DocsWithDisabilities Research and Resource Rounds

Collection III: Disability in health sciences: the need for and benefits of inclusion

This collection features studies and testimonials that  examine the current state of disability representation among health sciences students and professionals and that demonstrate how the presence of disabled healthcare practitioners and trainees benefits both patients and clinicians/trainees.

Key works in this emerging literature are gathered in this cluster that includes qualitative studies, the results of quantitative data analyses, and personal testimonials.

Title of Featured Article: Being on Both Sides’: Canadian Medical Students’ Experiences With Disability, the Hidden Curriculum, and Professional Identity Construction

Collection III: Disability in health sciences: the need for and benefits of inclusion

Authors: Erene Stergiopoulos, Oshan Fernando, and Maria Athina Martimianakis

 Article Link: https://pubmed.ncbi.nlm.nih.gov/29794527/

Episode Link:  https://bit.ly/DWDI_RR_17

Description: Stergiopoulos’, Fernando’s, and Martimianakis’ research article investigates how medical discourses shape the conceptualizations of the prototypical “good medical student” and “good patient” roles as featuring mutually exclusive characteristics. They explore how disabled medical students’ experiences during training and professional identity construction are shaped and hold complexity as students navigate positions in both these roles—as both patients and medical trainees. The authors drew on critical discourse analysis to analyze text and interviews, developing codes informed by academic work on the Hidden Curriculum and professional identity construction. Results show that the dominant portrayals of the “good student” and “good patient” roles, robustly and vividly constructed by medical discourse, are juxtaposing and mutually exclusive.

Producer: Zoey Martin Lockhart, Lisa Meeks

Audio Engineer: Jacob Feeman

Transcript

Release: Feb 2024

Keywords:

Medical students; Patient role; Wellbeing; Medical School; Disability Inclusion; Patient Care

DSM; Psychiatric Illness; Mental Illness; Mental Health; Disclosure; Ableism; Medical Education 

Learning Disabilities; Medical culture; Culture of Medicine; Diversity in Medicine; Disability Education

Title: Ethical and Public Health Considerations for Integrating Physicians with Mental Disability into the Physician Workforce. 

Collection III: Disability in health sciences: the need for and benefits of inclusion

Authors: Amalia Sweet, Omar Sultan Haque, and Michael Ashley Stein

Description: 

Sweet, Haque, and Stein’s article explores questions of and argues for increased support and inclusion of physicians with mental disability. Grounding their work in the framework of intersectional social justice, the authors examine medical cultural factors, safety questions, and logistics. They conclude that greater representation of and support for mental disability in medicine will increase the quality and culture of medicine. The article outlines unfair, unnecessary, and discriminatory barriers currently faced by physicians and trainees with disability, to show inclusion and engaged support of physicians and trainees with mental disability is an issue of intersectional social justice. Efforts to increase the diversity of the medical workforce often focus on race and gender, skipping over disability as a dimension of diversity. When disability is considered, the extra stigma and incorrect assumptions surrounding mental disability can mean that people with these disabilities are overlooked or even specifically excluded. Meanwhile, the authors demonstrate that medical education, medical culture, and patient care would benefit from greater numbers of physicians with mental disability and are under-served when these people are excluded from practice or not properly accommodated.

Producer: Zoey Martin Lockhart, Lisa Meeks

Audio Engineer: Jacob Feeman

DOI:  https://doi.org/10.1017/jme.2023.24.

Journal link: https://www.cambridge.org/core/journals/journal-of-law-medicine-and-ethics/article/abs/ethical-and-public-health-considerations-for-integrating-physicians-with-mental-disability-into-the-physician-workforce/B0F4C6CE019E648081F59AD928A15EF2

Transcript: https://docs.google.com/document/d/1UPF9WaE9qrQmrmywfd465jZHGd8n1uER3AXlL6BdSdw/edit?usp=sharing

Release: Dec 2023

Keywords:

Mental Disability

Disability Inclusion

Patient Care

DSM

Psychiatric Illness

Mental Illness

Mental Health

Neurodevelopmental Disability

Neurodevelopmental Disorders

Learning Disabilities

Medical culture

Culture of Medicine

Diversity in Medicine

Disclosure

Professionalism

Competency

Clinicians

Clients

Ableism

Disability Education

Disability Attitudes

Disability Competency

Healthcare Training

Medical training

Care work

Chronic Illness

Disability terminology

Disability studies

Medical model

Health Sciences

Medical Education

Description: Episode 15 discusses “‘Yourself in all your forms’: A grounded theory exploration of identity safety in medical students” (Bullock et al. 2023). Bullock and his colleagues develop a theory of identity safety through careful analysis of 16 in-depth interviews with 3rd and 4th medical students with a diverse range of identities and experiences. The article identifies and describes key dimensions of identity threat, threat mitigation, and identity safety. Three factors contributing to identity safety that emerged from the team’s analysis: Agency to serve, upholding personhood, and a sense of belonging. Identity safety manifested as students sharing a particular minoritized identity with their attending physician, wearing a particular item or hair style, presenting themselves in a particular way, or feeling respected as unique individuals by both their peers and supervisors. When experiencing identity safety, students felt empowered to draw on their own unique experiential knowledge grounded in their particular identities when treating a patient.

Authors: Justin Bullock, Javeed Sukhera, Amira del Pino-Jones, Timothy G. Dyster, Jonathan S. Ilgen, Tai M. Lockspeiser, Pim W. Teunissen, and Karen E. Hauer.

DOI: https://doi.org/10.1111/medu.15174

Journal link

Transcript

Title of Featured Article: Professionalism and Disabled Clinicians: The Client’s Perspective.

Collection III: Disability in health sciences: the need for and benefits of inclusion

Authors: Tal Jarus, Roberta Bezati, Sacha Trivett, Michael Lee, Laura Yvonne Bulk, Alfiya Battalova, Yael Mayer, Susan Murphy, Patricia Gerber, and Donna Drynan.

Description: Episode 14 is the second of two sister-episodes exploring perceptions of disabled clinicians from a range of specialties. The article featured, "Professionalism and Disabled Clinicians: The Client’s Perspective" (2020) analyzes how disabled clients and caregivers of people with disabilities responded to the prospect of being treated by a disabled clinician. Drawing on interviews and focus-group discussions, the authors find that clients held positive perceptions of and were affirmative about receiving care from disabled clinicians. Interviewees felt that these providers might be more “client-centered,” could act as “role models,” 

Client interviewees also suggested that power dynamics between clients and clinicians (usually weighted towards the healthcare provider) might be evenly balanced in the case of disabled clinicians, not because disability lowered the social status of the provider but because the clinicians' additional experiential knowledge of navigating the world with disability would imbue the clinical encounter with enhanced rapport and understanding of barriers (on the part of the physicians). Interviewees felt that disclosure of disability by a provider fell into the realm of appropriate and professional interactions with clients–and could even enhance provider-patient relationships. A consensus also emerged that disabled clinicians would pick fields and work conditions that suited their strengths; clients felt safe being treated by clinicians with disabilities.

Producer: Zoey Martin-Lockhart and Lisa Meeks

Sound: Jacob Feeman

DOI: https://doi.org/10.1080/09687599.2019.1669436

Journal link: https://www.tandfonline.com/doi/abs/10.1080/09687599.2019.1669436?journalCode=cdso20

Transcript

Release: August 2023

Keywords:

Disclosure

Professionalism

Competency

Clinicians

Clients

Ableism

Disability Education

Disability Attitudes

Disability Competency

Healthcare Training

Medical training

Care work

Chronic Illness

Disability terminology

Disability studies

Social model

Medical model

Health Sciences

Medical Education

Title of Featured Article: ‘I Can Understand Where They’re Coming From’: How Clinicians’ Disability Experiences Shape Their Interaction With Clients. (2020)

Collection III: Disability in health sciences: the need for and benefits of inclusion

Authors: Alfiya Battalova, Laura Bulk, Laura Nimmon, Rachelle Hole, Terry Krupa, Michael Lee, Yael Mayer, and Tal Jarus

Description: This is the first of sister-episodes exploring perceptions of disabled clinicians from a range of specialties. The article featured in this episode, 13, draws on the experiences of clinicians and trainees with disabilities via analysis of qualitative interviews. The authors find that clinicians’ insider, experiential knowledge of living with disability or chronic illness—and of navigating health care as a person with disability—facilitates better care to disabled and chronically ill clients for several reasons: improved rapport; deeper listening, understanding, and empathy; and an understanding of barriers to good care that exist inside and outside of healthcare that is grounded in professional and person experience. Precise concordance of diagnosis or experience did not appear to be necessary. This paper suggests that the experiences of disability and chronic illness that motivate professional medical trainees to engage in educational disability advocacy are themselves experiences that provide professionally valuable expertise. 

DOI: https://doi.org/10.1177/1049732320922193.

Journal link: https://journals.sagepub.com/doi/10.1177/1049732320922193

Transcript: https://docs.google.com/document/d/1ckx2wzDejugQTRFP88cGaBk4mG1yN7gW/edit

Release: August 2023

Keywords:

Disclosure

Professionalism

Competency

Ableism

Disability Education

Disability Attitudes

Disability Competency

Healthcare Training

Medical training

Care work

Chronic Illness

Disability terminology

Disability studies

Social model

Medical model

Health Sciences

Medical Education

Transcript: https://docs.google.com/document/d/1SBOWRq1Kq9WiegnJMvlJMUDDuj9xOBcRsXgW7MkQRtQ/edit?usp=sharing

Title: ADEPT-CARE: A pilot, student-led initiative to improve care for persons with disabilities via a novel teaching tool

Collection II: Integrating disability into health sciences curricula: implementation, recommendations, and the need for disability content in health sciences education 

Article: “ADEPT-CARE: A pilot, student-led initiative to improve care for persons with disabilities via a novel teaching tool.” (2023)

Authors: Lydia Smeltz, Sandra Carpenter, Lauren Benedetto, Nora Newcomb, Dana Rubenstein, Tonya King, Christopher Lunsford, and Ami L. DeWaters. 2023.

Description: This article describes the student-led development and piloting of a didactic tool intended to assist medical trainees’ and providers’ capability and confidence when interacting with disabled patients in clinical environments. ADEPT-CARE is a mnemonic for which each letter corresponds to a distinct dimension of clinical process or behavior that experts recommend following when interacting with disabled patients. The tool was introduced to a group of first-year medical students. While their feelings of competence in treating disabled patients did not change after a 15-minute asynchronous video training on the ADEPT-CARE protocol–possibly due to the small sample size–the student participants did endorse the utility of the protocol.

DOI: https://doi.org/10.1016/j.dhjo.2023.101462.

Journal link: https://www.sciencedirect.com/science/article/abs/pii/S1936657423000298

Transcript: https://docs.google.com/document/d/1Ww_U_TbTpjPwaovW3E2vQTagK5E04x53/edit

Release: June 2023

Keywords:

Disability Education

Disability attitudes

Disability Competency

Healthcare training

Medical training

Care work

Chronic Illness

Disability terminology

Disability studies

Social model

Medical model

Health Sciences

Medical Education

Description: 

Today we cover the 2021 article, Effect of Disability-Specific Education on Student Attitudes Toward People With Disabilities by authors: Khalid Alahmari, Kanagaraj Rengaramanujam, Ravi Shankar Reddy, Paul Silvian Samuel, Irshad Ahmad, Venkata Nagaraj Kakaraparthi, and Jaya Shanker Tedla.

This study is the first study in Saudi Arabia to look at the attitudinal effects of disability training amongst final-year health sciences students. The study also explored whether demographic variables, health sciences field, or exposure to disability had an effect on students’ attitude change—or lack thereof. The investigators found a statistically significant change in the attitude scores of students from fields that generally involve greater patient contact.

DOI: https://doi.org/10.1177/1090198121995774.

Transcript

Keywords:

Saudi Arabia

Disability Education

Disability attitudes

Disability Competency

Healthcare training

Medical training

Care work

Chronic Illness

Disability terminology

Disability studies

Social model

Medical model

Health Sciences

Medical Education

Article: Using the health humanities to impart disability competencies to undergraduate medical students

Authors: Singh, Khan, Dhaliwal, Khan

DOI: 10.1016/j.dhjo.2021.101218

 Description: 

In episode 10 we discuss the pedagogical method and results of a pilot project that used the health humanities to teach eight disability competencies to Indian undergraduate medical students. The authors’ pioneering educational approach included disabled patient panels, forum theater (a form of Theater of the Oppressed), visual art, and a field trip to an integrated school educating disabled and non-disabled children. 

Transcript 

Keywords:

Health Humanities

Medical Humanities

India

MBBS

Human rights model

Disability Competency

Healthcare training

Medical training

Care work

Chronic Illness

Disability terminology

Disability studies

Social model

Medical model

Health Sciences

Medical Education

In Research and Resource Rounds Episode 9, we review Improvements in Students’ Attitudes Toward People With Disabilities With or Without Semi-Structured Community-Based Interactions. 

The article describes and presents the results of a study in which the three authors tested the effect of a baseline curriculum and of an enhanced curriculum on doctor of physical therapy students’ attitudes towards people with disabilities. Two student cohorts from the University of Texas El Paso’s doctor of physical therapy program participated in the study which measured attitudes using two common measures: first, Attitudes Toward Disabled People or ATDP-A and the Multidimensional Attitudes Scale Toward Persons with Disabilities or MAS.

The baseline curriculum group and enhanced curriculum group both showed improvement in their attitudes, although the baseline group only showed a statistically significant improvement in attitudes towards people with disabilities on the MAS scale. Moreover, the two groups (baseline and enhanced curriculum) did not differ significantly on their pretest or posttest scores on either attitude measure.

Article: Improvements in Students’ Attitudes Toward People With Disabilities With or Without Semi-Structured Community-Based Interactions.

Authors: Jimenez, Pechak, Garrand

DOI: https://doi.org/10.1097/JTE.0000000000000102

Transcript

Keywords:

Physical Therapy

Doctor of Physical Therapy

Physical Therapy Education

Physical Therapy Curricula

Interdisciplinary health education

Healthcare training

Medical training

Care work

Chronic Illness

Disability terminology

Disability studies

Social model

Medical model

Health Sciences

Medical Education

EPISODE 8

This article shares the findings of qualitative interviews investigating university health science educators’ perspectives on and approaches to disability education at a New Zealand university. All participants reported that disability training was not a standard component of their field’s curriculum. Instead, these educators incorporated piecemeal disability content where possible. The authors identify six “perceived advantages” of fore-fronting lived experience in materials and techniques used to teach health science students about disability embodiments and care. Interviewees argued that disability training material should appear regularly in the standard 4-year curriculum, perhaps as part of cultural competency lessons that already recur throughout the 4-year program.

Article:

Peiris-John, Roshini, Neera R. Jain, Amy Hogan, and Shanthi Ameratunga. 2021. “Educating Health Science Students about Disability: Teachers’ Perspectives on Curricular Gaps.” Disability and Health Journal 14 (1): 100985. https://doi.org/10.1016/j.dhjo.2020.100985.

Transcript: https://docs.google.com/document/d/1QTczQW5S-oZyecgpNDJX33Bzwk0Rwga6aoJ-dyS9pvw/edit?usp=sharing

Release: March 2023

Keywords:

Interdisciplinary health education

Health curricula

Teacher

New Zealand

Healthcare training

Medical training

Care work

Chronic Illness

Disability terminology

Disability studies

Social model

Medical model

Health Sciences

Medical Education

This is the first episode of our second collection, Integrating disability into health sciences curricula: implementation, recommendations, and the need for disability content in health sciences education, we cover the 2021 article, “What Should We Teach about Disability? National Consensus on Disability Competencies for Health Care Education” published in the Disability and Health Journal by Havercamp, Barnhart, Robinson, and Whalen Smith.

The authors describe the necessity of widespread and consistent disability training across interprofessional health education, an umbrella that encompasses medicine, nursing, social work, and psychology—among other disciplines. Taking up their own imperative, the authors propose a set of competencies, sub-competencies, and principles that could act as a national standard. The article details the collaborative, multi-phase process of developing and repeatedly revising the competencies with help from expert reviewers with both lived and professional expertise in disability and its relevance in healthcare fields.

Transcript: https://docs.google.com/document/d/1TcbDgXWtWMR_TIp62a-jiZPq44FOFfaIlxrWicP_Ci4/edit?usp=sharing

Key Words: 

Disability competencies

Disability standards

Disability education

Interdisciplinary health education

Healthcare training

Medical training

Care work

Chronic Illness

Disability terminology

Disability studies

Social model

Medical model

Health Sciences

Medical Education

Episode 6 of Research and Resource rounds discusses the paper, “COVID-19 and the Need for Disability Conscious Medical Education, Training, and Practice.” published in the Journal of Pediatric Rehabilitation Medicine, as part of our collection disability in the health sciences: key arguments and issues at stake, language, and history.

Article: Doebrich, Adrienne, Marion Quirici, and Christopher Lunsford. 2020. “COVID-19 and the Need for Disability Conscious Medical Education, Training, and Practice.” Journal of Pediatric Rehabilitation Medicine 13 (3): 393–404. https://doi.org/10.3233/PRM-200763.

Authors: Doebrich, Adrienne, Marion Quirici, and Christopher Lunsford.

Transcript

Keywords:

Disability Consciousness

Covid-19

Medical training

Care work

Chronic Illness

Disability terminology

Disability studies

Social model

Medical model

Health Sciences

Medical Education

Episode 5 of Research and Resource rounds discusses the paper, “Racialized disablement and the need for conceptual analysis of “racial health disparities,” published in the journal Bioethics, as part of our collection disability in the health sciences: key arguments and issues at stake, language, and history.

Article: Racialized Disablement and the Need for Conceptual Analysis of ‘Racial Health Disparities.’

Author: Desiree Valentine

Link: https://doi.org/10.1111/bioe.12979.

Transcript

Keywords:

Racialized Disablement

Medical Racism

Racial Health Disparities

Disability terminology

Disability studies

Social model

Medical model

Health Sciences

Medical Education

In Episode 4 we review the prevalence of disability among individuals across the continuum of medical training and practice and data from three recently published studies that break down disability in medical school, residency, and among practicing physicians.

Keywords: Disability Prevalence; Data, Medical Education, DocsWithDisabilities 

Transcript

The authors enumerate a series of models used to conceptualize disability and the terminology associated with each model. They provide in-depth explorations of person-first and identity-first language, recommend avoiding euphemisms, and argue against the language restrictions imposed by some style guides.

Article:

“The Evolution of Disability Language: Choosing Terms to Describe Disability” by Erin E. Andrews, Robyn M. Powell, and Kara Ayers. https://doi.org/10.1016/j.dhjo.2022.101328

Key Words: Disability terminology, Disability language, Disability studies, Social model, Medical model, Health Sciences, Medical Education

Transcript: https://docs.google.com/document/d/1_oN-otcPRD2bv0CqZb4K_EFqTEHO_H5zxpZU1S6sEQ4/edit?usp=sharing

In Episode two we review the thought provoking commentary: “Disability and the Training of Health Professionals” by Tom Shakespare, Lisa I. Iezzoni, and Nora E. Groce (Lancet, 2009). DOI: https://doi.org/10.1016/S0140-6736(09)62050-X.

The authors argue that equitable treatment of disabled patients is an issue of human rights that can only be achieved by improving disability education in health sciences education. They write that the topic of disability must be increased across the health sciences, from educational training to infrastructural adjustments and the representation of people with disabilities among health sciences professionals and students.

The new Research and Resource Rounds are introduced: These mini-casts will provide an overview of literature and resources relevant to disability inclusion in the health sciences. Each short episode will review critical commentaries and research articles in 15 minutes or less. The podcast presents selected literature in themed “collections” listed in the podcast.