By Holly Harris, MA
At the end of August, I had the opportunity to travel to Glasgow to attend the annual Association for Medical Education in Europe (AMEE) Conference, the world’s leading international conference for health professions education. With over 4000 attendees, it is an impressively wide-reaching and impactful event. I was pleased to see a track of presentations on Equality, Diversity, and Inclusivity (EDI). Moreover, I was thrilled to see that disability and anti-ableism was a focus of one of the symposiums, a topic often under addressed in EDI initiatives and health professions education more broadly.
I attended the symposium entitled Disability Inclusion and Anti-Ableism in Healthcare Education, presented by Dr. Stephanie Van, MD (Harvard School of Medicine), Dr. Liz Bowen (PhD(c) (National Institute of Nursing Research), and Dr. Dorothy Tolchin, MD (Johns Hopkins University). The focus of this seminar was to demonstrate the value in and to promote disability conscious health professions education. In this article, I will summarize the symposium’s key messages as: 1) The importance of disability conscious healthcare; 2) The current state of disability conscious health professions education; and 3) Practical strategies for embodying a commitment to disability conscious health professions education and health systems more broadly.
Disability is defined by the National Council on Disability (2022) as a “natural part of the human condition, which occurs across all age, gender, racial, ethnic, language, and social groups”. Dominant understandings of disability pathologize disabilities and conceptualize them as problems located within an individual. In contrast, the presenters propose a biopsychosocial understanding of disability. That is, disability is created by inaccessible social and physical environments but there are also elements of disability that will not be alleviated by social and structural change (e.g. fatigue, pain, etc.). The disabled community is the largest and most diverse minority group and anyone can join at any time. Disabilities can impact a person’s identity, medical care, personal assistance needs, mental health, family and social interactions, and life style.
The Americans with Disabilities Act (ADA) Requirements for Medical Professionals (2008) mandate health professionals to adhere to accessible design standards, collaborate with patients with disabilities to determine reasonable accommodations, and forbids doctors from refusing care to someone on the basis of disability. Despite the prevalence of disabilities and these requirements, health systems remain ill equipped to provide disability conscious and accessible care. Research has shown that few medical professionals are aware of these ADA requirements related to disability, much less adhere to them. A clear area of opportunity is to embed disability conscious education in health professions education and continuing professional development/continuing medical education (CPD/CME) initiatives.
In health systems, and society more broadly, people with disabilities have been and continue to be subject to discrimination, marginalization, and exclusion on the basis of ableism. Ableism is defined as discrimination and oppression on the basis of disability. Ableism can be seen at the individual level in direct human interactions but also be seen and reinforced through systemic and structural forces (e.g. how disability is defined in law, how disability rights are encoded and enforced, etc.). Health systems that lack knowledge, familiarity, and ability to serve the disabled population risk perpetuating the impacts of ableism. Disability conscious health professions education can transform health systems to dismantle ableism in favor of equity and inclusion.
Currently, disability is not explicitly addressed in health professions education. When it is talked about, it is usually in the form of one-off presentations or mentioned in passing as part of curriculum on diversity. Current disability related education focuses on attitudes rather than practical knowledge and skills, leaving health professionals to their own devices to learn about disability conscious healthcare practices. In essence, healthcare providers are expected to care for people with disabilities but often aren’t provided the knowledge and skills to do so effectively.
The presenters acknowledged barriers to the inclusion of disability conscious health professions education. These included logistical barriers as well as the availability of teaching resources (e.g. curriculum, educators that are qualified to deliver disability conscious education, etc.). The presenters also highlighted the perpetuation of stigma, ableism, and other harmful practices in clinical teaching settings. That is, students may learn disability conscious healthcare practices in the classroom, but if they are working as residents with health professionals that do not embody these principles, their skills and knowledge will not be reinforced. This demonstrates a need for CPD/CE initiatives on health conscious healthcare practices in addition to the integration of these topics in the initial training of health professionals. Another barrier noted is the limited representation of learners and educators with disabilities. This limited representation highlights the inaccessibility of health professions education. In order to facilitate health systems that are responsive to the needs of disabled communities, health professions and associated education must be equally accessible.
Dr. Tolchin offered an example of Disability and Anti-Ableism Curriculum at Harvard Medical School and Dr. Van shared her experience working with her colleagues at Johns Hopkins University to advance disability conscious health professions education at their institution and beyond. Leveraging their learnings, the presenters offered some practical tips on how people involved in health professions education can advocate for and begin to actualize disability conscious health professions education:
- Start with language. Language can perpetuate or challenge power structures. As such, language, as a tool, can be leveraged to challenge ableism and realize a health system that is responsive to needs and preferences of people with disabilities. The presenters offered the following resources to promote helpful and humanizing language use:
- Grow your network. Connect with the people at your institution who are involved and/or interested in advancing disability conscious health professions education. Ensure to include people with diverse perspectives (i.e. different disciplinary backgrounds, professions, and lived experiences). System transformation occurs through collaboration
- Start where you are. Creating disability conscious health systems is an ongoing journey rather than a destination. Start where you are, meet people where they are at, get your foot in the door, and then gain momentum.
- Learn from people with disabilities. The slogan of the disability rights movement is “nothing about us, without us” meaning that no initiative or policy should be created without the people who it is about. Centre the voices of people with disabilities and collaborate to actualize their ideas. At the end of the symposium, participants were asked “How can you promote disability conscious healthcare education?” This summary is my first action. I brought the important call to action from the symposium to the SACME community, the most prominent community for CPD/CE in North America because we are well situated to answer this call. The conversation regarding disability conscious CPD/CE is emerging and gaining momentum (e.g. Soklaridis, Cooper, & de Bie, 2021). I invite you to continue the conversation, ponder how we can promote disability conscious education, connect with your colleagues, and commit to action. Together, we can equip health professionals to transform our health systems into places where people with disabilities are engaged, included, respected, and cared for.
Holly Harris, MA is a Research Coordinator for the Collaborative Learning College (formerly CAMH Recovery College), Toronto.