Current medical training does not prepare physicians for the needs of disabled patients. Despite the prevalence of disability and this population’s increased healthcare utilization, a survey of internal medicine and family medicine residents found that only a quarter of residents reported ever having received any disability training.16 Moreover, of the half of emergency medicine residency programs that have any time dedicated to disability training, they report spending only 1.5 hours on it.17 This problem has been recognized globally for a long time. The first World Report on Disability conducted by the World Health Organization (WHO) in 2011 articulated the lack of necessary knowledge and skills of health care providers to meet healthcare needs of disabled patients. 11 This includes items such as providing accommodations, addressing common misconceptions and biases towards disabled patients, and teaching how to perform a physical exam for a patient who uses a wheelchair. These skills and knowledge are not evaluated on licensing examinations and attitudinal barriers are not considered in determining ability to provide care.18 This provides little incentive to incorporate disability training and disability etiquette into medical training. Even when disability is addressed in medical training, it is often through the medical model lens, in which disability is considered solely a deficit of the individual without addressing the built environment, ableism, and structural barriers that impact disabled patients’ health and wellbeing.19 The current medical training system is producing trainees who leave with little to no time dedicated to learning how to properly care for disabled patients and the issues they face, despite the large number of disabled patients they will care for.
In response to this issue, some medical schools have started incorporating disability content into curricula. Many of these programs involve single sessions with some positive effects. For example, the University of South Carolina found that third-year medical students who attended a 90-minute session felt less “awkward” and “sorry for” disabled people,20 and the University of California San Francisco piloted a 2-hour session for first-year students involving a series of activities and discussions that students considered meaningful and relevant.21 While some content is better than none, it is more effective and far less “othering” to incorporate disability content across the years of medical school. For example, The Ohio State University’s Lead, Serve, Inspire curriculum includes content across all four years, including educational experiences incorporating disability in both clinical and community settings.22 They also partnered with the Alliance for Disability in Health Care Education to publish a set of core competencies for use across health professions.23 This trend is encouraging, but it is still a minority of medical schools with disability curricula and these curricula must expand programming past single lectures to a wider variety of formats, include direct interaction with disabled people, and consult disabled people in their design.
In fact, beyond simply being the object of education, disabled people themselves can directly contribute to this learning. A common approach to incorporate disabled people is through panel discussions. Depending on the choice of questions, these can give students insight into the everyday experience living with a disability. However, there are other ways to more fully allow disabled people to teach students how to provide appropriate care. Many medical schools use standardized or simulated patients (SPs) in which a well individual is trained and prepared to portray a patient with an illness. This allows students to build their skills and confidence prior to entering the clinical space. There are some institutions recognizing that disability is not simply a role to be played, but a lived experience to learn from, and so are training disabled people to serve as SPs.24 Many students, who noted having minimal to no prior experience with disabled patients, felt that working with disabled SPs was helpful in learning about the needs of disabled patients and improved targeted interviewing skills. While there were operational challenges, they were not insurmountable, and these individuals’ authenticity and expertise were considered worthwhile.24 Finally, to counter the “disability paradox,” it is important to allow students to have experiences that show how disabled people can have meaningful lives in the community.
In addition to having disabled people in patient and teaching roles, it is key to include disabled people in medicine itself. A 2019 study estimated 4.6% of medical students disclose a disability, 25 well below the 12% in overall graduate education.26 Many barriers hinder disabled individuals from pursuing careers in medicine. These include non-inclusive technical standards, lack of access to reasonable accommodations, and misconceptions about disabled physicians.27 In addition, studies estimate that ~40% of disabled medical students may not be disclosing their disabilities, with several structural and cultural barriers identified.28,29 This underrepresentation continues later in careers. Of 6,000 surveyed physicians, only 3.1% self-identified as having a disability.30 Many of these disabled physicians self-identified with multiple underrepresented identities which increases risk of experiencing bias, harassment, and discrimination, further underlining the importance of recognizing intersectionality in the disability community. Including more disabled people in medicine would not only benefit those who are enabled to join the profession but would also be an opportunity for nondisabled peers to learn directly from colleagues to challenge ableist assumptions.31 This would also give disabled patients increased likelihood of being seen by providers with whom they share an identity, something shown to lead to higher trust, satisfaction, and intention to adhere to treatment regimens.6