Medical Education: Students & Residents With Disabilities

From the application process, throughout medical training, and final career choices, medical students and physicians with disabilities, on a daily basis, will be challenged and need to make tough, and often, critical decisions along their journey.
 

How and when should you bring up your disability?  What kind of accommodation will you need if accepted?  What should be required skills or competencies for medical students upon graduation?  For the student with a disability, how will these competencies be assessed throughout their training? Is there such a thing as a completely undifferentiated medical student, capable of competency in any medical specialty?

 

Personal Story
 

When I first applied to medical school, at a time that most students applied to 7 to 10 different schools, I applied to 17!  As I am a Deaf physician, I struggled with how to mention my hearing loss on my application.  I felt that it was important to mention it, but mention it in a positive manner, realizing the challenges that would likely lie ahead.  I bravely submitted the applications and began my wait.
 

Of the 17 applications, I was pleasantly surprised to receive five interview requests; once done with the interviews, 3 schools had accepted me and I was “wait-listed” at two others.  My ultimate decision was Northwestern University Medical School (now the Feinberg School of Medicine).
 

Before I entered medical school, I contacted many people to ask about what to do with regard to accommodations.  I already had an FM system and an amplified stethoscope contact, for when I needed one, but at that time, had not needed sign language interpreters.  I wanted to be prepared, should I need interpreters in the future.  I was advised by Karen Meyer, a prominent disability consultant, and now feature reporter for ABC News in Chicago, to write a letter to Northwestern, advising them of the possible need for interpreters in the future.  This letter was placed in my admission file.
 

As I went through my training, various accommodation issues were addressed and solved relatively easily—volume amplified telephones, flashing lights, paging systems (as opposed to voiced overhead announcements), and the like were provided.

Interpreters were a challenge for a number of reasons.   But first, where would I find qualified interpreters; who would be willing to interpret for medical school!  With the help of friends and a well respected interpreter in the community, I slowly accumulated a core group of 5 interpreters, who were carefully screened with such questions as: “Can you stand the sight of blood and the operating room?” One female interpreter responded, “Blood?  I see that every month!”
 

Once that was done, the next practical concern was—complex medical terminology!  As I learned the terms, the interpreters would learn the terms, then, we would have to create signs that best fit!
 

Would my classmates accept me, should I have an interpreter in class?  For most students, no problem; they quickly got used to seeing an interpreter in class and continued to include me in group sessions.
 

Financially, interpreters presented another challenge.  This, was finally resolved by the time I graduated medical school.  As I was a student prior to the signing of the Americans with Disabilities Act of 1990, I was covered under the Human Rights Act of 1973 and Section 504.  After I graduated, because of my efforts and self advocacy for needed services, the University formally opened an Office of Students with Disabilities.
 

My technical and clinical skill assessments of patients were assessed throughout medical school and residency.  Faculty and preceptors observed my interaction with patients, listened to my stethoscope (and watched me use my stethoscope), and used other techniques, along with faculty and resident evaluations.
 

To this day, I feel it is an important challenge; it needs to be assessed based on the skill requirements and needs of each student.  While I was able to hear the required heart and lung tones with my amplified stethoscope, how could I explain to others what I could and could not hear?  Should I have to?
 

Or, should I just have the required knowledge of the issue or patient concern, know what is needed, and the resources at my disposal to use when in doubt—refer to a cardiologist, ask another colleague to listen, or send the patient for an echocardiogram?

 

The “Undifferentiated” Medical Student
 

Today, most medical schools still follow the “undifferentiated” curriculum; throughout the 4 years of training, students receive a general medical education, technical skills training, patient “models,” and clerkships.  This training provides hands on experience and training, as students are exposed to a variety of medical specialties, and potential career choices.

 
All students should be exposed to the variety that currently exists in medical school, but as our medical knowledge expands, there are more subspecialties in medicine than ever before!  As a result, many students, by their 3rd and 4th year, need to make critical career and elective choices to narrow down their field.

 
It has been shown that many students who enter medical school have already decided on the general area of medicine they wish to practice!  Several studies have demonstrated, that when students first enter medical school, they already have a preference for their career choice in medicine.1-4  Some students do change career choices during medical school, but many end up in fields closely linked to their original preferences.


This brings us back to the original discussion of the “undifferentiated” medical student, and the student with one or more disabilities.  Should medical schools require mastery of every subject, along with clinical and technical skill competency?  Or, should students be evaluated on cognitive and self advocacy skills, and ability to make competent utilization and resource decisions to practice medicine in a safe, effective manner?

 

Accommodations for Medical Students & Residents with Disabilities
 

For students with disabilities, this presents an interesting and important topic for discussion.  I strongly feel medical schools should not restrict or narrow career options for students with disabilities.  Nor should they restructure the curriculum toward a specific specialty for the student, based on the school’s view of an “appropriate” career option.  Technology continues to improve and usually this will expand opportunities.  Career negotiations and discussions should occur throughout training in an honest and open manner.


Most accommodations are not expensive; they simply require awareness and patience.  Others may cost more, such as interpreter services, but even that may change.  In addition, some have raised the possibility of having other health care professionals, such as aides or “physician extenders” to perform “required” physical skills that may be a barrier for the physician with a disability.


An aide or physician extender could be a sign language interpreter, or someone who provides cardiac and pulmonary auscultation for a Deaf or hard of hearing physician.  They could be a support provider that describes skin lesions to a blind physician, or help provide support services to a physician with cerebral palsy or paraplegia.



Our Melting Pot…
 

Ultimately, all medical students and residents should have the cognitive knowledge required of those who graduate from training.  We still need to discuss and explore what is absolutely required, as far as physical and technical skills for physicians when they graduate.

If we welcome the concept that America is truly a melting pot, we must realize that people with disabilities are critical participants, with invaluable resources and ideas; we, too, can contribute significantly toward better health for all.  Let’s work together to make this happen!


References

1.                  Carline JD, Greer T. Comparing physicians' specialty interests upon entering medical school with their eventual practice specialties. Acad Med 1991; 66:44-6. [Medline]

2.                  Zeldow PB, Preston RC, Daugherty SR. The decision to enter a medical specialty: timing and stability.  Med Educ 1992; 26:327-32. [Medline]

3.                  Pathman DE. Medical education and physicians' career choices: are we taking credit beyond our due?  Acad Med 1996; 71:963-8. [Medline]

4.                  Colwill JM. Where have all the primary care applicants gone? N Engl J Med 1992; 326:387-93. [Medline]