Health Professionals with Disabilities: Motivating Inclusiveness and Representation, Oct 16 – AMA Journal of Ethics

Introduction to the October 2016 issue on health professionals with disabilities. AMA Journal of Ethics is a monthly bioethics journal published by the American Medical Association.

Source: Health Professionals with Disabilities: Motivating Inclusiveness and Representation, Oct 16 – AMA Journal of Ethics

Health Professionals with Disabilities: Motivating Inclusiveness and Representation

Medical schools seeking to increase representation of minorities in the profession have sought to improve matriculation and graduation rates of racial and ethnic minorities [1]. But one minority group whose needs remain neglected in the medical field is persons with disabilities.

Although 18.7 percent of the US population [2, 3] and up to 8.9 percent of US residents aged 18 to 24 self-identify as having at least one disability [4], less than 1 percent of medical students have disabilities known to school administrators. A study published in 2012 found that since 2001, only 0.56 percent of matriculating and 0.42 percent of graduating medical students have physical or sensory disabilities [5]. These data suggest that persons with physical, cognitive, or sensory disabilities face significant hurdles in entering, continuing, and completing training in health professional fields. Furthermore, physicians who develop disabilities after completing their training can have difficulty obtaining accommodations from their employers and consequently leave clinical practice for administrative, teaching, or corporate positions that do not require direct patient care, preventing patients with disabilities from benefiting from the experiences of physicians intimately familiar with the process of adapting their activities of daily living.

The goal of this issue of the AMA Journal of Ethics® is to discuss the importance of increasing representation of people with disabilities in the medical field and to outline some of the obstacles that health professionals and trainees encounter in pursuing or continuing medical practice.

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Prevalence of Self-Disclosed Disability in US Allopathic Medical Students | Medical Education and Training | JAMA | The JAMA Network

Studying the performance of medical students with disabilities requires a better understanding of the prevalence and categories of disabilities represented.1- 4 It remains unclear how many medical students have disabilities; prior estimates are out-of-date and psychological, learning, and chronic health disabilities have not been evaluated.5 This study assessed the prevalence of all disabilities and the accommodations in use at allopathic medical schools in the United States.

Source: Prevalence of Self-Disclosed Disability in US Allopathic Medical Students | Medical Education and Training | JAMA | The JAMA Network

Empowering medical students with disabilities: The student perspective – Herzer – 2016 – Disability Compliance for Higher Education – Wiley Online Library

Source: Empowering medical students with disabilities: The student perspective – Herzer – 2016 – Disability Compliance for Higher Education – Wiley Online Library

Medical school can be a stressful and high-stakes experience. For medical students with disabilities, that experience may be even more stressful as students navigate the accommodations process, worry about possible discrimination if they disclose their disabilities, and fear being viewed as inferior compared to their peers. Disability services providers play a vital role in supporting students through the medical school experience.

MU medical students’ complaints describe humiliation, discrimination | Higher Education |

MU medical students’ complaints describe humiliation, discrimination

Source: MU medical students’ complaints describe humiliation, discrimination | Higher Education |

COLUMBIA — Matt Darrough didn’t take a traditional path to the MU School of Medicine.

When he applied in November 2013, he was 43 and working full time as a lawyer. He was also preparing to have his legs amputated below the knee and get prosthetics. An accident years earlier had left him paralyzed from the knees down.

Darrough was worried that his age and disability would make medical school more difficult, but in his interview, the chief of surgery said he was exactly the type of student the school was seeking. The admissions committee wanted greater diversity, including students like Darrough with no background in science.

Three years later, Darrough dropped out, frustrated with what he described as constant bullying, a lack of accommodation of his disability and an overall hostile environment.

He filed a complaint — one of 15 filed by students against the medical school in the past two years, according to documents requested by the Missourian in September and obtained Dec. 8 through a Sunshine Law request. Most of the complaints involved public humiliation, and others described experiences of gender discrimination.

The Missourian obtained medical students’ reports of mistreatment from September 2014 to present through a Sunshine Law request. The following are selections of students’ narratives.

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Moving From Disability to Possibility | Humanities | JAMA | The JAMA Network

Source: Moving From Disability to Possibility | Humanities | JAMA | The JAMA Network

When I was in the first grade, an astute teacher noticed that I had trouble seeing the blackboard. This finding was quickly confirmed by a vision test. Formal evaluation by an ophthalmologist revealed that I had a rare degenerative retinal disease. Worse than that diagnosis was the ophthalmologist’s devastating prognosis for my life: attending college would be very challenging, sports and certain activities would be difficult or impossible, and it was unlikely that I would ever have a professional career.

Doctor’s care is a balance of skill, empathy for Virginia Tech Carilion School of Medicine student : Augusta Free Press

Source: Doctor’s care is a balance of skill, empathy for Virginia Tech Carilion School of Medicine student : Augusta Free Press

Alyssa Savelli has wanted to be a doctor for as long as she can remember. “When I was 5, I would just sit and watch Discovery Health Channel and watch open heart surgery.”

A learning disability as a child made Savelli second-guess her dreams. “As I worked with special tutors, I got over it, but it wore on my confidence for a long time. I still worried that medicine would be too hard for me.”

A life-altering illness in her family caused her to refocus on her early dream. During her freshman year at Virginia Tech, Savelli’s father was diagnosed with acoustic neuroma, a brain tumor that impacts a nerve that runs from the ear to the brain. Along with numerous doctors’ appointments, he had to undergo complicated surgery to remove the tumor.

“Through that period, I noticed what makes a good doctor,” Savelli said, in particular noting the work of Rafael Tarmargo, a neurosurgeon at Johns Hopkins Medicine who performed her dad’s surgery. “Despite the fact that Dr. Tamargo was a brilliant surgeon and he is really busy, he was also very empathetic. Whenever my dad came in, he would ask how everyone else in the family was doing by name.”

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Disclosure of Disabilities by Medical Students

Source: Disclosure of Disabilities by Medical Students

In Reply Ms Schwartz emphasizes the importance of disclosure as it relates to providing opportunities to medical students with disabilities. Although disclosure is important, if not necessary, for receiving accommodations from an institution, disclosure alone is unlikely to change the broader attitudes and cultural norms that limit access to medical education for students with disabilities. First, the direction of causality is unclear. The fear of disclosure and the culture that precipitates that fear are likely jointly determined: lack of disclosure may contribute to a less-inclusive culture for students with disabilities, but that culture may also breed a fear of disclosure. Second, full disclosure would be difficult to enforce. The decision to disclose may be weighed differently by the applicant, who desires admission, compared with the matriculant, who has already been admitted and desires accommodations. Third, not all disabilities are readily apparent. Although Schwartz emphasizes physical disabilities, research suggests that nonphysical disabilities such as attention-deficit/hyperactivity disorder, learning disabilities, and psychological disabilities are more prevalent among US medical students.1 Those with nonapparent disabilities may face considerable bias that disclosure alone does little to resolve.

Lessons in Increasing Access to Care: Symposium at Rush brings together disability and health care leaders

By Kevin McKeough, Anne Burgeson and Kathleen Ziemer

Illinois Attorney General Lisa Madigan observed that “at almost any moment, any of us could be living with a disability, whether through our life circumstances or as we age. This is an issue that is personal to all of us, whether we realize it our not.”

Madigan the was the featured speaker at the Rush ADA 25 Symposium, held on Oct. 6 at Rush University Medical Center. The event celebrated the 25th anniversary of the Americans With Disabilities Act, which became law on July 26, 1990.

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Diversity among doctors: Students with disabilities are finding their place in medical schools—and beyond

Diversity among doctors: Students with disabilities are finding their place in medical schools—and beyond

Cathy Gulli

September 25, 2015

For Jessica Dunkley, getting into medical school was no ordinary childhood dream. Deaf since the day she was born, Dunkley aspired to become a doctor when, at age 10, her aunt gave her a plastic human anatomy model with removable organs.

She didn’t think it was possible until, in her mid-20s, she happened to read about deaf doctors practising in the United States. “I realized the opportunity was out there,” and she became “determined to do medicine.” Dunkley applied to numerous medical schools and, in 2010, completed the undergraduate program at the University of Ottawa, where a sign language interpreter accompanied her to class and clinical sessions. Today, Dunkley is finishing her second year of residency in public health and family medicine at the University of Alberta—making her one of the first deaf doctors in Canada.

Dunkley’s accomplishment represents the latest diversification of medicine, which was first practised mostly by white male doctors, and has since flourished with the inclusion of women and people of different races and ethnicities. Now the profession is set to expand again, as students with disabilities—including limited mobility or dexterity, hearing or vision loss, learning or developmental disorders, and psychological or mental health issues—are increasingly being accepted and supported at medical schools.

Like Dunkley, a handful of other young Canadians are making history by becoming doctors with disabilities: Megan Jack, who is also deaf, graduated from the University of Manitoba in 2013, and is now a family physician. Janel Nadeau had a stroke at 19, which partially paralyzed her and has affected her memory; she is finishing her training as a neurologist at the University of Calgary. Steven Daniel was paralyzed from the waist down during a paratrooping accident while serving in the military; although he is in a wheelchair, Daniel is training to be a family doctor at the Northern Ontario School of Medicine.

Part of what makes Dunkley’s experience so remarkable is the legal precedent she’s established along the way. In late June, she won a human-rights case against the University of British Columbia, which failed to provide her with a sign language interpreter in 2010, when Dunkley was supposed to start her residency. (She was later accepted at the University of Alberta, which provides interpreters.) Dunkley says the discrimination “came as a shock,” but she was not deterred. This ruling means others won’t be, either. “I just knew I didn’t want the next person to go through this,” says Dunkley. “I’m pleased it [will] improve accessibility.”

While disabled doctors have always practiced—in 2011, there were approximately 9,000 working, according to Statistics Canada—most of them became disabled after their education and training. What’s different “is the entry point,” says Melanie Lewis, associate dean of learner wellness and advocacy at the University of Alberta’s faculty of medicine and dentistry. “You have medical students presenting with disability.”

Over the last five years, there has been “a big tipping point” at medical schools toward “embracing the possibility of accommodation and looking at what we can do [for disabled students], rather than dismissing that it’s a possibility,” says Lewis, whose office supports students such as Dunkley with a range of conditions, including sleep disorders, depression, epilepsy and multiple sclerosis. “We’re recognizing that medicine needs to attract people [who] represent the diversity in society in order to provide good care.”

That’s forced universities and students to get creative. Dunkley has had to invent sign language for medical terms. She uses a digital stethoscope or portable ultrasound machine to check a patient’s heart. In the operating room, colleagues wear clear surgical hoods rather than paper face masks so she can lip-read. Daniel has used a “stand up” wheelchair, which allows him to be positioned upright at a patient’s bedside during surgery or in the emergency room. He gets help “scrubbing in,” and his colleagues position his wheelchair at the operating table.

Universities must identify the needs of students and residents, figure out how to meet their needs on campus and inside hospitals, then determine “who is going to pay,” says Geneviève Moineau, who was undergraduate dean at the University of Ottawa when Dunkley was a student. Since then, accommodation is “a topic that has become more important within our faculties,” says Moineau, now president of the Association of Faculties of Medicine of Canada.

Part of the conversation is about how impairment can actually facilitate better doctor-patient relationships: A disabled doctor may empathize more with patients, who, in turn, may relate to or trust a disabled doctor more because they feel understood. Dunkley has experienced this first-hand. “People come in and they are frustrated or going through a painful experience, and they feel they are the only one,” she says, “and then they [see] me and it just [gives] them a better perspective.”

What’s more, disabled doctors have all been patients, so they understand personally how a doctor’s disposition and bedside manner can affect someone. While Nadeau was recovering from her stroke, she saw “the whole spectrum of doctors,” and that’s partly what motivated her to pursue medicine. “I was determined to add to the good ones.”

While disabled doctors may be better equipped to bond with patients, it can also alienate them from other physicians. “You can sense this uncertainty or questioning about how you are going to be able to do it,” says Dunkley. This can be especially challenging during medical training, when students and residents move between different hospitals and clinics for brief rotations. “The most problematic people are usually [those] who do not work with me directly, and they have assumptions.”

That medical students and residents face stigma because of a health condition is ironic—but not so surprising. “There’s some deep psychological theory around how doctors in general may not necessarily accept their mortality,” says Vera Krejcik, president of the Canadian Association of Physicians with Disabilities. “A lot of people have noticed a certain discomfort; colleagues don’t know how to negotiate being with somebody with a difference.”

Krejcik had a stroke while studying medicine at the University of Calgary. With limited use of one arm, she switched her focus from internal medicine to psychiatry. It was a matter of being “realistic,” says Krejcik. “I don’t worry about hobbling around or needing to suture.”

Before anyone can become a doctor, there are technical standards they must meet, both physical and cognitive, says Lewis, who helped Dunkley establish herself as a resident at the University of Alberta. But there are intangibles to consider, too. Dunkley and others are proving that. As Lewis puts it, “Any candidate who comes from an extraordinary background with a unique perspective, they often do make extraordinary physicians.”