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

Abstract

Introduction Technical standards document US medical school's nonacademic criteria necessary for admission, persistence, and graduation and communicate the school's commitment to disability inclusion and accommodation but are considered one of the largest barriers for students with disabilities. Calls for more inclusive technical standards have increased in recent years, yet the impact of this work on changing technical standards has not been measured. The establishment of 15 new US MD- and DO-granting medical schools between 2017 to 2020 offered a unique opportunity to evaluate differences in the inclusive nature of newly developed technical standards. Method We conducted a document analysis of 15 newly formed medical schools’ technical standards to determine the availability and inclusive nature of the standards as they pertain to students with sensory and mobility disabilities. Technical standards were coded for: ease of obtaining technical standards, the school's stated willingness to provide reasonable accommodations, the origin of responsibility for accommodation request and implementation, and the school's openness to intermediaries or auxiliary aids. Results Of the 15 schools, 73% of the technical standards were not easy to locate online. Few (13%) included language that support disability accommodations. Most (73%) used language that was coded as ‘restrictive’ for students with physical or sensory disabilities. Coding of the newly accredited US MD and DO medical schools suggests that newly created technical standards are more restrictive than those in previous studies. Conclusions Efforts to create more inclusive technical standards have not yet been realized. Newly formed US MD- and DO-granting medical schools may perpetuate historically restrictive technical standards that serve as barriers to applicants with disabilities. Future research should evaluate the role of medical school accrediting bodies to go beyond simply requiring technical standards to ensuring that the standards are readily available and appropriately convey the availability of reasonable accommodations for students with disabilities.

Institutional Accountability for Students With Disabilities: A Call for Liaison Committee on Medical Education Action

“…1,4,49–53 LCME standard 10.5, titled Technical Standards, requires that medical schools “develop and publish technical standards for the admission, retention, and graduation of applicants or medical students in accordance with legal requirements.” 35 Despite this requirement, research shows that many schools maintain technical standards that do not comply with legal requirements, yet they remain accredited. 4,54 We propose that the LCME ensure that medical schools maintain technical standards that comply with legal requirements and that the LCME conduct a robust review of medical schools’ technical standards as part of the reaccreditation process. This review should ensure that technical standards are nondiscriminatory, do not uniformly denounce the use of any specific accommodation (e.g., interpreters or intermediaries), and include a statement about the ability of students with disabilities to meet the standards with or without accommodations, all of which are in keeping with legal requirements and best practices.…”

Reframing Our Health Care System for Patients With Hearing Loss

“…Removing application barriers at health professional schools and training programs, such as restrictive technical standards, can help improve the recruitment and retention of those with disabilities and hearing loss into health care and audiology fields ( Meeks & Jain, 2018 ; Zazove et al, 2016 ). Restrictive technical standards, unlike functional technical standards, requires that the student be able to display physical, cognitive, and sensory abilities (e.g., “ student must be able to hear heart sounds ”; McKee et al, 2016 ; Stauffer et al, 2022 ). A student with a hearing loss would normally be discouraged from applying even though existing accommodations and assistive technologies can overcome limitations caused by the hearing loss.…”

Disability inclusion in medical education: Towards a quality improvement approach

“…19 The 'State' of disability inclusion can be measured by systemic barriers to access, which lead to disparate outcomes for trainees with disabilities compared to their non-disabled peers. 20 These barriers are present in several domains, including: admissions, 3,21,22 instruction, 18 process, 16 access to accommodation in medical training and licensure exams, 23,24 lack of knowledge regarding reasonable and appropriate accommodation/ adjustments 3,16 and discriminatory practices for physician licensure. 24,25 In the context of an ableist and historically hostile environment.…”

“…The admissions process itself may prove burdensome, with inaccessible formats for application, lack of access to accommodation on medical school entry examinations, inequitable access to physician shadowing and lack of anti-ableist training for admissions committees. 15,21,22 Conversely, admissions committees, faculty and administrators may fear the unknown, and may falsely believe that individuals with disabilities are not well suited for a career in medicine. In order to encourage disability inclusion, fear must be driven out of learners through trust and a clear understanding that the programme is a safe space to disclose and request accommodations.…”

“…Given the competitive nature of medical school admissions, many trainees are driven by fear of disclosure and may be encouraged not to share information that might be considered a deficit, like a disability. The admissions process itself may prove burdensome, with inaccessible formats for application, lack of access to accommodation on medical school entry examinations, inequitable access to physician shadowing and lack of anti‐ableist training for admissions committees 15,21,22 …”