Disability doesn't exist in medical training: study
By Louise Kinross
In medical school, the hidden curriculum refers to what is included as core competencies and what is knowingly left out.
Disability is left out of standard American medical coursework, according to a new study in the Journal of Internal Medicine. Researchers held focus groups with eight medical faculty and nine medical students who either identified as having a disability or were involved in promoting disability-competent training.
"I felt like disability was kind of the forgotten minority," one medical student said. "I think we've spent a lot of time talking about racial justice... and then all of those issues and how they're wrapped up in medicine, and the LGBTQ folks... It was very thoroughly incorporated in all the different areas, but we just never really came around to... ableism and all of those things, as well."
The researchers identified four themes that contribute to ableism in medical education: Omission of disability in standard courses; when included, disability is described as an undesirable problem located in a person; pervasive discrimination against people with disabilities in medicine; and over-reliance on ad-hoc faculty and student efforts to beef up disability training.
Discussions about disability and disability-related care were limited to select lectures or elective courses, participants said. "The fact that [disability training] is not required and it's not seen as a core part of the medical school curriculum... reinforces the idea that these aren't really your patients, or they're not important enough for you to learn about," one professor said.
Faculty and students said when disability was discussed, it was described as a problem situated within an individual to be diagnosed and treated.
"My curriculum does not cover very common disabilities, such as cerebral palsy, Down syndrome, Fragile X," said one student. "We do not talk about those conditions, like in a daily life sort of sense. We talk about the pathophysiology, but we don't talk about services, resources, life... In medical school, we have a very pejorative care ideology where... we're always presented with the cure for how to rehabilitate an individual with [disabilities] and in some cases, I feel that the cure is presented as elimination of people with this specific condition."
The authors note that "across time, locating disability within an individual has had negative consequences, including underpinning eugenics and care rationing—concerns that persist today."
Due to the lack of disability training and a limited medical model description, participants across focus groups reported seeing or experiencing discrimination against disabled students.
"Students encountered questions in the application process which specifically signaled preference for people without disabilities," the researchers write. For example, listing detailed body functions and skills as requirements. "We're sending the message from the get-go that you're not welcome..." one educator said.
Students said professors teach in a way that assumes trainees are non-disabled, creating a culture where it's risky to disclose a disability.
One professor who used a wheelchair said: "[The discrimination is] intentional... It's explicit bias... I've had people directly say to me, 'no offence, but I just want the best doctor I could have, and I don't know how you would be able to be that when you can't even help yourself... They actually feel as though, for the betterment of society and clinical care, let's keep these disabled people away from patients that they're going to harm."
Finally, efforts to bring disability into core medical training came from students and ad-hoc faculty, not from leadership, institutions or accrediting and licensing authorities.
"Failure to include disability as a standard part of the curriculum stands in contrast to recent curricular changes aimed at reducing health disparities for other marginalized groups," the researchers say. "Often, there is no buy-in from leadership, disability advocates themselves are under-valued and over-worked, and disability discrimination is embedded in informal teaching contexts that are difficult to audit."
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