Medical Schools Do a Poor Job Teaching About Disability
/By Crystal Lindell
Medical schools don’t teach their students well about disability, which can have negative effects for both disabled patients and disabled medical students, according to a new study published in the Journal of General Internal Medicine.
Researchers found that medical school curriculum often treats disability as a problem, leading students to make negative assumptions about the health and quality of life of people with disabilities. That makes them ill-prepared for treating disabled patients.
The overall attitude also results in fewer disabled people becoming doctors.
“Doctors do not know how to care for people with disabilities because they never learned,” lead author Carol Haywood, PhD, assistant professor at Northwestern University’s Feinberg School of Medicine, said in a press release.
“Ultimately, our work reveals how medical education may be playing a critical role in creating and perpetuating ideas that people with disabilities are uncommon and unworthy in health care.”
Haywood and her colleagues hosted virtual focus groups for both medical school faculty and students. They found four recurring themes in the discussions:
1. Disability is often neglected in medical education
Participants said disability was only mentioned in select lectures and elective coursework, largely relegating the training to students and faculty who are already familiar with or have a personal interest in disability.
One faculty participant 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.”
2. Disability is often framed as a “problem” in medical school
Most medical schools define disability as a condition where an individual is simply diagnosed and treated, rather than something rooted in physical barriers, social bias and stigmatization.
One student said: “Just seeing how biases can be sort of continued on through generations of doctors … whether that means that thinking of disability as a tragedy or … a medical condition.”
3. Negative ideas about disability limit diversity in medicine
Participants described a neglect of disability training as being part of a “hidden curriculum” in medical education that teaches students that disability does not belong in society. Students with disabilities are often viewed as weak or incapable of excelling in medical practice.
One participant said: “We're just sending the message from the get-go that you’re not welcome, which is so damaging in every possible way.”
4. There’s an over-reliance on faculty and student-led efforts to cultivate change
When their training fell short, faculty and students sought mentorship and communities to discuss and understand disability-related healthcare.
One student said: “It’s hard to be mad at physicians …. Because they weren’t taught how to do it or taught to ask the questions, or it wasn’t emphasized.”
Insufficient support from institutional and licensing authorities has also stymied efforts to improve disability training. Disability is often not included in studies focused on mitigating healthcare disparity — despite well-known vulnerabilities of people with disabilities.
“While we have known about physician bias and discrimination against people with disabilities in health care for some years now, this new work emphasizes the need for medical schools and regulating bodies… to take on the responsibility of educating future physicians about the care of people with disabilities,” said co-author Tara Lagu, MD, adjunct professor of medicine and medical social sciences at Feinberg.
Improving disability-related medical education will require systemic reform, such as adding a “disability-competent” to medical education to make students more aware of abelism – a tendency to think that everyone has the same mental and physical abilities.
Other remedies include having disabled guest speakers share their experiences navigating the healthcare system; having physical therapists, occupational therapists and speech language pathologists discuss their treatment of people with disabilities; and having students participate in the care of disabled patients during patient rounds, physical exams, documentation, and clinical decision making.
