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Meeks LM, Bullock JL. Transforming medical education: Implementing 'disruptors' to break the cycle of ableism. MEDICAL EDUCATION 2024; 58:1023-1025. [PMID: 38775101 DOI: 10.1111/medu.15445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 05/09/2024] [Indexed: 08/16/2024]
Abstract
@meekslisa and @jbullockruns in @MedEd_Journal highlight the struggles of disabled students and call for strategic disruptions to dismantle ableism and foster inclusion in #HPE. #DocsWithDisabilities #MedTwitter #MedEd
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Affiliation(s)
- Lisa M Meeks
- Department of Learning Health Sciences and Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- DocsWithDisabilities Initiative, Chicago, Illinois, USA
| | - Justin L Bullock
- DocsWithDisabilities Initiative, Chicago, Illinois, USA
- Department of Nephrology, University of Washington Medical School, Seattle, Washington, USA
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Abdelghaffar W, Haloui N, Bouzid IM, Rafrafi R. Perception of Tunisian Medical Students with Chronic Conditions: Pilot Study. MEDICAL SCIENCE EDUCATOR 2024; 34:49-55. [PMID: 38510410 PMCID: PMC10948705 DOI: 10.1007/s40670-023-01884-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 03/22/2024]
Abstract
Background Medical studies are hard to manage especially for students with specific needs. These students warrant some adaptations in studies and trainings in order to achieve learning goals. Studies showed they face structural and cultural barriers and stigma. Current efforts aim to encourage integration of these persons in order to increase diversity. Objective This study aimed to assess perception of Tunisian medical students with specific needs. Method Cross-sectional study through online questionnaire including learners affiliated to the Faculty of Medicine of Tunis (students, interns, and residents) who consider they have specific needs. This questionnaire was elaborated by authors and explored barriers faced by participants, needed help, and suggested solutions. Study respected consent and confidentiality. Results This study included 40 participants. Most of them (n = 32) were post-graduate (interns and residents). The most reported condition was mental disability (n = 14). Main challenges faced by participants were work time schedule, unhealthy lifestyle, and negative attitudes from peers and supervisors, and 19 felt victim of stigma. Reported specific needs were adapting work schedule and psychological support from peers, from supervisors, or from mental health professionals. Almost half of the participants did never disclose their difficulties (n = 21). Suggested solutions involved to have a counseling center within the faculty. Only 8 participants knew there was a new unit helping students with specific needs in FMT. Conclusions Despite efforts of the university, medical learners with chronic conditions still face many structural and cultural barriers to inclusion. Most participants suggested to have more psychological support from faculty.
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Affiliation(s)
- Wafa Abdelghaffar
- Mental Health Department, Mongi Slim Hospital, La Marsa, Tunisia
- University Tunis El Manar, Tunis, Tunisia
| | - Nadia Haloui
- Mental Health Department, Mongi Slim Hospital, La Marsa, Tunisia
- University Tunis El Manar, Tunis, Tunisia
| | - Ines Meriem Bouzid
- Mental Health Department, Mongi Slim Hospital, La Marsa, Tunisia
- University Tunis El Manar, Tunis, Tunisia
| | - Rym Rafrafi
- Mental Health Department, Mongi Slim Hospital, La Marsa, Tunisia
- University Tunis El Manar, Tunis, Tunisia
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Nuechterlein A, Barretto T, Yehia A, Illes J. Bridges of perspectives: representation of people with lived experience of spinal cord injury in editorial boards and peer review. Res Integr Peer Rev 2023; 8:12. [PMID: 37730666 PMCID: PMC10512589 DOI: 10.1186/s41073-023-00138-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/10/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Diversity among editorial boards and in the peer review process maximizes the likelihood that the dissemination of reported results is both relevant and respectful to readers and end users. Past studies have examined diversity among editorial board members and reviewers for factors such as gender, geographic location, and race, but limited research has explored the representation of people with disabilities. Here, we sought to understand the landscape of inclusivity of people with lived experience of spinal cord injury specifically in journals publishing papers (2012-2022) on their quality of life. METHODS An open and closed 12-question adaptive survey was disseminated to 31 journal editors over a one-month period beginning December 2022. RESULTS We received 10 fully completed and 5 partially completed survey responses (response rate 48%). Notwithstanding the small sample, over 50% (8/15) of respondents indicated that their journal review practices involve people with lived experience of spinal cord injury, signaling positive even if incomplete inclusivity practices. The most notable reported barriers to achieving this goal related to identifying and recruiting people with lived experience to serve in the review and editorial process. CONCLUSIONS In this study we found positive but incomplete trends toward inclusivity in journal practices involving people with lived experience of spinal cord injury. We recommend, therefore, that explicit and genuine efforts are directed toward recruitment through community-based channels. To improve representation even further, we suggest that editors and reviewers be offered the opportunity to self-identify as living with a disability without discrimination or bias.
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Affiliation(s)
- Anna Nuechterlein
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, 2211 Wesbrook Mall, Koerner S124, Vancouver, BC, V6T 2B5, Canada
| | - Tanya Barretto
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, 2211 Wesbrook Mall, Koerner S124, Vancouver, BC, V6T 2B5, Canada
| | - Alaa Yehia
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, 2211 Wesbrook Mall, Koerner S124, Vancouver, BC, V6T 2B5, Canada
| | - Judy Illes
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, 2211 Wesbrook Mall, Koerner S124, Vancouver, BC, V6T 2B5, Canada.
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Meeks LM, Pereira-Lima K, Plegue M, Jain NR, Stergiopoulos E, Stauffer C, Sheets Z, Swenor BK, Taylor N, Addams AN, Moreland CJ. Disability, program access, empathy and burnout in US medical students: A national study. MEDICAL EDUCATION 2023; 57:523-534. [PMID: 36456473 DOI: 10.1111/medu.14995] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 05/12/2023]
Abstract
OBJECTIVE The objective of this study is to investigate whether self-disclosed disability and self-reported program access are associated with measures of empathy and burnout in a national sample of US medical students. METHODS The authors obtained data from students who responded to the Association of Medical Colleges (AAMC) Year 2 Questionnaire (Y2Q) in 2019 and 2020. Data included demographic characteristics, personal variables, learning environment indicators, measures of burnout (Oldenburg Burnout Inventory for Medical Students), empathy (Interpersonal Reactivity Index) and disability-related questions, including self-reported disability, disability category and program access. Associations between disability status, program access, empathy and burnout were assessed using multivariable logistic regression models accounting for YQ2 demographic, personal-related and learning environment measures. RESULTS Overall, 23 898 (54.2%) provided disability data and were included. Of those, 2438 (10.2%) self-reported a disability. Most medical students with disabilities (SWD) self-reported having program access through accommodations (1215 [49.8%]) or that accommodations were not required for access (824 [33.8%]). Multivariable models identified that compared with students without disabilities, SWD with and without program access presented higher odds of high exhaustion (1.50 [95% CI, 1.34-1.69] and 2.59 [95% CI, 1.93-3.49], respectively) and lower odds of low empathy (0.75 [95% CI, 0.67-.85] and 0.68 [95% CI, 0.52-0.90], respectively). In contrast, multivariable models for disengagement identified that SWD reporting lack of program access presented higher odds of high disengagement compared to students without disabilities (1.43 [95% CI, 1.09-1.87], whereas SWD with program access did not (1.09 [95% CI, 0.97-1.22]). CONCLUSIONS Despite higher odds of high exhaustion, SWD were less likely to present low empathy regardless of program access, and SWD with program access did not differ from students without disabilities in terms of disengagement. These findings add to our understanding of the characteristics and experiences of SWD including their contributions as empathic future physicians.
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Affiliation(s)
- Lisa M Meeks
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Karina Pereira-Lima
- Department of Neurology, The University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Melissa Plegue
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Neera R Jain
- Centre for Health Education Scholarship, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | | | - Catherine Stauffer
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
| | - Zoie Sheets
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Bonnelin K Swenor
- Johns Hopkins Disability Health Research Center, Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Nichole Taylor
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Amy N Addams
- Association of American Medical Colleges, Washington DC, USA
| | - Christopher J Moreland
- Department of Internal Medicine, Dell Medical School at the University of Texas at Austin, Austin, Texas, USA
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Roy-O'Reilly M, Salles A. Stigma Associated With Requesting Accommodations-the High Cost of Ableism in Medicine. JAMA Netw Open 2023; 6:e2312131. [PMID: 37166805 DOI: 10.1001/jamanetworkopen.2023.12131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Affiliation(s)
- Meaghan Roy-O'Reilly
- Department of Neurology, Stanford University School of Medicine, Palo Alto, California
| | - Arghavan Salles
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
- Clayman Institute for Gender Research, Stanford University, Palo Alto, California
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Pereira-Lima K, Meeks LM, Ross KET, Marcelin JR, Smeltz L, Frank E, Sen S. Barriers to Disclosure of Disability and Request for Accommodations Among First-Year Resident Physicians in the US. JAMA Netw Open 2023; 6:e239981. [PMID: 37166801 PMCID: PMC10176117 DOI: 10.1001/jamanetworkopen.2023.9981] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/12/2023] [Indexed: 05/12/2023] Open
Abstract
Importance Ensuring access to accommodations is critical for resident physicians and their patients. Studies show that a large proportion of medical trainees with disabilities do not request needed accommodations; however, drivers of nonrequests are unknown. Objective To assess the frequency of accommodation requests among first-year resident physicians (ie, interns) with disabilities and to identify possible drivers of nonrequest for needed accommodations. Design, Setting, and Participants As part of the Intern Health Study, a longitudinal cohort study of first-year resident physicians, residents at 86 surgical and nonsurgical residency programs in 64 US institutions provided demographic and training characteristics 2 months prior to matriculation (April-May 2021). At the end of their intern year (June 2022), participants completed a new survey with questions about disability-related information, including disability status, disability type, whether they received accommodations, and if not, reasons for nonaccommodation. Poststratification and attrition weights were used to estimate the frequency of accommodation requests and reasons for not requesting accommodations. Interns reporting at least 1 disability were included in the analysis. Main Outcomes and Measures Prevalence of reported disabilities, residency specialties distribution, frequency of accommodation requests, and reasons for nonaccommodation among resident physicians with disabilities. Results Among the 1486 resident physicians who completed the baseline survey, 799 (53.8%) replied to the disability questions. Of those, 94 interns (11.8%; weighted number, 173 [11.9%]) reported at least 1 disability and were included in the present study (weighted numbers, 91 [52.6%] men, 82 [47.4%] women, mean [SD] age, 28.6 [3.0] years). Among interns with reported disability and need for accommodations (83 of 173 [48.0%]), more than half (42 [50.6%]) did not request them. The most frequently reported reasons for not requesting needed accommodations were fear of stigma or bias (25 [59.5%]), lack of a clear institutional process for requesting accommodations (10 [23.8%]), and lack of documentation (5 [11.9%]). Conclusions and Relevance Program directors should investigate cultural and structural factors within their programs that contribute to an environment where residents do not feel safe or supported in disclosing disability and requesting accommodation and review their disability policies for clarity.
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Affiliation(s)
| | - Lisa M. Meeks
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor
| | | | - Jasmine R. Marcelin
- Department of Internal Medicine, University of Nebraska Medical School, Omaha
| | - Lydia Smeltz
- currently a medical student at Penn State College of Medicine, Hershey, Pennsylvania
| | - Elena Frank
- Michigan Neuroscience Institute, University of Michigan Medical School, Ann Arbor
| | - Srijan Sen
- Eisenberg Family Depression Center, University of Michigan Medical School, Ann Arbor
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Singh S, Meeks LM. Disability inclusion in medical education: Towards a quality improvement approach. MEDICAL EDUCATION 2023; 57:102-107. [PMID: 35837829 DOI: 10.1111/medu.14878] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
THE ISSUE The shift to a more diverse workforce that includes physicians with disabilities has gained considerable international traction. Indeed, disability inclusion is experiencing a renaissance in medical education. However, the philosophy of disability inclusion must be adjusted from one where disabled trainees are viewed as problematic and having to 'overcome' disability to one where institutions anticipate and welcome disabled trainees as a normative part of a diverse community. OBSERVATIONS Most trainees with disabilities will enter an unregulated, uninformed system leaving them vulnerable to under-accommodation, systems barriers and lack of informed support. Further, the perception of the super human good doctor creates disincentives for candidates to disclose their disability, creating structural barriers that the system needs to address. A less often discussed contributor to health care inequities is the inadequate training of health professional educators on disability rights and disability competencies. Indeed, the lack of education, coupled with minimal exposure to disability outside of the hierarchical patient-provider relationship, perpetuates to stereotypes and biases that impact clinical care. APPROACH Disability inclusion has not been reviewed through the lens of quality improvement. To close this gap, we examine the state of the science through the lens of disability inclusion and offer considerations for a quality improvement approach in medical education that addresses the global revised trilogy of World Federation for Medical Education standards of quality improvement at all three levels of education, training and practice. CONCLUSION We propose a vision of systems-based disability-inclusive, accessible and equitable medical education using 9 of Deming's 14 points as applicable to medical education.
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Affiliation(s)
- Satendra Singh
- University College of Medical Sciences, University of Delhi, Delhi, India
| | - Lisa M Meeks
- Departments of Learning Health Sciences and Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Dhanani Z, Huynh N, Tan L, Kottakota H, Lee R, Poullos P. Deconstructing Ableism in Health Care Settings Through Case-Based Learning. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2022; 18:11253. [PMID: 35601662 PMCID: PMC9072618 DOI: 10.15766/mep_2374-8265.11253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/09/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Patients with disabilities face health disparities, and providers with disabilities confront professional roadblocks and institutional bias. Yet their experiences are often excluded from medical education, and few case studies address culturally humble care for those with disabilities. METHODS We created two 1-hour case-based modules on disability and ableism from patient and provider perspectives. Modules were piloted in June 2020 and presented at two conferences in April 2021. Modules included a prereading, introductory disability presentation, and facilitated case discussions. Sessions were evaluated with pre- and/or postsession surveys. Modules were rated on 5-point Likert scales for educational value, professional growth contribution, and interactive/engaging design. RESULTS Participants rated the patient and provider modules 4.5, 4.4, and 4.4 and 4.5, 4.4, and 4.5 for the three categories, respectively. Participants noted that the sessions were insightful and validating and improved their understanding of ableism and the importance of disability curricula. There were significant improvements in participants' perceptions of ability to discuss ableism's impacts, recognize barriers, identify resource/support gaps for trainees, and advocate. A total of 171 participants completed our modules, with survey response rates of 38% (60 out of 160) and 48% (77 out of 160) for one conference and a postsurvey response rate of 64% (seven out of 11) for the second. DISCUSSION Designed for health care trainees, providers, administration, and staff, our sessions introduced concepts of ableism, accommodation, and health care barriers. Our results suggest the modules can contribute to professional growth, understandings of ableism, and participants' disability advocacy tool kit.
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Affiliation(s)
- Zainub Dhanani
- Third-Year Medical Student, Stanford University School of Medicine
| | - Nina Huynh
- First-Year Medical Student, A.T. Still University School of Osteopathic Medicine in Arizona
| | - Louis Tan
- Stanford Medicine Abilities Coalition (SMAC) Intern, Department of Radiology, Stanford University School of Medicine
| | - Harika Kottakota
- First-Year Medical Student, University of California, Los Angeles, David Geffen School of Medicine
| | - Rosa Lee
- Associate Medical Professor, Department of Medical Education, CUNY School of Medicine
| | - Peter Poullos
- Clinical Associate Professor of Radiology, Gastroenterology, and Hepatology, and Director, Stanford Medicine Abilities Coalition (SMAC), Stanford University School of Medicine
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Impact of USMLE Step-1 accommodation denial on US medical schools: A national survey. PLoS One 2022; 17:e0266685. [PMID: 35421144 PMCID: PMC9009603 DOI: 10.1371/journal.pone.0266685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 03/24/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION In 2019, 4.6% of US-MD students self-identified as students with disabilities (SWD); many of these students will require accommodations on the USMLE Step-1 examination. Given the high-stakes nature of Step-1 for medical school advancement and residency match, SWD denied accommodations on Step-1 face considerable consequences. To date no study has investigated the rate of accommodation denial and its impact on medical school operations. METHODS To investigate the rate of accommodation denial and evaluate whether Step-1 accommodation denial impacts medical school operations, a 10-question survey was sent to Student Affairs Deans and disability resource professionals at all fully-accredited US-MD granting programs. Two open-ended questions were analyzed using qualitative content analysis. RESULTS Seventy-three of the 141 schools responded (52%). In the 2018-2019 academic year, 276 students from 73 schools applied for Step-1 accommodations. Of these, 144 (52%) were denied. Of those denied, 74/144 (51%) were delayed entry into the next phase of curriculum and 110/144 (76%) took the Step-1 exam unaccommodated. Of the 110 who took Step-1 without accommodations, 35/110 (32%) failed the exam, and 4/110 (3%) withdrew or were dismissed following exam failure. Schools reported varied investments of time and financial support for students denied accommodations, with most schools investing less than 20 hours (67%) and less than $1,000.00 (69%). Open-responses revealed details regarding the impact of denial on schools and students including frustration with process; financial and human resources allocation; delay in student progression; lack of resourcing and expertise; and emotional and financial burdens on students. DISCUSSION Step-1 accommodation denial has non-trivial financial, operational, and career impacts on medical schools and students alike. The cause of accommodation denial in this population requires further exploration.
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Meeks LM, Stergiopoulos E, Petersen KH. Institutional Accountability for Students With Disabilities: A Call for Liaison Committee on Medical Education Action. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:341-345. [PMID: 34670236 DOI: 10.1097/acm.0000000000004471] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Medical educators and leaders have called for greater diversity among the physician workforce, including those with disabilities. However, many students with disabilities are precluded from entering and completing medical training due to historically restrictive technical standards and poor internal practices to protect student privacy. This limits the possibilities for growing this part of the workforce and making progress toward the ultimate goal of having a physician workforce that better represents the patients it serves. To achieve diversity among the physician workforce, medical education must create environments that allow students with disabilities to apply to, flourish in, and feel well supported in medical school. Recent additions to Accreditation Council for Graduate Medical Education requirements have helped to catalyze work in the area of disability inclusion by incorporating disability-focused mandates into graduate medical education accreditation standards. However, similar mandates for undergraduate medical education have not yet materialized. In this article, the authors call for the Liaison Committee on Medical Education (LCME) to elevate disability as a valued part of medical school diversity in its accreditation standards and to include protections for disabled students. The authors propose that the LCME can take 5 actions to promote institutional accountability toward students with disabilities: (1) define disability as diversity, (2) mandate disability support, (3) protect from conflicts of interest, (4) protect privacy, and (5) verify schools' technical standards comply with the Americans with Disabilities Act. By adopting these recommendations, the LCME would send the powerful message that students with disabilities bring welcome expertise and value to the medical community.
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Affiliation(s)
- Lisa M Meeks
- L.M. Meeks is adjunct assistant professor of family medicine, University of Michigan Medical School, Ann Arbor, Michigan, researcher, Center for a Diverse Healthcare Workforce, UC Davis School of Medicine, Sacramento, California, and associate professor of psychiatry, University of Colorado Medical School, Aurora, Colorado; ORCID: https://orcid.org/0000-0002-3647-3657
| | - Erene Stergiopoulos
- E. Stergiopoulos is a third-year resident, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0002-8039-872X
| | - Kristina H Petersen
- K.H. Petersen is assistant professor, Department of Biochemistry and Molecular Biology, and assistant dean of academic support, New York Medical College, Valhalla, New York; ORCID: https://orcid.org/0000-0002-1944-6972
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Meeks LM, Case B, Stergiopoulos E, Evans BK, Petersen KH. Structural Barriers to Student Disability Disclosure in US-Allopathic Medical Schools. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2021; 8:23821205211018696. [PMID: 34104788 PMCID: PMC8161841 DOI: 10.1177/23821205211018696] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/22/2021] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Leaders in medical education have expressed a commitment to increase medical student diversity, including those with disabilities. Despite this commitment there exists a large gap in the number of medical students self-reporting disability in anonymous demographic surveys and those willing to disclose and request accommodations at a school level. Structural elements for disclosing and requesting disability accommodations have been identified as a main barrier for students with disabilities in medical education, yet school-level practices for student disclosure at US-MD programs have not been studied. METHODS In August 2020, a survey seeking to ascertain institutional disability disclosure structure was sent to student affairs deans at LCME fully accredited medical schools. Survey responses were coded according to their alignment with considerations from the AAMC report on disability and analyzed for any associations with the AAMC Organizational Characteristics Database and class size. RESULTS Disability disclosure structures were collected for 98 of 141 eligible schools (70% response rate). Structures for disability disclosure varied among the 98 respondent schools. Sixty-four (65%) programs maintained a disability disclosure structure in alignment with AAMC considerations; 34 (35%) did not. No statistically significant relationships were identified between disability disclosure structures and AAMC organizational characteristics or class size. DISCUSSION Thirty-five percent of LCME fully accredited MD program respondents continue to employ structures of disability disclosure that do not align with the considerations offered in the AAMC report. This structural non-alignment has been identified as a major barrier for medical students to accessing accommodations and may disincentivize disability disclosure. Meeting the stated calls for diversity will require schools to consider structural barriers that marginalize students with disabilities and make appropriate adjustments to their services to improve access.
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Affiliation(s)
- Lisa M Meeks
- Department of Psychiatry, The University of Colorado, Aurora, CO, USA
- Department of Family Medicine, The University of Michigan Medical School, Ann Arbor, MI, USA
- Center for a Diverse Healthcare Workforce, University of California, Davis, School of Medicine, Sacramento, CA, USA
| | - Ben Case
- Department of Psychiatry, The University of Colorado, Aurora, CO, USA
- Department of Family Medicine, The University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Brianna K Evans
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kristina H Petersen
- Department of Biochemistry & Molecular Biology, New York Medical College, Valhalla, NY, USA
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