National Medical Organizations’ Changing Stance and Policies on Disability

In the decades since the Americans with Disabilities Act (ADA) was passed, individual undergraduate and graduate medical education programs and the national bodies responsible for accrediting these programs slowly began to recognize the need to support disabled trainees and to craft policies and procedures that would do so. The unique value of disabled trainees and practitioners dawned more slowly. Approaches to disability inclusion across medical institutions and organizations are disparate and uneven in their effect and application.

Individual undergraduate medical education (UME) programs—that is, those offering four-year MD or DO degrees—outpaced graduate medical education (residency and fellowship) in basic disability inclusion: maintaining disability policies, hiring disability service providers to facilitate accommodations, and even teaching disability-focused content (Martin-Lockhart, 2022). Of course, the actualities of these steps varied—and vary—greatly. Disability service providers are frequently housed outside medical colleges and little time is devoted to disability education in the mere 23-52%  of accredited UME programs that integrate disability topics into their curricula (exact numbers are unknown) (L. Meeks & Jain, 2018; L. M. Meeks, Stergiopoulos, et al., 2022; L. Meeks & Neal-Boylan, 2020; Seidel & Crowe, 2017).

Graduate medical education (GME) programs rarely include equivalent disability education and/or infrastructure for accommodations. Residents and fellows are employees not students so cannot be served by the same disability services that work with UME students. Thus, GME was and is often been criticized for lacking even the most fundamental disability inclusiveness (L. Meeks & Jain, 2018; L. M. Meeks et al., 2019; Rotoli et al., 2020; Sapp et al., 2021).

Groundbreaking changes to national-level GME policies saw the recognition of disability as a valuable axis of experiential knowledge and identity. In 2019, nearly thirty years after the passage of the ADA, the American Counsel of Graduate Medical Education (ACGME) released new policies and accreditation criteria that increased the profile of disability inclusion, rights, and protections in graduate medical education (GME) (L. M. Meeks et al., 2019, 2021, p. 211). The ACGME classify disability as a dimension of diversity and instituted requirements that:
(i) medical institutions with residency positions possess a formal disability policy and

(ii) accommodations be offered by GME programs (ibid).

These changes followed a 2018 American Association of Medical Education (AAMC)-sponsored report on the experiences of disabled trainees that recommended strategies for disability inclusivity in medical education (L. Meeks & Jain, 2018).

The accrediting body for undergraduate medical education programs, the Liaison Committee on Medical Education (LCME), did not take similar steps.

Students, physicians, educators, and other advocates subsequently sought to put pressure on the LCME to follow the ACGME’s lead by implementing policies and standards to improve disability inclusivity. Medical Students with Disability and Chronic Illness (MSDCI), a national-level advocacy and community group, sent a letter to the LCME in 2021 imploring the organization to add disability education to its UME program accreditation criteria. Moreover, though the LCME requires that UME programs value diversity in their student body and that they maintain a policy of nondiscrimination with respect to disability status, up to the spring of 2022 the LCME has done little to ensure that medical schools’ technical standards and other policies adhere to the ADA. LCME’s own materials fail to include disability as a form of diversity (L. M. Meeks et al., 2021). However, visitors to MSDCI’s website (MSDCI, n.d.) in the spring of 2022 could see an announcement that, in the wake of the group’s letter, the LCME Subcommittee on Standards is planning soon to discuss its proposals.

Despite advocacy and the concrete policy shifts towards disability inclusion in medicine, adherence and actual disability representation remain uneven and limited. Research from the same summer that the ACGME policy changes took effect (2019) found that only 32 of 47 handbooks from large-scale GME programs included a specific disability policy (L. M. Meeks, Taylor, et al., 2020). While the profile of disability shot up amongst medical institutions and organizations since the mid-late 2010s, the provision of basic disability accommodations and tangible movement towards true inclusivity in both UME and GME remain uneven and limited.

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

Meeks, L., & Jain, N. (2018). Accessibility, Inclusion, and Action in Medical Education: Lived Experiences of Learners and Physicians With Disabilities,. AAMC.

Meeks, L. M., Case, B., Joshi, H., Harper, D. M., & Graves, L. (2021). Disability Policies and Practices in Family Medicine Residencies: A CERA Study. Family Medicine, 53(3), 211–214. https://doi.org/10.22454/FamMed.2021.726731

Meeks, L. M., Jain, N. R., Moreland, C., Taylor, N., Brookman, J. C., & Fitzsimons, M. (2019). Realizing a Diverse and Inclusive Workforce: Equal Access for Residents With Disabilities. Journal of Graduate Medical Education, 11(5), 498–503. https://doi.org/10.4300/JGME-D-19-00286.1

Meeks, L. M., Stergiopoulos, E., & Petersen, K. H. (2022). Institutional Accountability for Students With Disabilities: A Call for Liaison Committee on Medical Education Action. Academic Medicine, 97(3), 341–345. https://doi.org/10.1097/ACM.0000000000004471

Meeks, L. M., Taylor, N., Case, B., Stergiopoulos, E., Zazove, P., Graves, L., McKee, M., Swenor, B. K., Salgat, A., Cerilli, C., Joshi, H., & Moreland, C. J. (2020). The Unexamined Diversity: Disability Policies and Practices in US Graduate Medical Education Programs. Journal of Graduate Medical Education, 12(5), 615–619. https://doi.org/10.4300/JGME-D-19-00940.1

Meeks, L., & Neal-Boylan, L. (2020). Disability as Diversity: A Guidebook for Inclusion in Medicine, Nursing, and the Health Professions.

MSDCI. (n.d.). Retrieved April 30, 2022, from https://msdci.org/

Rotoli, J., Backster, A., Sapp, R. W., Austin, Z. A., Francois, C., Gurditta, K., Mirus, C., & Poffenberger, C. M. (2020). Emergency Medicine Resident Education on Caring for Patients With Disabilities: A Call to Action. AEM Education and Training, 4(4), 450–462. https://doi.org/10.1002/aet2.10453

Sapp, R. W., Sebok-Syer, S. S., Gisondi, M. A., Rotoli, J. M., Backster, A., & Poffenberger, C. M. (2021). The Prevalence of Disability Health Training and Residents With Disabilities in Emergency Medicine Residency Programs. AEM Education and Training, 5(2), e10511. https://doi.org/10.1002/aet2.10511

Seidel, E., & Crowe, S. (2017). The State of Disability Awareness in American Medical Schools. American Journal of Physical Medicine & Rehabilitation, 96(9), 673–676. https://doi.org/10.1097/PHM.0000000000000719