Just what the doctor ordered: removing barriers to inclusivityWe need to challenge medical schools everywhere to re-evaluate their expectations of people with disabilities and their image of the ‘ideal’ physician, believes University of Auckland doctoral student Neera Jain.
Ms Jain, who is currently in the final stages of a PhD focused on US medical students with disabilities at the University’s Faculty of Education and Social Work, believes having health professionals who are themselves disabled would also benefit patient care.
“Patients can relate to a doctor who looks like them or has similar life experiences, and hopefully that will shift peer perspectives about disability,” she says.
Having worked as an advocate for health science students with disabilities at Columbia University in New York and University of California San Francisco (UCSF), she has first-hand experience of the hurdles these students have to face in a highly competitive and relentlessly pressured field.
“It’s clear they understand their position is precarious and they are excludable, they feel they’re only there because they were given a chance, and that could just as easily be taken away.”
In the US, around 4.6 percent of medical students disclose a disability which can range from physical impairments like quadriplegia, visual impairments, deafness and being hard of hearing, chronic health conditions and learning disabilities to mental health issues and other conditions like ADHD and Asperger’s.
And while it hasn’t been well-researched yet, Ms Jain says it would be accurate to say that the majority of these students successfully graduate. However, she says there is still a prevailing tendency in the field, as there is in the world generally, to equate disability with inability.
“Students worry about how to be seen as capable rather than needy, especially when the training is not designed to allow for an approach that would suit them better. For example, it’s standard practice for trainee doctors to rotate through all the specialties, but is that really the only way to do things if you want to be inclusive?”
Another potential stumbling block is the pace of medical training which is very intense, requires long hours and is difficult to do more slowly. This creates problems for all students, but in particular, those with disabilities.
“A programme that allowed for part-time or more flexible hours and the ability to lengthen training would be beneficial,” she says.
She would particularly like to see a general shift in the culture from one of perfectionism to one where trainees can discuss their learning needs with their teachers without the worry of being deemed incapable.
“This would also have a positive effect on other important issues like student mental health and patient safety.”
Making inherent requirements, called technical standards in the US, more inclusive, or even better, obsolete, would be another step forward, she believes.
“New Zealand’s inherent requirements for studying medicine, set by the Medical Deans of Australia and New Zealand (MDANZ), suggest you must be able to speak, see, and hear, have gross and fine motor skills and attend medical training fulltime; all of these appear to exclude many students with physical disabilities. However these requirements are currently under review and I’m hopeful that the revised standards will reflect a stronger spirit of inclusion.”
Students with disabilities in New Zealand are protected under the Human Rights Act (1993), however Ms Jain says there seem to be more significant barriers to their inclusion here than in the US, and US legislation has more teeth.
“In the US, there have been lawsuits testing the law and its enforcement, and decisions about complaints are usually made public. There is also a campaign that involves qualified physicians and trainees publicly sharing their disability stories.”
She admits solutions are not easy as they involve working with a variety of student needs in a challenging environment.
“Legislation is helpful but limited. I think we need some philosophical, real high-level thinking in this area, our medical schools need to be thinking beyond individual students to a broader culture shift.”
And New Zealand has opportunities to leapfrog ahead, benefitting from others who’ve begun to do the hard work and ironed out the kinks, she believes.
“Once students and medical professionals work alongside disabled people with equal status to them, they start to understand disability differently and this will change how they treat patients with disabilities.”
In an ideal world she would like to see a complete shift from the idea of disability as a deficit to be accommodated, to the vision of a diverse workforce as a positive benefit for everyone.
“If we can start from a place where we assume disabled people will make great doctors, we can begin to design training that takes them into account from the beginning. This will transform training and care for everyone.”
Later this year in Michigan, United States, there will be an international conference on disability inclusion and health to which several New Zealand delegates have been invited.