Medical Schools' Willingness to Accommodate Medical Students with Sensory and Physical Disabilities: Ethical Foundations of a Functional Challenge to “Organic” Technical Standards

Abstract

Students with sensory and physical disabilities are underrepresented in medical schools despite the availability of assistive technologies and accommodations. Unfortunately, many medical schools have adopted restrictive "organic" technical standards based on deficits rather than on the ability to do the work. Compelling ethical considerations of justice and beneficence should prompt change in this arena. Medical schools should instead embrace "functional" technical standards that permit accommodations for disabilities and update their admissions policies to promote applications from qualified students with disabilities. Medical schools thus should focus on what students with disabilities can do, rather than what they cannot do, because these students further diversify the health care profession and improve our ability to care for an expanding population of patients with disabilities.

Technical Standards from Newly Established Medical Schools: A Review of Disability Inclusive Practices

“… 10 , 30 , 31 Second, schools should focus on “functional” or competency-based technical standards, emphasizing educational and healthcare outcomes, rather than “organic” standards that overemphasize how the skill is performed. 6 , 8 Finally, technical standards should include explicit language that welcomes applicants with disabilities and allows the use of auxiliary aids and intermediaries, as appropriate. 32 The addition of these items would reduce confusion and may encourage more students with disabilities to apply.…”

“…These interventions often fall under the category of “reasonable accommodations,” eg, “modifications that do not fundamentally alter an academic program” or interfere with essential academic instruction. 8 Finally, the authors compared findings from the sample of new schools’ technical standards to those from the 2016 findings of US medical schools 7 to investigate changes in practice.…”

“…A commentary reflecting on the aforementioned study argued that technical standards should employ “functional” rather than “organic” language. 8 Organic technical standards focus on the “specific physical, cognitive, sensory, or behavioral abilities that a student must demonstrate, without accommodation,” placing process-oriented emphasis on sensorimotor skills rather than cognitive abilities. 8 Conversely, functional technical standards focus on competency outcomes without delineating how a student achieves these outcomes and allowing for accommodations including intermediaries and assistive technologies.…”

“… 8 Organic technical standards focus on the “specific physical, cognitive, sensory, or behavioral abilities that a student must demonstrate, without accommodation,” placing process-oriented emphasis on sensorimotor skills rather than cognitive abilities. 8 Conversely, functional technical standards focus on competency outcomes without delineating how a student achieves these outcomes and allowing for accommodations including intermediaries and assistive technologies. 9 Functional standards are further supported by Kezar and colleagues who offer an exemplar for medical schools seeking to align their technical standards with the aforementioned guidance.…”

“…The addition of 15 new US MD and DO medical schools in the last three years provides an opportunity to evaluate newly developed technical standards to assess the adoption of more inclusive standards, as recommended in the literature. 7 , 8 , 10 , 11 , 13 In this study the authors evaluated technical standards from 15 new medical schools whose inaugural classes matriculated between 2017 and 2020. Using an analytical framework like that used in a previous study, 7 the authors evaluated technical standards for (1) willingness to accommodate, (2) functional level required across hearing, vision, and mobility, and (3) the locus of responsibility for providing accommodations.…”