LISA M. MEEKS, PHD

1. Learners and Physicians with Disabilities: Accessibility, Action, and Inclusion in Medical Education

2. LISA M. MEEKS, PHD UNIVERSITY OF MICHIGAN MEDICAL SCHOOL Meeksli@med.umich.edu NEERA R. JAIN, MS, CRC UNIVERSITY OF AUCKLAND FACULTY OF EDUCATION & SOCIAL WORK njai104@aucklanduni.ac.nz

3. 1. WHAT WE KNEW

4. ACROSS SCHOOLS Inconsistent policies and procedures Inconsistent support Lack of ADA understanding

5. AD/HD 33.7%Learning 21.5%Psychological 20%Chronic Health 13.1%Visual 3%Mobility2.5%Deaf or hard of hearing 2.2%Other functional 3.9%Overall 2.7% (0-12%) (Meeks & Herzer, 2016)

6. DRIVERS Rights of STUDENTS Benefit to PATIENTS Near PEER learning UNIVERSITY process Richards, 2014

7. 2. WHAT WE DID

8. RESEARCHQUESTION What are the lived experiencesof students, trainees, and practicing physicians with disabilities through training? • Barriers • Supports • Recommendations UCF College of Medicine

9. METHODOLOGY Modified grounded theory Semi-structured interviews Open coding Themes: Barriers, Supports, Recommendations

10. 3. WHO PARTICIPATED

11. 17 Men 47 Participants 30Women 17 Students, 15 Medical Residents, 15 Physicians

12. Disability Types Co-occurring Psychological: 14Learning disability: 5

13. 4. WHAT WE FOUND

14. STRUCTURAL BARRIERS Disability Services Appropriate accommodations Access to health and wellness support Technical Standards Access to accommodations for the USMLE Access to community and support

15. Disability Services Knowledge Collaboration Clear policies Nuance: Clinic & AT [Untitled Image of Michael Argenyi]

16. I remember citing the ADA and I was like, ‘I have a 504 plan,’ and she said, ‘What's the ADA?’ I thought, ‘How do you work in the disability office when you don't know what the ADA is?’ I felt like I gave up on that office immediately.

17. Access to Health & Wellness Cost, distance, & time Confidentiality UCF College of Medicine

18. [The mental health outpatient services] are on the same floor as one of the main rotations for all 3rd and 4th year medical students. . . I think the breaking point for me in terms of not wanting to go there for services was sitting in the waiting room and [a classmate] thought it was okay to just sit in the waiting room with me and try to have a conversation.

19. Technical Standards Unnecessary organic TS Lack of ADA compliance Impact of bias of confusing language

20. I was very concerned about disclosing any disabilities, or that I had accommodations for testing always, and that I did things a little bit differently. . . I know that many schools are very strict about the technical standards . . . there should be a disclaimer saying, ‘We have accommodations,’ or something, but there [were] no schools that put that [guidance about disability accommodations] in their program out there.

21. USMLE Unnecessary wait time Lack of communication Time commitment Lack of guidance DS Knowledge Kartushka, 2016

22. I spent so much time on [my Step 1 personal statement] . . . The whole document at the end, I think it was 130 pages of documentation. . .The process is so involved. It actively detracts from. . . your ability to progress through school. If you’re dealing with disabilities, things are already harder for you. . . In addition to it, you have a whole 130 pages to write and collate and put together and organize, and send forth, etc. You’re putting yourself at an even greater disadvantage. Forget the disability. It’s like a double disability. I had a very negative experience.

23. Effect of Culture and Climate Role of program climate Impact of attitude on lived experience Knowledge of disability Role of interpersonal relationships Impact of supportive administration

24. In most hospitals, there's a lot of talk and people will find out [about the disability], but you are just hoping to prove yourself enough that they can say, ‘Okay, well, she's very smart. She's very good with patients. She knows her stuff. She works well. We don't care if she has whatever.’ It almost feels like you have to prove yourself extra to get to that point where people accept you.

25. Attitudinal Barriers Stigma Disclosure Clinicalized culture Twice as good Peers Specialties UCF College of Medicine

26. Stigma in admissions UCF College of Medicine

27. Needing to be twice as good UCF College of Medicine

28. SUPPORTS • Program culture • Mentors • Knowledge of disability • Supportive administration • Appropriate accommodations • Shared experiences

29. Program Culture Climate Attitudes Evaluation of supports Reputation UCF College of Medicine

30. The admissions dean, the dean who interviewed me . . . she is a big reason why I loved [the school] right away. Her attitude about everything and really the whole admissions office, their whole attitude…Everybody was just very supportive, and very much, ‘Whatever we have to do to help you, we’ll do and it’s not a big deal.’ I think it was a part of it…the attitude about the disability, and it wasn’t a big deal to anybody…in the program.

31. Mentors Physicians Peers Medical school personnel CNN, 2015

32. I was advised by a number of people that medicine was a very unreasonable occupation for me… I sought out a network and tried to find other people like myself that were successful in their careers… it was helpful to me to see people who were succeeding. I started to think more seriously about medicine…I started shadowing patients to see if it was doable and reached out to other deaf doctors. Phillip Zazove was one, I read his book, When the phone rings my bed shakes and reached out to him early on.

33. Knowledge of Disability Admissions Open dialogue In support roles

34. Applying for a career in medicine—especially surgery—with an [apparent] disability, it’s obviously a part of the discussion. It’s obviously something that’s going to come up. And if it doesn’t come up, then it almost feels that—that the whole process is disingenuous. There are places I would go where people were obviously trying to dance around the issue and would have wanted to ask about it, but didn’t ask about it. And that, to me, does both of us a disservice, because I know it’s there, you know it’s there, and you might as well talk about it. . .

35. Supportive Administration From the top down Positive interactions with DS Hospitalist, 2014

36. [The DS provider] was just so kind and welcoming, and he made it easy. He was so nice, so cheery, even in his email, and just welcoming. I had to fill out a one-page form or something, that was it. I was like really? Are you sure? I had to forward him whatever documents I had. There weren't even requirements for which documents. He asked what accommodations did I think I needed, and there was no question of my motives.

37. Knowledge and Support of DSPs UCF College of Medicine

38. Appropriate Accommodations Hearing and Vision Center, n.d. Innovative & effective Simple solutions Ease of access Knowledge of clinical accommodations & medicine Meaningful access

39. There was no question in either of our minds, I was not going to be an anesthesiologist…but he set out, and spent the entire rotation, trying to give me the richest experience possible. It was amazing. Before they had all those monitors, the anesthesiologists all wore a little earplug with a tube down to basically a stethoscope that they would tape on to the patient's chest. They would just listen to them breathe and listen to their heartbeat throughout the whole surgery…. He dug one of those things up and it's like this is how we used to do it. You do it this way.

40. Shared Experiences A network Student organizations UCF College of Medicine

41. One thing that I was talking about last week with the Dean for Diversity and Inclusion was how there is a lack of a national organization for students with disabilities, similar to how there are for underrepresented groups in medicine. . . We thought that would be something to explore to try to normalize the culture a bit more, towards including people with disabilities.

42. 4. WHERE TO FROM HERE?

43. TRAINING THE NEXT GENERATION OF DSPs IN HEALTH SCIENCE

44. Amplifying Student Voices UCF College of Medicine

45. INSTITUTIONS Culture Program assessment Training Disability in diversity DS Providers

46. With thanks to RESEARCH TEAM • Stacy C. Jones, Harvard Medical SchoolMijiza M. Sanchez, EdD, Stanford University School of MedicineAlice Wong, MS University of California, San Francisco • FUNDERS • Association of American Medical Colleges • UCSF School of Medicine RESEARCH PARTICIPANTS

47. Image credits • CNN. (2015). [Untitled image of Philip Zazove]. Retrieved from: http://edition.cnn.com/2015/05/20/health/human-factor-philip-zazove/index.html • Hearing and Vision Center. (n.d.). Retrieved from: http://hearingandvisioncenter.com/thinklabs-one-amplified-stethoscope/ • Hospitalist. (2014). [Untitled image of Christopher Moreland]. Retrieved from: http://www.medscape.com/viewarticle/830303_5 • Kartushka. (2016). Keep calm…USMLE. Retrieved from: https://www.keepcalm-o-matic.co.uk/p/keep-calm-study-really-hard-and-get-278-usmle-step-1-3/ • Richards, E. (2014). [Untitled image of Chris McCullough]. Retrieved from: http://protomag.com/articles/doctors-with-disabilities-tough-job-made-tougher • [Untitled image of Michael Argenyi]. Retrieved from: http://www.steinvargas.com/about-us/ • Various images and video material by University of Central Florida, College of Medicine (2017). Used with permission. Do not duplicate.