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Guest Blog Post: Disability as Diversity in the Health Sciences

Alice Wong, Project Coordinator and Founder of the Disability Visibility Project, wrote an introduction to an upcoming book, The Guide to Assisting Students With Disabilities: Equal Access in Health Science and Professional Education, co-edited by Lisa M. Meeks, PhD, and  Neera R. Jain, MS, CRC. Copyright 2015. ISBN: 978-0-8261-2374-9

Below are several excerpts from the Introduction. Reproduced with the permission of Springer Publishing Company, LLC.

A Call for Equal Access in Health Science and Professional Education

People with disabilities are easily understood as “the patient” within the health professional-patient dyad and very rarely seen as “the professional.” Systemic and institutionalized ableism marginalizes people with disabilities by categorizing them as “vulnerable populations” that are “objects of care,” not “professionals with expertise.” That a person with a disability can be a healthcare professional challenges, at minimum: 1) the notion of what comprises a “typical” healthcare professional (i.e., what they look like and how they perform their work); and 2) the low societal expectation that people with disabilities will attain a role with such authority, legitimacy, and competency.

The terms “diversity” and “cultural competency” are touted as important priorities in health science and medical education programs because having a diverse workforce is a social good that makes business sense and a way to reduce health disparities (Cohen, Gabriel, & Terrell, 2002). This is all true. However, the definition of diversity most often used leaves much to be desired. Universities aim to have diversified workforces and students by focusing outreach to women, racial/ethnic/linguistic minorities, LGBT individuals, immigrants, and veterans. With approximately 57 million Americans with disabilities in the United States—the country’s largest minority at 18.7% of the general population—people with disabilities are still often excluded from diversity initiatives, practices, and policies (Brault, 2012; McKee, Smith, Barnett, & Pearson, 2013).

The Association of American Medical Colleges has included disability in their description of cultural competence for less than a decade (DeLisa & Lindenthal, 2012). One recent survey suggests people with disabilities are vastly underrepresented in the health professions with 2-10% of practicing physicians even though they make up about 20% of the overall population (DeLisa & Lindenthal, 2012). Societal attitudes, blatant discrimination, and access issues are several reasons for such low numbers, suggesting serious challenges to providing equal access to students with all types of disabilities in the health sciences and medical education.

The definition of disability, like diversity, has a narrow meaning by some. Having a disability is still considered by many as something purely related to health, disease, functional limitation, and impairment of the body, especially in the health sciences (Long-Bellil et al., 2011). However, there is disability culture and there are disability communities everywhere (Robey et al., 2013). Increasing the number of culturally competent professionals with disabilities in the health sciences will broaden the knowledge base and breadth of experience within all fields, in addition to filling a critical shortage in the healthcare workforce. The increased presence and perspectives of people with disabilities will influence the way professionals view disability and the assumptions associated with it. Moreover, professionals with disabilities can improve patient care, impact research agendas, workplace attitudes toward disability, and reduce the significant barriers to healthcare, discrimination, and ableism experienced by people with disabilities (Disability Rights Education and Defense Fund, n.d.; Smeltzer, Avery, & Haynor, 2012; Moreland, Latimore, Sen, Arato, & Zazove, 2013).

An expansion of what disability and diversity means is a step in the right direction. Another critical step requires challenging the presumed abilities associated with being a student or professional in the health sciences (American Association of Medical Colleges, 2013). A student with a visual impairment may need a microscope slide projected onto a screen rather than looking into the actual microscope. A student of short stature may use a step stool or an adjustable exam table to have access to a patient during rotations. These types of accommodations and adaptations do not take away from the patient experience or the student’s abilities. In fact, I would argue that the exposure of these different ways of doing things improves healthcare in general. Other students may discover having images projected from a microscope to a screen can reduce eyestrain and provide easier viewing. Adjustable exam tables that are meant for a disabled patient or health professional can suddenly become popular and used by a wide array of patients and colleagues because of their ergonomic features.

University leaders need to initiate a policy and culture shift that encourages prospective students with disabilities and communicates that they belong and are needed in the health sciences and medical education.

Academic institutions can take several steps to ensure equal access for students with disabilities in the health sciences and medical education:

  1. Embrace people with disabilities as a culturally diverse group in hiring, recruitment, and admission practices.
  2. Create a welcoming campus climate for students with disabilities (e.g., accessible built environment, staff and faculty familiar with provision of accommodations, resources for students with disabilities such as campus organizations, and an administration that is responsive to the needs of students with disabilities).
  3. Re-frame accommodations as a diversity best practice that benefits the entire student body and campus community.
  4. Establish staff and programs that provide streamlined services to students with disabilities once they are enrolled, including clear policies and courses of actions for students to take in order to access needed services and appeal or file grievances, if needed.
  5. Highlight the visibility of staff and faculty with disabilities (who have already disclosed this information) working at on campus.
  6. Support early educational programs and outreach efforts that encourage young students with disabilities to go into the health sciences, similar to current STEM initiatives for girls and people of color.
  7. Integrate disability culture within cultural competency curricula (Thomas Smith, Roth, Okoro, Kimberlin, & Odedina, 2011).

The authors in this book describe how universities can serve students with disabilities effectively and provide recommendations and solutions to complex issues related to accommodations and communication about disability-related needs. As professionals who work with students with disabilities everyday, these authors demonstrate how even the most difficult or seemingly impossible case can be adequately resolved through good working relationships with students, creativity, and flexibility – while maintaining rigorous academic standards.

Diversity by disability matters beyond mere representation—it provides a critical counterbalance to the healthcare experience, benefiting patients, professionals, and communities. For me, it is simply an issue of power and equity.

References

American Association of Medical Colleges. (February 2013). Part II: Medical students or health care professionals with disabilities. GDI Navigator to Excellence: Summaries of Disability Articles in the Journal of Academic Medicine 2001-2012. Retrieved from

https://www.aamc.org/download/328092/data/disabilityarticlesinacademicmedicine.pdf

Brault, M. W. (2012). Americans with Disabilities: 2010. Retrieved from http://www.census.gov/prod/2012pubs/p70-131.pdf

Cohen, J. J. Gabriel, B. A. & Terrell, C. (2002). The case for diversity in the health care workforce. Health Affairs, 21(5), 90-102.

DeLisa, J. A. & Lindenthal, J. J. (2012). Commentary: Reflections on diversity and inclusion in medical education. Academic Medicine, 87(11), 1461-1463.

Disability Rights Education and Defense Fund. (n.d.). Welcome to healthcare stories. Retrieved from http://dredf.org/healthcare-stories/

Long-Bellil, L. M., O’Connor, D. M., Robey, K. L., Earle Hahn, J., Minihan, P. M., Graham, C. L. & Smeltzer, S. C. (2011). Commentary: Defining disability in health education. Academic Medicine, 86(9), 1066-1068.

McKee, M. M., Smith, S., Barnett, S. & Pearson, T. A. (2013). Commentary: What are the benefits of training deaf and hard-of-hearing doctors? Academic Medicine, 88(2), 158-161.

Moreland, C. J., Latimore, D., Sen, A., Arato, N. & Zazove, P. (2013). Deafness among physicians and trainees: A national survey. Academic Medicine, 88(2), 224-232.

Robey, K. L., Minihan, P. M., Long-Bellil, L. M., Earle Hahn, J., Reiss, J. G. & Eddey, G. E. (2013). Teaching health care students about disability within a cultural competency context. Disability and Health Journal, 6, 271-279.

Smeltzer, S. C., Avery, C. & Haynor, P. (2012). Interactions of people with disabilities and nursing staff during hospitalization. American Journal of Nursing, 112(4), 30-37.

Smith, L., Foley, P. F. & Chaney, M. P. (2008). Addressing classism, ableism, and heterosexism in counselor education. Journal of Counseling & Development, 86, 303-309.

Thomas Smith, W., Roth, J. J., Okoro, O., Kimberlin, C. & Odedina, F. T. (2011). Disability in cultural competency pharmacy education. American Journal of Pharmaceutical Education, 75(2). Article 26.

Wen, L. S. (2014, October 27). For people with disabilities, doctors are not always healers. The Washington Post. Retrieved from

http://www.washingtonpost.com/national/health-science/for-people-with-disabilities-doctors-are-not-always-healers/2014/10/24/afb632e6-45a0-11e4-b437-1a7368204804_story.html

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