National Prevalence of Disability and Clinical Accommodations in Medical Education

Mental Health Nurses Who Experience Disabilities: Adapting to Workplace Barriers

Mental health nurses with disabilities experience discrimination and issues with inclusion and accessibility. Ten mental health nurses who self-identified with a disability were interviewed using interpretive description to gain insight into their experiences and to better understand practices that promote inclusion. Participants discussed challenges associated with the mental healthcare system, the need to adapt, and the importance of support and feeling accepted. To improve accessibility and inclusion of mental health nurses, the system requires increased flexibility. This would benefit all nurses and those who are cared for by them.

Disability competency training in medical education

PURPOSE

Lack of health care providers' knowledge about the experience and needs of individuals with disabilities contribute to health care disparities experienced by people with disabilities. Using the Core Competencies on Disability for Health Care Education, this mixed methods study aimed to explore the extent the Core Competencies are addressed in medical education programs and the facilitators and barriers to expanding curricular integration.

METHOD

Mixed-methods design with an online survey and individual qualitative interviews was used. An online survey was distributed to U.S. medical schools. Semi-structured qualitative interviews were conducted via Zoom with five key informants. Survey data were analyzed using descriptive statistics. Qualitative data were analyzed using thematic analysis.

RESULTS

Fourteen medical schools responded to the survey. Many schools reported addressing most of the Core Competencies. The extent of disability competency training varied across medical programs with the majority showing limited opportunities for in depth understanding of disability. Most schools had some, although limited, engagement with people with disabilities. Having faculty champions was the most frequent facilitator and lack of time in the curriculum was the most significant barrier to integrating more learning activities. Qualitative interviews provided more insight on the influence of the curricular structure and time and the importance of faculty champion and resources.

CONCLUSIONS

Findings support the need for better integration of disability competency training woven throughout medical school curriculum to encourage in-depth understanding about disability. Formal inclusion of the Core Competencies into the Liaison Committee on Medical Education standards can help ensure that disability competency training does not rely on champions or resources.

The utility of accessibility clauses in resident contracts

Resident organizations and unions have a powerful role in advocating for resident physicians with disabilities. Ongoing efforts to ensure accessibility for resident physicians with disabilities would be promoted through the inclusion of clauses in resident contracts that ensure accessible work environments.

Prevalence of Persons with Disability Enrolled in Undergraduate Medical Schools in Brazil, 2019

Introduction

The affirmative policies in Brazil guarantee the provision of undergraduate medical education to People with Disability (PWD). The objective was to estimate the prevalence of PWD undergraduate medical students in Brazil in 2019.

Methods

This is an exploratory, descriptive study that used census data from the total population of the undergraduate medical students (N=183,646) who were enrolled at the Brazilian medical schools, in 2019. The data are secondary, unidentified and accessed online, and were originally collected by the Higher Education Census conducted by Anísio Teixeira National Institute of Educational Studies and Research (INEP), which used a questionnaire designed to capture information from students and medical courses. The descriptive analysis was based on absolute and relative frequencies.

Results

The prevalence of medical students that were PWD was 0.80% (1,460/183,646), and this includes both Brazilian and foreign students. The latter includes people from 76 different countries. Foreign students who are PWD came from eight different countries: Bolivia, Burundi, Cabo Verde, Republic of Congo, Paraguay, Philippines, Singapore and Spain. Most of the PWD were male (51.37%), aged 20 to 24 years (46.78%) and of non-white ethnicity (52.26%). Most students were enrolled in public medical schools (73.97%). A fraction of PWD students (6.51%) was enrolled in medical schools with no specific resource or assistance for PWD. The highest prevalence was the physical disability (39.11%), followed by low vision accuracy (24.45%), intellectual (15.41%), low hearing (14.11%), blindness (3.97%), multiple disabilities (2.47%) and deafness (1.51%).

Conclusions

The prevalence of PWD medical students in Brazil is low, and is dominated by students with physical and sensory disabilities but lacks the deaf-blind. Despite the existence of legal regulations favoring PWD to study medicine, some medical schools have not done adequate adjustments to accommodate them. This suggests that affirmative policies for the inclusion of PWD in higher education, particularly in medicine, still need improvement.

Accessibility of drug databases and resources with assistive technology

INTRODUCTION

Pharmacy programs are responsible for providing appropriate academic accommodations to student learners in the classroom including individuals with disabilities according to Accreditation Council for Pharmacy Education Accreditation Standards.

COMMENTARY

In the literature, faculty have published methods on teaching strategies and assistive technologies to increase accessibility in a laboratory setting and implementation of resources for learners with visual or hearing impairment. An area that has not been highlighted in the literature is the accessibility of drug databases and resources often utilized in pharmacy practice and is an integral part of pharmacy curricula. This commentary provides information about the accessibility of the content and features within drug databases and resources using assistive technology for individuals with visual impairment.

IMPLICATIONS

Pharmacy programs must conduct testing of software and drug resources commonly used to ensure appropriate accommodations are provided for learners with disabilities. In addition, external stakeholders who develop drug information resources may need to consider accessibility of content for student learners with visual impairment and other forms of disability.

Impact of USMLE Step-1 accommodation denial on US medical schools: A national survey

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.

The Performance and Trajectory of Medical Students With Disabilities: Results From a Multisite, Multicohort Study

PURPOSE

To conduct a post-Americans with Disabilities Act Amendments Act of 2008 multisite, multicohort study called the Pathways Project to assess the performance and trajectory of medical students with disabilities (SWDs).

METHOD

From June to December 2020, the authors conducted a matched cohort study of SWDs and nondisabled controls from 2 graduating cohorts (2018 and 2019) across 11 U.S. MD-granting medical schools. Each SWD was matched with 2 controls, one from their institution and, whenever possible, one from their cohort for Medical College Admission Test score and self-reported gender. Outcome measures included final attempt Step 1 and Step 2 Clinical Knowledge scores, time to graduation, leave of absence, matching on first attempt, and matching to primary care.

RESULTS

A total of 171 SWDs and 341 controls were included; the majority of SWDs had cognitive/learning disabilities (118/171, 69.0%). Compared with controls, SWDs with physical/sensory disabilities had similar times to graduation (88.6%, 95% confidence interval [CI]: 77.0, 100.0 vs 95.1%, 95% CI: 90.3, 99.8; P = .20), Step 1 scores (229.6 vs 233.4; P = .118), and match on first attempt (93.9%, 95% CI: 86.9, 100.0 vs 94.6%, 95% CI: 91.8, 97.4; P = .842), while SWDs with cognitive/learning disabilities had lower Step 1 scores (219.4; P < .001) and were less likely to graduate on time (81.2%, 95% CI: 69.2, 93.2; P = .003) and match on first attempt (85.3%, 95% CI: 78.0, 92.7; P = .009). Accommodated SWDs had Step 1 scores that were 5.9 points higher than nonaccommodated SWDs (95% CI: -0.7, 12.5; P = .08).

CONCLUSIONS

Structural barriers remain for SWDs with cognitive/learning disabilities, which could be partially mitigated by accommodations on high-stakes exams.

Technical Standards from Newly Established Medical Schools: A Review of Disability Inclusive Practices

INTRODUCTION

Technical standards document US medical school's nonacademic criteria necessary for admission, persistence, and graduation and communicate the school's commitment to disability inclusion and accommodation but are considered one of the largest barriers for students with disabilities. Calls for more inclusive technical standards have increased in recent years, yet the impact of this work on changing technical standards has not been measured.The establishment of 15 new US MD- and DO-granting medical schools between 2017 to 2020 offered a unique opportunity to evaluate differences in the inclusive nature of newly developed technical standards.

METHOD

We conducted a document analysis of 15 newly formed medical schools' technical standards to determine the availability and inclusive nature of the standards as they pertain to students with sensory and mobility disabilities. Technical standards were coded for: ease of obtaining technical standards, the school's stated willingness to provide reasonable accommodations, the origin of responsibility for accommodation request and implementation, and the school's openness to intermediaries or auxiliary aids.

RESULTS

Of the 15 schools, 73% of the technical standards were not easy to locate online. Few (13%) included language that support disability accommodations. Most (73%) used language that was coded as 'restrictive' for students with physical or sensory disabilities. Coding of the newly accredited US MD and DO medical schools suggests that newly created technical standards are more restrictive than those in previous studies.

CONCLUSIONS

Efforts to create more inclusive technical standards have not yet been realized. Newly formed US MD- and DO-granting medical schools may perpetuate historically restrictive technical standards that serve as barriers to applicants with disabilities. Future research should evaluate the role of medical school accrediting bodies to go beyond simply requiring technical standards to ensuring that the standards are readily available and appropriately convey the availability of reasonable accommodations for students with disabilities.

Structural Barriers to Student Disability Disclosure in US-Allopathic Medical Schools

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.