Disability often neglected in medical school curricula, new study finds

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Disability often neglected in medical school curricula, new study finds

'Doctors do not know how to care for people with disabilities because they never learned'

• Disability often framed as a 'problem' in medical school curriculum for doctors to diagnose, treat
• Negative ideas about disability have a direct, negative effect on workforce diversity in medicine
• Some faculty, trainees create disability-related curriculum on their own or in affinity groups
• Northwestern is addressing critical gaps in curricula

CHICAGO --- Doctors in the U.S. have reported feeling unprepared to care for people with disabilities and have revealed significant negative bias about this population, according to previous research. A new Northwestern Medicine study has found much of this could be rooted in their medical school training.

Medical school curricula often view disability as a problem, leading medical trainees to make negative assumptions about people with disabilities' health and quality of life, the study found. A lack of sufficient medical school training about disabilities and disability-related care across settings perpetuates ableism and leaves medical trainees inadequately prepared, said corresponding author Carol Haywood, assistant professor of medical social sciences at Northwestern University Feinberg School of Medicine.

"Doctors do not know how to care for people with disabilities because they never learned," Haywood said. "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."

The study was published today (Jan. 15) in the Journal of General Internal Medicine.

Negative attitudes, inaccessible exam rooms

More than one in four U.S. adults have some type of disability, according to the U.S. Centers for Disease Control and Prevention. People with disabilities experience significant disparities in their health care quality, access and outcomes, such as negative attitudes from physicians, inaccessible exam rooms and a lack of appropriate communication methods.

"Often, physicians think of disability as something important to certain specialties (e.g., physical medicine and rehabilitation), but if this isn't their specialty, they assume they do not have to think about disability access and quality of care for their patient panel," Haywood said.

"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 such as the ACGME (Accreditation Council for Graduate Medical Education) and LCME (Liaison Committee on Medical Education) to take on the responsibility of educating future physicians about the care of people with disabilities," said co-author Dr. Tara Lagu, adjunct professor of medicine and medical social sciences at Feinberg.

Critical shortfalls in medical education

Interviews with faculty and students from medical schools across the U.S. between September 2021 and February 2022 revealed the following prominent themes related to critical shortfalls in medical education:

• Disability is often neglected in medical education curricula. Participants said disability was only mentioned in select lectures across all years of medical school, and/or disability was incorporated only into elective coursework, largely relegating the essential training to students or faculty who already had familiarity and/or interest in disability. A 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."
• Disability being framed as a "problem" within individuals. Most medical schools define disability as a condition within an individual to be 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."
• Negative ideas about disability have a direct, negative effect on workforce diversity in medicine. Participants described a neglect of disability training and a reduction of disability to pathology as being part of a "hidden curriculum" in medical education that ultimately teaches medical students that disability does not belong in society. By extension, trainees with disabilities are often viewed as weak or incapable of excelling in their 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."
• Overreliance on ad hoc, faculty and student-led efforts to cultivate curricular change. When their own training fell short, faculty and students sought personal mentorship and communities of practice to discuss and understand disability-related health care. 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. That's why it comes back to this medical education piece."

How Northwestern is addressing these gaps in curricula

Advancing disability-related medical education will require systemic reform, the scientists said. There has increasingly been a push for "disability-competent" and "ableism-aware" medical education.

At Feinberg, Dr. Leslie Rydberg, associate professor of physician medicine and rehabilitation and of medical education, has been charged with transforming how medical trainees learn about disability.

For example, medical students elicit a history from individuals with a disability, focusing on asking about the patient's disability and their function; learn directly from guest speakers who are individuals with a disability who share their journey in the medical system; learn from various rehabilitation team members including a physical therapist, occupational therapist and speech language pathologist, who discuss their roles in the assessment and treatment of people with disabilities; and work with an inpatient rehabilitation team and participate in the medical care of people with disabilities, including inpatient rounds, physical exams, clinical decision making, documentation in the medical record and more.

The study is titled "'The forgotten minority:' Perpetuation of ableism in medical education." Funding for the study was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant number 5R01HD091211).