Negotiating legitimacy and belonging: Disabled students' and practitioners' experience

Abstract

Introduction People with disabilities are underrepresented in health professions education and practice. Barriers for inclusion include stigma, disabling discourses, discriminatory programme design and oppressive interactions. Current understandings of this topic remain descriptive and fragmented. Existing research often includes only one profession, excludes particular types of disability and focuses on one aspect of the career journey. To expand understanding, we examined the recurrent forms of social relations that underlie the participation of disabled individuals in learning and practice contexts across five health professions. Method We analysed 124 interviews with 56 disabled health practitioners and students. Participants were interviewed up to three times over 1.5 years. Using constructivist grounded theory, authors used a staged analytic approach that resulted in higher level conceptual categories that advance interpretations of social processes. Finally, the authors compared and integrated findings among students and practitioners. Results Participants experience challenges to their sense of legitimacy and belonging as health providers. They describe tensions within the health education and practice between the commitment to inclusion and the day‐to‐day realities experienced by disabled participants. We identified six distinct, but related, conditions underlying these tensions: (i) validity and transparency of competencies' evaluation; (ii) the social and physical contexts; (iii) integration of inclusive practices; (iv) boundaries between personal and professional identities; (v) vulnerability to authority figures; and (vi) dynamic person‐level factors. Discussion If we are to commit to health practitioners and students with disabilities experiencing an overall sense of legitimacy and belonging, priority needs to be given to system‐level practices and policies to support inclusion. Attention to the day‐to‐day marginalisation of students and practitioners with disabilities in the health professions is also needed. Additionally, inclusive and transparent delineation of competency requirements is needed. Finally, educational actions are needed to increase understanding of disability in the health professions, with particular attention to promoting social relations that foster collective responsibility for supporting inclusion.

Barriers to Disclosure of Disability and Request for Accommodations Among First-Year Resident Physicians in the US

“…However, compliance with requirements and recommendations remains low. 2 Furthermore, qualitative studies [3][4][5][6] and anecdotal reports [7][8][9] suggest that stigmatizing attitudes toward disability and an embedded culture of ableism in medicine are barriers frequently encountered by medical trainees with disabilities.…”

What makes a ‘good doctor’? A critical discourse analysis of perspectives from medical students with lived experience as patients

“…2020; Meeks, Herzer, and Jain 2018; Stergiopoulos and Rosenburg 2020; Meeks and Jain 2018). The growing literature on medical students with disabilities has revealed that these learners face pervasive social, cultural and structural barriers to accessing and performing in educational environments (Meeks, Herzer, and Jain 2018; Meeks, Herzer, and Jain 2018; Jain 2020a; Jarus et al . 2022; Meeks et al .…”

Disability, medicine and widening participation: A whole system approach

“…When reflecting on disability within medical education, I was struck by both the complexity of the relationship between these phenomena and how poorly defined and understood it appears to be when we think about widening participation. In their research papers, Jarus et al 1 and Meeks et al 2 use markedly different methods to explore some of these complexities and arguably leave readers with many more questions than answers.…”

“…Jarus et al 1 implemented in‐depth qualitative methods to examine the participation of disabled learners and practitioners within the health professions in Canada. In doing so, they unearthed complex social conditions perpetuating unjust challenges that individuals must navigate if they are to succeed.…”

“…When thinking about disability in terms of equity, diversity and inclusion it is possible to draw similar comparisons in light of prevailing ableist norms within higher and medical education. Both Meeks et al 2 and Jarus et al 1 call for systemic change that promotes programme access for disabled health students and professionals, and challenges entrenched structural discourses and practices that frame individuals as both incapable and burdensome when it comes to participation in medicine. Medical education needs to re‐evaluate its position in becoming more inclusive, redistributive and equitable to people with disability.…”