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Farzana Ali (left) and Daniel W. Sheehan, Associate Dean for Medical Curriculum at the Jacobs School of Medicine and Biomedical Sciences.

 

How are you going to do the long hours of clinical rotation in this condition?

As a premedical student, the strong emotion invoked by that question left me speechless. Especially since it was posed by the Associate Dean of medical education from my beloved undergraduate institution, Stony Brook University, a community where I developed my values of inclusion and service for the betterment of humanity. I just wished he could see how much effort went into the long hours of research and volunteer work I did in that community, alongside my hectic premedical curriculum. Then he would realize that dedication and hard work can make a student achieve their goals, regardless of their disability. But he was so preoccupied with my wheelchair-bound paralyzed appearance, that my years of academic and extracurricular accomplishments were reduced to meager scribbles on paper.

The question was an explicit expression of the bias against students with disabilities held by an individual with the highest authority to decide who can pursue medical education in his institution. But even more unfortunate are the cases where such bias is held implicitly, barring a dedicated student from pursuing their lifelong dream. Despite the enactment of several acts to ensure equal access to education in the United States, many students still face discrimination due to the ambiguity of those acts and the reluctance of authorities to provide necessary accommodation. A recent article published in the Journal of the Association of American Medical Colleges addresses the lack of support from most medical schools in providing accommodation for students with disabilities, despite the evidence that physicians with disabilities are more empathetic towards patients, and are actually preferred by patients.

A 1987 study reported only 0.25% of US medical students had disabilities, and still today, less than 1% of medical students have any disability, compared to 20% of our general population. Even though individuals with disabilities constitute the largest minority group in the US, their representation in the medical field is well below the percentage of other minority groups. One major component of medical admission that may work against students with disabilities is the technical standards (TS) set by medical schools in the US and Canada. The medical schools need to delineate these standards before receiving accreditation from the Liaison Committee on Medical Education (LCME), a voluntary organization that ensures the quality of medical education based on established standards. Majority of US medical schools state in their TS the need for full participation of the student in every aspect of medical training with or without accommodation. Even though a third of US medical schools explicitly express their openness to the provision of reasonable accommodations to otherwise qualified students with disabilities, more than half of the medical schools remain vague in their statements regarding reasonable accommodations. Moreover, it is up to the institution to decide what type of accommodation is considered “reasonable”.

Schools are required to provide reasonable accommodation, and are prohibited to discriminate against students with disabilities, in accordance with the Rehabilitation Act of 1973 and its Section 504. The nondiscrimination concepts of Section 504 were further reinforced by the passage of the Americans with Disabilities Act in 1990, and its amendment in 2008. Yet, the variation in applicability of these acts depending on individual’s condition adds more ambiguity to the notion of reasonable accommodation. This contributes to the uncertainty of a student’s eligibility for being considered for medical education in a particular institution. As a result, applicants with disabilities to medical programs have to rely on the knowledge and open-mindedness of a medical school regarding their disability. Even after the admission of a medical student with disability, the Institution needs to implement a team-oriented approach including the student and knowledgeable individuals to ensure proper training that meets established standards.

Despite these stated complications, there have been many medical students in the US who have not only completed their medical education, but also flourished in their practice. Dr. Shane VerVoort was the first quadriplegic to enter medical school in 1979, who currently practices in physical medicine and rehabilitation, a specialty dedicated to patients with conditions similar to his own. In 1992, James Post was rejected by all the medical schools he applied to, because of his disability, despite his outstanding academic performance. But his perseverance led to his acceptance into the Albert Einstein College of medicine, where he graduated in the top 10% of the class, and is now practicing as a kidney specialist. Meghan Wilson is one of the recent success stories for medical students with disabilities, even though she had to initially struggle to get into a medical program due to her disability. She became quadriplegic from a skiing accident at the age of 17, but later went on to finish her M.D./ Ph.D. degree, and is currently doing residency in the Department of Physical Medicine and Rehabilitation at the University of California, Irvine School of Medicine.

The presence of students with disabilities adds a unique dimension to diversity in medical education by enlightening students without disabilities about disability issues through personal interaction with their fellow students with disabilities, as indicated by the lead physician author of the aforementioned article. The proactive measures taken by the Association of American Medical Colleges have been useful for educating faculty and administrative staff members of medical colleges in the US about reasonable accommodations for medical students, and broadening their viewpoint on accepting students with disabilities. The LCME can play a vital role in this process by reinforcing ADA compliance in TS evaluation of medical schools in the US and Canada. Such efforts will not only improve diversity in the medical field, but also enable patients to receive care from physicians who can connect through personal experience and unique insights.

Farzana Z Ali

Class of 2020

Jacobs School of Medicine and Biomedical Sciences