Disability in Medical Education

Disability in Medical Education

Medical students receive little-to-no training that focuses on disability specifically—from social, biomedical, or other clinical angles—and the slow pace of change in this regard is a likely factor in the long-standing biases against disabled patients and doctors among medical practitioners. Recent work began to quantify the ableist ideology common in medicine that practitioners, patients, and scholars have qualitatively described for decades –probably for centuries.

A team led by Lisa Iezzoni, one of the highest profile doctors with a disability in the US (Blauwet, 2017; Gordon, 2018), found that 82.4 percent of over 700 physicians surveyed felt that significant disabilities were associated with a worse quality of life (Iezzoni et al., 2021). Their survey also revealed a degree of uncertainty and lack of confidence when it came to treating disabled patients (ibid). This research suggests that the continuing failure of medical education to cover disability endangers patient outcomes in addition to reducing the inclusiveness of medical institutions towards disabled physicians.

Iezzoni herself was barred from applying to residency and thus from practicing medicine due to her disability. When she graduated from Harvard Medical School in the 1980s after developing multiple sclerosis (MS) during her tenure there the medical school refused to write the requisite letter of recommendation for her residency application because they did not believe that she would be capable of practicing medicine (Blauwet, 2017). The Americans with Disabilities Act (ADA) of 1990 mitigates such overtly discriminatory behavior, but medical schools still do little to counteract the ableist biases that students enter with, absorb from peers and educators, and are taught in the process of their medical training.

And yet, as recently as 2015, a maximum of half of medical schools indicated  that they included any disability-focused material in their undergraduate medical education (UME) curriculum (Seidel & Crowe, 2017). The constraints faced by the study’s authors, Seidel and Crowe (2017), suggests that even after the ADA and the Amendment Act in 2008 medical schools’ investment in disability writ large is limited; less than half (45%) of the 167 accredited medical schools (those granting MD and DO degrees)  responded to the 2015 survey about curricular coverage of disability.

Students and professors in medical schools interviewed in a 2021 article by Stat, a medical news site, attested to the minimal or non-existent coverage disability receives in coursework, even in anti-bias trainings (Sohn, 2021). And, over three decades after the ADA, the Licensing Council for Medical Education (LCME) does not require schools to include disability-focused material in their curricula to achieve full accreditation.

Advocates point out that the presence of disabled medical trainees and doctors can help counteract, and is protective against, further bias developing in their non-disabled peers. Disabled students and doctors recently started to argue, publicly, that disabled providers can surpass their non-disabled peers in empathy, communication skills, maturity, resilience, and the capacity to cope with obstacles (Anonymous, 2019; L. M. Meeks, Stergiopoulos, et al., 2022; Rastogi, 2021). Thus, forms of disability education in medical contexts can take many forms, from overt classroom instruction to passive, even implicit exposure to disabled peers and disability-related issues.

Anonymous. (2019). In My Experience: How Educators Can Support a Medical Student With Mental Illness. Academic Medicine, 94(11), 1638–1639. https://doi.org/10.1097/ACM.0000000000002953

Blauwet, C. A. (2017, December 6). I Use a Wheelchair. And Yes, I’m Your Doctor. The New York Times. https://www.nytimes.com/2017/12/06/opinion/doctor-wheelchair-disability.html

Gordon, E. (2018, August 6). Doctors With Disabilities Push For Culture Change In Medicine. NPR. https://www.npr.org/sections/health-shots/2018/08/06/635414552/doctors-with-disabilities-push-for-culture-change-in-medicine

Iezzoni, L. I., Rao, S. R., Ressalam, J., Bolcic-Jankovic, D., Agaronnik, N. D., Donelan, K., Lagu, T., & Campbell, E. G. (2021). Physicians’ Perceptions Of People With Disability And Their Health Care. Health Affairs, 40(2), 297–306. https://doi.org/10.1377/hlthaff.2020.01452

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

Rastogi, S. (2021). Establishing Equity in Medical Education—Supporting Clinical Trainees with Disabilities. New England Journal of Medicine, 384(10), 885–887. https://doi.org/10.1056/NEJMp2035279

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

Sohn, R. (2021, February 1). Survey: Majority of docs hold misconceptions about people with disabilities. Stat. https://www.statnews.com/2021/02/01/large-majority-of-doctors-hold-misconceptions-about-people-with-disabilities-survey-finds/