The Movement to Revise Technical Standards

Technical standards, itemized physical and mental capacities that medical schools require students meet, represent a particularly trenchant and slow-to-change manifestation of medical school disability exclusion—and discrimination.

Medical schools nationwide produced and instituted technical standards after a 1979 recommendation by the Association of American Medical Colleges (AAMC) that programs outline a “universal skill set among applicants to ensure success in any specialty” (Joy, 2017, np). Idealization of the “undifferentiated physician”—capable of carrying out all medical tasks and diagnoses and of administering any treatment—might have made sense for country doctors isolated from any medical facilities but the codification of this ideal in technical standards poses an insurmountable and likely illegal barrier for many prospective medical students with disabilities. As medicine became increasingly specialized, the expectation of absolute and independent capacity did not diminish and many institutions’ technical standards have not been reworked to reflect changing realities of medical practice (ibid).

A growing number of medical schools are changing their technical standards to use less disability-excluding language and to explicitly permit accommodations. For example, a technical standard might use terminology like “perceive” rather than “see.” The University of Michigan Medical School (Ann Arbor), a leader in disability inclusion, adjusted their technical standards in 2016, prompting an inquiry from the Association of American Medical Colleges (AAMC) asking whether they should promote similar revisions among other medical schools and requesting further information on the process (ibid). Many schools’ technical standards still exclude many people with disabilities—barring accommodations or requiring particular physically specific tasks like CPR. Current precedent from post-Americans with Disabilities Act court rulings holds that a program may only be deemed to be discriminating against disabled students (when it comes to accommodations that allow students to meet school requirements) if the accommodation does not involve “substantial changes to its curriculum [such as removing CPR or a similar task as a technical standard requirement] as a disability accommodation” (Laird-Metke, Elisa et al., 2016). (It remains unclear how—and if—a technical standard like CPR that requires particular physical abilities and thus likely excludes only disabled candidates comports with the ADA.)

Changes are occurring now and more are visible on the horizon: Stanford is preparing to revamp its technical standards (after already doing so around 2017) while the University of Washington at St. Louis recently overhauled their technical standards as part of a larger curriculum review (Martin-Lockhart, 2022).

Sources:

Joy, K. (2017, October 10). ‘A Seat at the Table’: Why U-M’s Medical School Wants More Students with Disabilities. University of Michigan. https://labblog.uofmhealth.org/med-u/a-seat-at-table-why-u-ms-medical-school-wants-more-students-disabilities

Laird-Metke, Elisa, Serrantino, J., & Culley, J. L. (2016). The Process for Determining Disability Accomodations. In L. Meeks & N. R. Jain (Eds.), The guide to assisting students with disabilities: Equal access in health science and professional education (pp. 53-???????). Springer Publishing Company.

Martin-Lockhart, Z. (2022). Disabled Doctors Dissertation Fieldwork [manuscript in preparation].