<p>Text only version AHEAD 2017 Learners and Physicians with Disabilities: Accessibility, Action, and Inclusion in Medical Education</p><p>Slide 1: Learners and Physicians with Disabilities: Accessibility, Action, and Inclusion in Medical Education</p><p>Slide 2: LISA M. MEEKS, PHD UNIVERSITY OF MICHIGAN MEDICAL SCHOOL [email protected]</p><p>NEERA R. JAIN, MS, CRC UNIVERSITY OF AUCKLAND FACULTY OF EDUCATION & SOCIAL WORK [email protected]</p><p>Slide 3: 1. WHAT WE KNEW</p><p>Slide 4: ACROSS SCHOOLS Inconsistent policies and procedures Inconsistent support Lack of ADA understanding</p><p>Slide 5: AD/HD 33.7% Learning 21.5% Psychological 20% Chronic Health 13.1% Visual 3% Mobility 2.5% Deaf or hard of hearing 2.2% Other functional 3.9% Overall 2.7% (0-12%) Meeks & Herzer, 2016</p><p>Slide 6: DRIVERS Rights of STUDENTS Benefit to PATIENTS Near PEER learning UNIVERSITY process Image description: Black and white photo of a smiling young, white, male doctor. The camera angle is at his eye level. He wears scrubs and has a stethoscope around </p><p>1 Text only version AHEAD 2017 Learners and Physicians with Disabilities: Accessibility, Action, and Inclusion in Medical Education his neck. He is sitting and looking up at several doctors who stand, slightly out of frame wearing white coats.</p><p>Slide 7: 2. WHAT WE DID</p><p>Slide 8: RESEARCH QUESTION What are the lived experiences of students, trainees, and practicing physicians with disabilities through training? Barriers Supports Recommendations Image description: A young Latina woman sits at a table in front of a microphone. She is wearing glasses and has a chunky necklace and long wavy hair. Her hands are gesturing upwards and she is smiling.</p><p>Slide 9: METHODOLOGY Modified grounded theory Semi-structured interviews Open coding Themes: Barriers, Supports, Recommendations</p><p>Slide 10: 3. WHO PARTICIPATED</p><p>Slide 11: 47 participants 17 Men 40 Women 17 Students, 15 Medical Residents, 15 Physicians</p><p>Slide 12: Pie Graph depicting the number of participants who reported various types of disability: Mobility: 10 DHOH: 9 ADHD: 8 Learning: 5 Chronic Health: 4 Psychological: 3 Visual: 2</p><p>Co-occurring</p><p>2 Text only version AHEAD 2017 Learners and Physicians with Disabilities: Accessibility, Action, and Inclusion in Medical Education Psychological: 14 Learning disability: 5</p><p>Slide 13: 4. WHAT WE FOUND</p><p>Slide 14: STRUCTURAL BARRIERS Disability Services Appropriate accommodations Access to health and wellness support Technical Standards Access to accommodations for the USMLE Access to community and support</p><p>Slide 15: Disability Services Knowledge Collaboration Clear policies Nuance: Clinic & AT Image description: Image of a young man with spiky hair wearing glasses. He is smiling and holding a sign above his head that reads: Today a #CreightonGrad tomorrow a #DeafDoctor</p><p>Slide 16: “I remember citing the ADA and I was like, ‘I have a 504 plan,’ and she said, ‘What's the ADA?’ I thought, ‘How do you work in the disability office when you don't know what the ADA is?’ I felt like I gave up on that office immediately.”</p><p>Slide 17: Access to Health & Wellness Cost, distance, & time Confidentiality Image description: A young woman sits at a table in front of a microphone. Her hair is pulled back and she is gesturing with her hands. Behind her is a projection of live captioning.</p><p>Slide 18: “[The mental health outpatient services] are on the same floor as one of the main rotations for all 3rd and 4th year medical students. . . I think the breaking point for me in terms of not wanting to go there for services was sitting in the waiting room and [a classmate] thought it was okay to just sit in the waiting room with me and try to have a conversation.”</p><p>3 Text only version AHEAD 2017 Learners and Physicians with Disabilities: Accessibility, Action, and Inclusion in Medical Education Slide 19: Technical Standards Unnecessary organic TS Lack of ADA compliance Impact of bias of confusing language Image description: A diverse group of people wearing white coats surround a patient on a table. Some are using stethoscopes and some have placed their hands on the patient’s body.</p><p>Slide 20: “I was very concerned about disclosing any disabilities, or that I had accommodations for testing always, and that I did things a little bit differently. . . I know that many schools are very strict about the technical standards . . . there should be a disclaimer saying, ‘We have accommodations,’ or something, but there [were] no schools that put that [guidance about disability accommodations] in their program out there.”</p><p>Slide 21: USMLE Unnecessary wait time Lack of communication Time commitment Lack of guidance DS Knowledge Image description: White text on a black background with an image of a crown at the top, reads: “Keep calm study really hard and get 278 USMLE Step 1-3”</p><p>Slide 22: “I spent so much time on [my Step 1 personal statement] . . . The whole document at the end, I think it was 130 pages of documentation. . .The process is so involved. It actively detracts from. . . your ability to progress through school. If you’re dealing with disabilities, things are already harder for you. . . In addition to it, you have a whole 130 pages to write and collate and put together and organize, and send forth, etc. You’re putting yourself at an even greater disadvantage. Forget the disability. It’s like a double disability. I had a very negative experience.”</p><p>Slide 23: Effect of Culture and Climate Role of program climate Impact of attitude on lived experience Knowledge of disability Role of interpersonal relationships Impact of supportive administration</p><p>Slide 24:</p><p>4 Text only version AHEAD 2017 Learners and Physicians with Disabilities: Accessibility, Action, and Inclusion in Medical Education “In most hospitals, there's a lot of talk and people will find out [about the disability], but you are just hoping to prove yourself enough that they can say, ‘Okay, well, she's very smart. She's very good with patients. She knows her stuff. She works well. We don't care if she has whatever.’ It almost feels like you have to prove yourself extra to get to that point where people accept you.”</p><p>Slide 25: Attitudinal Barriers Stigma Disclosure Clinicalized culture Twice as good Peers Specialties Image description: Image of a young white man wearing a suit and tie and glasses. He holds his left hand up to emphasize a point.</p><p>Slide 26: Stigma in admissions</p><p>Slide 27: Needing to be twice as good</p><p>Slide 28: SUPPORTS Program culture Mentors Knowledge of disability Supportive administration Appropriate accommodations Shared experiences</p><p>Slide 29: Program Culture Climate Attitudes Evaluation of supports Reputation Image description: A young, white woman wearing glasses with long brown hair sits behind a microphone. Her left hand is pointing towards the ceiling. She sits in front of a projected PowerPoint slide on which we can read the words “importance of self care and a supportive team”</p><p>Slide 30:</p><p>5 Text only version AHEAD 2017 Learners and Physicians with Disabilities: Accessibility, Action, and Inclusion in Medical Education “The admissions dean, the dean who interviewed me . . . she is a big reason why I loved [the school] right away. Her attitude about everything and really the whole admissions office, their whole attitude…Everybody was just very supportive, and very much, ‘Whatever we have to do to help you, we’ll do and it’s not a big deal.’ I think it was a part of it…the attitude about the disability, and it wasn’t a big deal to anybody…in the program.”</p><p>Slide 31: Mentors Physicians Peers Medical school personnel Image description: Image of Dr. Philip Zazove examining a patient. He wears a shirt, tie, and white coat, and his stethoscope is seen around his neck with small stuffed animals clipped to it. He is pointing an opthalmascope towards the patient, whose back is to us.</p><p>Slide 32: “I was advised by a number of people that medicine was a very unreasonable occupation for me… I sought out a network and tried to find other people like myself that were successful in their careers… it was helpful to me to see people who were succeeding. I started to think more seriously about medicine…I started shadowing patients to see if it was doable and reached out to other deaf doctors. Phillip Zazove was one, I read his book, When the phone rings my bed shakes and reached out to him early on.”</p><p>Slide 33: Knowledge of Disability Admissions Open dialogue In support roles Image description: A doctor using a standing wheelchair wearing a surgical mask and cap is seen in the process of donning a surgical gown with assistance from two people who are also wearing scrubs and other protective surgical gear. </p><p>Slide 34: “Applying for a career in medicine—especially surgery—with an [apparent] disability, it’s obviously a part of the discussion. It’s obviously something that’s going to come up. And if it doesn’t come up, then it almost feels that—that the whole process is disingenuous. There are places I would go where people were obviously trying to dance around the issue and would have wanted to ask about it, but didn’t ask about it. And that, to me, does both of us a disservice, because I know it’s there, you know it’s there, and you might as well talk about it. . .”</p><p>Slide 35:</p><p>6 Text only version AHEAD 2017 Learners and Physicians with Disabilities: Accessibility, Action, and Inclusion in Medical Education Supportive Administration From the top down Positive interactions with DS Image description: Image of Dr. Christopher Moreland wearing a white coat, shirt and tie. He stands in front of a white board and he is gesturing towards it.</p><p>Slide 36: “[The DS provider] was just so kind and welcoming, and he made it easy. He was so nice, so cheery, even in his email, and just welcoming. I had to fill out a one-page form or something, that was it. I was like really? Are you sure? I had to forward him whatever documents I had. There weren't even requirements for which documents. He asked what accommodations did I think I needed, and there was no question of my motives.”</p><p>Slide 37: Knowledge and Support of DSPs</p><p>Slide 38: Appropriate Accommodations Innovative & effective Simple solutions Ease of access Knowledge of clinical accommodations & medicine Meaningful access Image description: Image of a ThinkLabs amplified stethoscope </p><p>Slide 39: “There was no question in either of our minds, I was not going to be an anesthesiologist…but he set out, and spent the entire rotation, trying to give me the richest experience possible. It was amazing. Before they had all those monitors, the anesthesiologists all wore a little earplug with a tube down to basically a stethoscope that they would tape on to the patient's chest. They would just listen to them breathe and listen to their heartbeat throughout the whole surgery…. He dug one of those things up and it's like this is how we used to do it. You do it this way.”</p><p>Slide 40: Shared Experiences A network Student organizations Image descriptions: two young women wearing glasses and dresses are smiling, mid-conversation. One is taller and leaning against a podium. The other is shorter and has one hand on her hip, the other rests on the podium.</p><p>Slide 41:</p><p>7 Text only version AHEAD 2017 Learners and Physicians with Disabilities: Accessibility, Action, and Inclusion in Medical Education “One thing that I was talking about last week with the Dean for Diversity and Inclusion was how there is a lack of a national organization for students with disabilities, similar to how there are for underrepresented groups in medicine. . . We thought that would be something to explore to try to normalize the culture a bit more, towards including people with disabilities.”</p><p>Slide 42: 4. WHERE TO FROM HERE?</p><p>Slide 43: Training the next generation of DSPs in health science Image description: a group of 26 people stand holding copies of the book “The guide to assisting students with disabilities: Equal access in health science and professional education”</p><p>Slide 44: Amplifying student voices Image description: A group of 6 young men and women sit at a long table with microphones in front of them. A sign language interpreter is seated with them, interpreting the conversation. Projected above their heads is a PowerPoint slide titled “Physical and sensory disabilities in the clinic: A panel discussion”</p><p>Slide 45: INSTITUTIONS Culture Program assessment Training Disability in diversity DS Providers Image description: close up image of a stack of books with a stethoscope draped over them.</p><p>Slide 46: With thanks to: RESEARCH TEAM Stacy C. Jones, Harvard Medical School Mijiza M. Sanchez, EdD, Stanford University School of Medicine Alice Wong, MS University of California, San Francisco FUNDERS Association of American Medical Colleges UCSF School of Medicine RESEARCH PARTICIPANTS</p><p>Slide 47: Image credits:</p><p>8 Text only version AHEAD 2017 Learners and Physicians with Disabilities: Accessibility, Action, and Inclusion in Medical Education CNN. (2015). [Untitled image of Philip Zazove]. Retrieved from: http://edition.cnn.com/2015/05/20/health/human-factor-philip- zazove/index.html Hearing and Vision Center. (n.d.). Retrieved from: http://hearingandvisioncenter.com/thinklabs-one-amplified-stethoscope / Hospitalist. (2014). [Untitled image of Christopher Moreland]. Retrieved from: http://www.medscape.com/viewarticle/830303_5 Kartushka. (2016). Keep calm…USMLE. Retrieved from: https://www.keepcalm-o-matic.co.uk/p/keep-calm-study-really-hard-and-get-278- usmle-step-1-3 / Richards, E. (2014). [Untitled image of Chris McCullough]. Retrieved from: http ://protomag.com/articles/doctors-with-disabilities-tough-job-made-tougher [Untitled image of Michael Argenyi]. Retrieved from: http://www.steinvargas.com/about-us/ Various images and video material by University of Central Florida, College of Medicine (2017). Used with permission. Do not duplicate.</p><p>9</p>