gambrel” by Blue Dot Sessions
- “The Poplar Grove” by Blue Dot Sessions
- “An Oddly Formal Dance” by Blue Dot Sessions
- “True Blue Sky” by Blue Dot Sessions
- “Positive and Fun” by Blue Dot Sessions
- “Lovers Hollow” by Blue Dot Session

a. Resource 1: Story Collider Podcast, episode called Strangers (will go ‘live’ tomorrow https://www.storycollider.org/podcasts)

b. Resource 2: I have a few articles, not sure which we should promote.
Bulk, L., Easterbrook, A., Roberts, E., Groening, M., Murphy, S., Lee, M., Ghanouni, P., & Jarus, T. (2017). “We are not anything alike”: Marginalization of health professionals with disabilities. Disability and Society, 32, 615-634.
Battalova, A., Bulk, L., Mayer, Y., Hole, R., Krupa, T., Lee, M., & Jarus, T. (2019). “I can understand where they’re coming from”. How clinicians’ disability experiences shape their interaction with clients. Qualitative Health Research.
Bulk, L., Tikhonova, J., Mayer, Y., Batalova, A., Gagnon, J., Krupa, T., Lee, M., Nimmon, L., & Jarus, T. (2019). Disabled healthcare professionals’ diverse, embodied, and socially embedded experiences. Advances in Health Sciences Education. 25(1). 111-129. doi:10.1007/s10459-019-09912-6.

Bulk, L., Smith, A., Nimmon, L., & Jarus, T. (2020). A closer look at opportunities for blind adults. British Journal of Visual Impairment. https://doi.org/10.1177%2F0264619620911424.

a. Resource 3: Bulk, L. (2015). Disability and disclosure: A student perspective. Occupational Therapy Now, 17(6), 18-19.