Accommodations for disabilities in dental education: A focus on technical standards and clinical skills

Providing disability-based accommodations is a multifaceted process that must balance the needs of dental students and their institutions. Reasonable accommodations must not compromise patient safety or cause an undue burden on the student or institution. Therefore, more creative approaches must be considered as the number of individuals and the types of learning disabilities have increased in recent years. In the clinical setting, providing accommodations also requires detailed advanced planning and collaboration to maintain program quality. However, current technical standards (TS) may serve as a barrier to entry into the health professions for people with disabilities. These individuals remain substantially underrepresented in dentistry despite bringing unique perspectives and experiences that can contribute to a diverse workforce of culturally proficient practitioners. In response, many schools have adopted a "functional" approach to TS that emphasizes a student's abilities rather than their limitations. In addition, innovative assistive technologies coupled with the application of critical pedagogy and universal design learning practices that engage people with the widest possible range of capabilities allows equitable approaches for learning and assessment while maintaining professional standards.

Wheels of Injustice: How Medical Schools Retained the Power to Discriminate Against Applicants in Wheelchairs in the Era of Disability Rights

In the era of disability rights, medical schools retained the power to discriminate against applicants in wheelchairs. This article explores how medical schools set boundaries for admission into the profession, remained intransigent in their discrimination, and persuaded courts to side with them. Interviews with physicians in wheelchairs, legal documents, medical journal articles, and white papers demonstrate how medical schools established physical standards for entry into the profession specifically in response to applicants with disabilities. In the 1970s, medical schools created exclusionary physical requirements and persuaded the Supreme Court that these "technical standards" preserved patient safety. In the 1980s, schools asserted that students with disabilities would require expensive accommodations and lower educational standards. In the 1990s, medical schools strategically interpreted vague language in the Americans with Disabilities Act to justify continuing to exclude applicants with disabilities. This article complicates triumphalist histories of disability activism and reveals the continuation of exclusion in medical education, which had historically occurred based on race and gender. Interviews with successful applicants in wheelchairs provide powerful testimony against medical school policies and offer a clear path forward. Technical standards should change to value compassion and critical thinking over physical fitness. Physicians in wheelchairs perform most medical tasks and bring unique perspectives to a historically homogenous profession.

Call to Action: Eliminate Barriers Faced by Medical Students With Disabilities

When physicians have a disability or chronic condition, they can offer deeper insight and ability into managing the needs of patients with similar conditions. Yet an alarming 2021 survey found that only 40.7% of physicians feel confident that they provide the same level of care to people with disabilities (PWD) as those without. This may contribute to troubling health care disparities for the over 61 million Americans living with disabilities. In a recent report, The American Medical Association (AMA) recognized that increased concordance between patients and physicians with disabilities is key to resolving health care inequities for PWD, yet although 1 in 5 patients reports a disability, only 1 in 33 physicians identifies as such. This is because prospective medical students with disabilities face many barriers in medical education and practice. We call for specific changes to medical school admission processes and curricula to promote a more just and diverse workforce which includes more physicians with disabilities.

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.

Technical standards in allergen exposure chambers worldwide - an EAACI Task Force Report

Allergen exposure chambers (AECs) can be used for controlled exposure to allergenic and non-allergenic airborne particles in an enclosed environment, in order to (i) characterize the pathological features of respiratory diseases and (ii) contribute to and accelerate the clinical development of pharmacological treatments and allergen immunotherapy for allergic disease of the respiratory tract (such as allergic rhinitis, allergic rhinoconjunctivitis, and allergic asthma). In the guidelines of the European Medicines Agency for the clinical development of products for allergen immunotherapy (AIT), the role of AECs in determining primary endpoints in dose-finding Phase II trials is emphasized. Although methodologically insulated from the variability of natural pollen exposure, chamber models remain confined to supporting secondary, rather than primary, endpoints in Phase III registration trials. The need for further validation in comparison with field exposure is clearly mandated. On this basis, the European Academy of Allergy and Clinical Immunology (EAACI) initiated a Task Force in 2015 charged to gain a better understanding of how AECs can generate knowledge about respiratory allergies and can contribute to the clinical development of treatments. Researchers working with AECs worldwide were asked to provide technical information in eight sections: (i) dimensions and structure of the AEC, (ii) AEC staff, (iii) airflow, air processing, and operating conditions, (iv) particle dispersal, (v) pollen/particle counting, (vi) safety and non-contamination measures, (vii) procedures for symptom assessments, (viii) tested allergens/substances and validation procedures. On this basis, a minimal set of technical requirements for AECs applied to the field of allergology is proposed.

Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement

Background: Spirometry is the most common pulmonary function test. It is widely used in the assessment of lung function to provide objective information used in the diagnosis of lung diseases and monitoring lung health. In 2005, the American Thoracic Society and the European Respiratory Society jointly adopted technical standards for conducting spirometry. Improvements in instrumentation and computational capabilities, together with new research studies and enhanced quality assurance approaches, have led to the need to update the 2005 technical standards for spirometry to take full advantage of current technical capabilities.Methods: This spirometry technical standards document was developed by an international joint task force, appointed by the American Thoracic Society and the European Respiratory Society, with expertise in conducting and analyzing pulmonary function tests, laboratory quality assurance, and developing international standards. A comprehensive review of published evidence was performed. A patient survey was developed to capture patients' experiences.Results: Revisions to the 2005 technical standards for spirometry were made, including the addition of factors that were not previously considered. Evidence to support the revisions was cited when applicable. The experience and expertise of task force members were used to develop recommended best practices.Conclusions: Standards and consensus recommendations are presented for manufacturers, clinicians, operators, and researchers with the aims of increasing the accuracy, precision, and quality of spirometric measurements and improving the patient experience. A comprehensive guide to aid in the implementation of these standards was developed as an online supplement.

Evolution of Electronic Noses from Research Objects to Engineered Environmental Odour Monitoring Systems: A Review of Standardization Approaches

Since electronic noses are used more and more for air quality monitoring purposes, and in some countries are starting to have a legal value, there is a need for standardization and programs for the quality verification of instruments. Such quality programs have the aim to guarantee the main characteristics of the instrument for both the final user and local authorities, let the user establish a suitable maintenance procedure and give information on measurement uncertainty. One critical aspect when dealing with electronic noses for environmental odour monitoring is that environmental odours are complex mixtures that are not repeatable nor reproducible, giving that they are not suitable for quality verifications. This paper aims to review and discuss the different approaches that can be adopted in order to perform quality checks on electronic noses (e-noses) used for environmental odour monitoring, thereby referring to existing technical standards, such as the Dutch NTA 9055:2012, the new German VDI 3518-3:2018, and the Italian UNI 1605848 project, which directly refer to electronic noses. Moreover, also the European technical standards that are prescriptive for automatic measuring systems (AMSs) are taken into consideration (i.e., EN 14181:2014 and EN 15267:2009), and their possible applicability to electronic noses is investigated. Finally, the pros and cons of the different approaches are presented and discussed in the conclusions section.

A Review of Legal Decisions Relevant to Technical Standards Used in Pharmacy School Admissions

The implementation of an effective and legally sound technical standards procedure for pharmacy schools requires a proactive approach by admissions officers. Applicants with disabilities are accorded significant rights that must not be infringed during the admissions process in order to ensure compliance with applicable law. This article provides a review of applicable state cases, federal cases, and OCR decisions and guidance to help pharmacy schools identify procedures and implement technical standards into their admissions processes as required by ACPE Standards 2016.

Using Competency-Based Digital Open Learning Activities to Facilitate and Promote Health Professions Education (OLAmeD): A Proposal

Background

Traditional learning in medical education has been transformed with the advent of information technology. We have recently seen global initiatives to produce online activities in an effort to scale up learning opportunities through learning management systems and massive open online courses for both undergraduate and continued professional education. Despite the positive impact of such efforts, factors such as cost, time, resources, and the specificity of educational contexts restrict the design and exchange of online medical educational activities.

Objective

The goal is to address the stated issues within the health professions education context while promoting learning by proposing the Online Learning Activities for Medical Education (OLAmeD) concept which builds on unified competency frameworks and generic technical standards for education.

Methods

We outline how frameworks used to describe a set of competencies for a specific topic in medical education across medical schools in the United States and Europe can be compared to identify commonalities that could result in a unified set of competencies representing both contexts adequately. Further, we examine how technical standards could be used to allow standardization, seamless sharing, and reusability of educational content.

Results

The entire process of developing and sharing OLAmeD is structured and presented in a set of steps using as example Urology as a part of clinical surgery specialization.

Conclusions

Beyond supporting the development, sharing, and repurposing of educational content, we expect OLAmeD to work as a tool that promotes learning and sets a base for a community of medical educational content developers across different educational contexts.

A repository of codes of ethics and technical standards in health informatics

We present a searchable repository of codes of ethics and standards in health informatics. It is built using state-of-the-art search algorithms and technologies. The repository will be potentially beneficial for public health practitioners, researchers, and software developers in finding and comparing ethics topics of interest. Public health clinics, clinicians, and researchers can use the repository platform as a one-stop reference for various ethics codes and standards. In addition, the repository interface is built for easy navigation, fast search, and side-by-side comparative reading of documents. Our selection criteria for codes and standards are two-fold; firstly, to maintain intellectual property rights, we index only codes and standards freely available on the internet. Secondly, major international, regional, and national health informatics bodies across the globe are surveyed with the aim of understanding the landscape in this domain. We also look at prevalent technical standards in health informatics from major bodies such as the International Standards Organization (ISO) and the U. S. Food and Drug Administration (FDA). Our repository contains codes of ethics from the International Medical Informatics Association (IMIA), the iHealth Coalition (iHC), the American Health Information Management Association (AHIMA), the Australasian College of Health Informatics (ACHI), the British Computer Society (BCS), and the UK Council for Health Informatics Professions (UKCHIP), with room for adding more in the future. Our major contribution is enhancing the findability of codes and standards related to health informatics ethics by compilation and unified access through the health informatics ethics repository.

Professional technical standards in colleges and schools of pharmacy

OBJECTIVE

To determine the prevalence, characteristics, and use of professional technical standards among colleges and schools of pharmacy accredited by the Accreditation Council for Pharmacy Education (ACPE).

METHODS

The Web site of every college and school of pharmacy accredited by ACPE was searched to identify information regarding the availability, content, and use of technical standards and to obtain demographic information.

RESULTS

Information was obtained from all of the 114 colleges and schools of pharmacy and 67 (59%) had technical standards in place. Common themes for technical standards were: observation; communication; motor; intellectual, conceptual, integrative and quantitative abilities; and behavioral and social attributes. Of those colleges and schools with technical standards, 61 (91%) had standards that addressed all 5 of these themes and 34 (51%) specified that the technical standards were used in their admission, progression, and graduation procedures.

CONCLUSION

More than half of the colleges and schools of pharmacy examined in this study have technical standards; however, 41% have yet to develop and implement them. Colleges and schools of pharmacy looking for guidance in technical standards development could use the technical standards themes identified in this study.