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

https://www.rush.edu/news/lessons-increasing-access-care

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.”

The Voice of Disability in Nursing

The Voice of Disability in Nursing
by Holly Clayton, RN, MSN
New Hampshire Nursing News
www.NHNurses.org

Recently, I represented NHNA in a monthly American Nurses Association’s Nursing Practice & Work Environment (NP&WE) conference call. With the goal of “promoting the health, safety, and wellness of the nurse and the nursing profession,” this call served to educate and disseminate information of interest to nurses. ANA members included Marie Barry, MSN, Senior Policy Analyst; Holly Carpenter, Senior Staff Specialist; Jaime Dawson, MPH, Senior Policy Analyst and Ruth Francis, MPH, MCHES, Sr. Administrative Assistant. Current projects of the ANA NP&WE include HealthyNurseTM, Safe Patient Handling and Mobility, Fatigue, Safe Staffing and Care Coordination.

A portion of this monthly conference call focuses on current issues with this meeting highlighting the National Organization of Nurses with Disabilities (NOND). Guest speakers included Karen McCulloh, RN, BS, Founder, NOND and Beth Marks, RN, PhD, President, NOND.

I learned the majority of members of the nurse board of NOND, a volunteer organization, have a variety of disabilities. The organization has a mission of “being the voice of disability in nursing.” According to NOND, of those nurses that have disclosed their disability, three per cent of the workforce have disabilities. There are challenges and employment gaps, but there are new expectations with legal and social changes.

Student standards were discussed. Standards must be achievable by students with reasonable accommodations. The presenters discussed students achieving a standard centered on “what,” not “how.” The example provided was “able to gather vitals” rather than “hear the heart murmur through a stethoscope.”

The presenters cited a study demonstrating the aging workforce, with increased incidence of chronic health conditions and disabilities in nurses. They emphasized nurses need to become more knowledgeable, increase their awareness of possible accommodations and be prepared to advocate for themselves.

Following this meeting, I phoned NOND co-founder Karen McCulloh, RN, BS to learn more. She stated NOND is “here for nurses with chronic health conditions and disability.” She discussed strategies for nurses to collaborate with other nurses practicing with disabilities and advised that nurses should not assume they can’t do something based on a disability. Advances in technology and a changing paradigm enable nurses to be nurses, not “patients.” McCulloh provided an example of a nurse who sustained permanent injuries but completed her nursing program with a personal assistant. According to McCulloh, doors can be opened, but nurses need to increase their understanding of how to navigate.

The NOND website www.NOND.org, emphasizes that NOND is the voice for nurses with disabilities. New members are encouraged to join.

Holly Clayton RN, MSN is an active NHNA member and Associate Editor of the NHNursing News.

Moving From Disability to Possibility

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.

Health Care Professionals with Disabilities Career Trends, Best Practices, & Call-to-Action Policy Roundtable

March 18, 2014

Advancing Inclusion in Health Care
NOND ODEP Alliance Roundtable Final Report
http://www.dol.gov/odep/alliances/nond.htm

More than 40 employers, federal and state policymakers, researchers and nursing school administrators convened at the U.S. Access Board on March 18 for a policy roundtable hosted by the Office of Disability Employment Policy in collaboration with the National Organization of Nurses with Disabilities. “We know that health-care occupations dominate the list of jobs predicted to be in most demand in coming years,” said Assistant Secretary of Labor Kathy Martinez, who heads ODEP, as she welcomed attendees. Martinez was joined by acting Assistant Secretary of Labor for Employment and Training Eric Seleznow, along with leaders from the Health Resources and Services Administration and the Department of Education. They explored strategies for using the skills and talents of people with disabilities, including veterans, to meet anticipated labor shortages in nursing and allied health occupations. Because “there is simply not enough talent in the pipeline,” that people with disabilities “have an important role to play in meeting the demands of this changing landscape,” Martinez told attendees.

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Deaf Medical Student Wins ADA Case Against Creighton

Deaf Medical Student Wins ADA Case Against Creighton

On September 4, 2013, Michael Argenyi, a deaf medical student, represented by the National Association of the Deaf (NAD), the law firm of Stein & Vargas and Disability Rights Nebraska, won a jury trial against Creighton University in the United States District Court for the District of Nebraska. Mr. Argenyi had been a student in the medical school at Creighton University beginning in 2009, and had requested that Creighton University provide him with real time captioning for classes and oral interpreters for clinics. Creighton refused to provide him with such services and also refused to allow Mr. Argenyi to bring interpreters even if he paid for the interpreters himself.

With NAD and the other lawyers representing Mr. Argenyi, a lawsuit was filed against Creighton in the United States District Court for the District of Nebraska. The District Court originally dismissed Mr. Argenyi’s case and ruled that Mr. Argenyi had not demonstrated that medical school was beyond his capacity without captioning or interpreting services. Upon appeal, the Eighth Circuit Court of Appeals reversed the District Court’s ruling, and remanded the case back to the District Court, holding that “Section 504 of the Rehabilitation Act and Title III of the ADA each require Creighton to provide reasonable auxiliary aids and services to afford Argenyi ‘meaningful access’ or an equal opportunity to gain the same benefit as his nondisabled peers.”A trial began in Omaha with opening arguments on August 22nd and ended with closing arguments on August 30th, and the jury returned with a verdict that Creighton University violated Mr. Argenyi’s right to communication access under the Rehabilitation Act and the ADA.

The NAD appreciates the strength and courage of Michael Argenyi for standing up to the improper conduct of Creighton University.

“Every university, college and school in the country should take note that deaf and hard of hearing people can achieve any dream including becoming a doctor, and the law clearly requires communication access to make such dreams possible. All schools should heed this case and support these dreams,” said Howard A. Rosenblum, CEO of the National Association for the Deaf.

For more information, contact Marc Charmatz at the National Association of the Deaf via email at nad (dot) info (at) nad (dot) org or telephone at 301-587-1788, or Mary Vargas at Stein & Vargas, LLP by email at Mary (dot) Vargas (at) steinvargas (dot) com or telephone at 240-793-3185.

Deaf Student Denied Interpreter by Medical School

Deaf Student Denied Interpreter by Medical School

Deaf Student, Denied Interpreter by Medical School, Draws Focus of Advocates

By JOHN ELIGON

Speaking with the parents of a sick infant, Michael Argenyi, a medical student, could not understand why the child was hospitalized. During another clinical training session, he missed most of what a patient with a broken jaw was trying to convey about his condition.

His incomprehension, Mr. Argenyi explained, was not because of a deficiency in academic understanding. Rather, he simply could not hear.

Mr. Argenyi, 26, is legally deaf. Despite his repeated requests to use an interpreter during clinical training, administrators at the Creighton University School of Medicine in Omaha, Neb., have refused to allow it. They have contended that Mr. Argenyi, who is able to speak, communicated well enough without one and that patients could be more hesitant to share information when someone else was present. They added that doctors needed to focus on the patient (not a third party) to rely on visual clues to make a proper diagnosis.

Mr. Argenyi took a leave of absence at the end of his second year, in 2011, after suing Creighton for the right to finish his medical training with an interpreter. The case, scheduled to go to trial on Tuesday in Federal District Court in Omaha, is attracting the attention of the federal government and advocates who are concerned that it could deal a setback to continuing efforts to achieve equality for people with disabilities.

“I couldn’t understand so much of the communication in the clinic,” Mr. Argenyi wrote in an e-mail. “It was humiliating to present only half of a history because I had missed so much of what was communicated. I was embarrassed every time I would miss medicine names that I knew from classes but couldn’t understand when the patient or a colleague spoke them.”

Despite making tremendous strides over the past four decades with the passage of the Rehabilitation Act and the Americans with Disabilities Act, those with disabilities remain underrepresented in higher education and in the work force. In the medical field, people who are deaf or hard of hearing remain less likely to hold high-skilled positions than those without impairments.

Universities tend to provide requested accommodations after admitting a student who they know has a disability, proponents for the deaf say. And most arrangements for the deaf are settled long before any issues reach a courtroom, said Curtis Decker, the executive director of the National Disability Rights Network, a federally financed association of legal services programs.

But, he said of Mr. Argenyi’s lawsuit, “It’s a very important case because, I think, if it’s successful it will send a very powerful message to the university community that the law does cover them and the law is clear about the accommodations that they need to provide.”

Creighton officials maintain that they have provided Mr. Argenyi with the necessary tools for him to succeed in medical school.

“Michael Argenyi is a very bright, capable young man who Creighton believes will make a good doctor,” said Scott Parrish Moore, the lead counsel for Creighton.

After being accepted to Creighton four years ago, Mr. Argenyi asked the university to provide a real-time captioning system for lectures and a cued speech interpreter. (Mr. Argenyi, who does not know sign language, can read lips. An interpreter helps by mouthing words while using hand signals to clarify sounds.) These were the same accommodations that Mr. Argenyi, who had a diagnosis of profound deafness when he was 8 months old, received for much of his schooling, from grade school through undergraduate studies at Seattle University.

Creighton provided Mr. Argenyi with just one of the aides that his audiologist had recommended — an FM system, which amplifies the sounds he hears in cochlear implants. The university also provided note takers for lectures, priority seating and audio podcasts. Soon after classes began, Mr. Argenyi told school officials that the accommodations were inadequate and that he was missing information. He sued in federal court in Omaha in September 2009, arguing that the university was legally required to pay for and provide necessary aides.

Mr. Argenyi said he hired his own interpreter and transcription service, which cost him more than $100,000 during his two years in medical school. The breaking point, he said, came during his clinical work in his second year when Creighton refused to allow him to use an interpreter, even if he paid for it himself. The university did allow Mr. Argenyi to use interpreters during a couple of clinics while the Justice Department was trying to broker a settlement, but stopped when a deal could not be reached. Mr. Argenyi is pursuing degrees in public health and social work at Boston University, which is providing his requested transcription services, while the lawsuit is pending.