Navigating Accommodation Challenges in Medical School: A Guide to Addressing Disability-Based Discrimination

By: Henrike Schmalfuss and Brittany Taylor

Introduction

Despite the protections, laws, and systems in place to provide equitable access to education for medical students, students may encounter discrimination based on their disability, including difficulties throughout the accommodations process, wrongful dismissal, or rescinding of their acceptance offers. This post aims to provide a brief, general overview of next steps for students who encounter such barriers and equip them with tools to advocate for themselves and their accommodation needs. For a more complete guide to requesting accommodations; understanding your rights as an individual with a disability under the Americans with Disabilities Act (ADA), Section 504 of the Rehabilitation Act of 1973 (Section 504), and Family Educational Rights and Privacy Act (FERPA); and steps you can take if you believe your rights have been violated, please see the “MSDCI Guide to Accessing Disability Accommodations During Undergraduate Medical Education. This resource is intended to be a general guide, not an exhaustive list, individualized guidance, or legal advice. We recommend you consult a lawyer at any point in this process for individualized legal advice.

In addition to a private lawyer, another option for legal support is the federally mandated Protection and Advocacy (P&A) Systems and Client Assistance Programs (CAP). They exist nationwide to provide free legal advice and advocacy support for disability and accommodations concerns. The National Disability Rights Network has a complete list of the agencies for each state, U.S. territory, and the Native American community in the Four Corners area.

Resources on an Institutional Level

The following section includes general advice regarding navigating the process for disabilities and accommodations at your university. Each institution has its own policies, but there are some basic standards that all universities must follow. To see your institution’s policies regarding disabilities and accommodations, check the student handbook for a section on disability and accommodations. Some universities may have more information in this section than others, but it is a good starting point if you are unsure of the process at your university. If you cannot find your institution’s student handbook or its policies on the university’s website, you can also consider contacting a trusted dean, faculty member, or advisor for further information.

What are some ways that I can protect myself during the accommodations process?

1. Keep all documentation, email communications, etc., related to your accommodations request.
   1. If you encounter difficulties with your accommodations in the future, you will have documented evidence to support your claims.
2. Whenever possible, make sure conversations are documentable.
   1. If you have a meeting in person or via an audio or video call, follow up on the meeting with an email to that person(s) that summarizes and documents the content of your conversation.
   2. You can also ask if a virtual meeting can be recorded and whether the recording can be provided to you for your records.
3. Bring an advocate to meetings with you who can provide support throughout the accommodations process. This can be someone you trust either from a professional or personal setting.

Do I have to disclose my disability to my institution?

This depends on whether you will request accommodations from your university.

1. You are not obligated to disclose a disability to your institution. According to the Learning Disabilities Association of America, “There is no standardized form or set of requirements regarding what people must share about their disabilities, and the choice to disclose is a personal decision that individuals with disabilities must make for themselves. They should decide to whom they choose to disclose and how much information to provide.”
   1. However, if you request accommodations, you must disclose the disability and provide documentation to support your request.
2. You do not have to disclose your disability to individual professors or faculty members. Once a memo containing your approved accommodations is created, it should not include private information, such as your diagnoses or specific medical details.
3. Any staff members working on your accommodations request may not disclose your disability or medical details to any other individuals, per FERPA.

What if a professor or instructor objects to my accommodations?

1. In most cases, a professor or instructor may not forbid a student from using an approved accommodation or aid. For guidance and clarification, contact the person who helped you complete the accommodations process.
2. A professor or instructor may forbid a student from using an approved accommodation or aid if it would fundamentally alter the program.
   1. For example, if an accommodation would change a course or program’s academic standards, or would result in a student failing to meet the learning objectives outlined in the course syllabus, the accommodation may be rejected.
   2. The Center for Excellence in Disabilities provides examples of situations when accommodations may not be reasonable or feasible.
3. Suppose the professor or instructor has specific concerns, such as copyright concerns and the use of recording devices. In that case, the school can work with the professor on creating an agreement to be signed that would allow the student to use their approved auxiliary aid or accommodation. See more information in the Q&A section of the U.S. Department of Education “Auxiliary Aids and Services for Postsecondary Students with Disabilities.”

Can I request accommodations later if I did not request them during previous academic years?

1. Yes! If you did not initially request accommodations but decide later on that you may need accommodations, you may request accommodations at any time using the same process as detailed in the “MSDCI Guide to Accessing Disability Accommodations During Undergraduate Medical Education.”

What is a reasonable amount of time for the accommodations process?

1. Unfortunately, there is no specification within the law about what would be considered a reasonable turnaround time for requesting and approving accommodations.
   1. Ask your institution if they can estimate how long the process will take.
   2. Check the student handbook to see if the school has a specific policy about the timing of accommodations requests and approvals.
2. Ensure the person handling your accommodations request is aware that delays in implementing your accommodations will impede your ability to perform well in the program and impact the quality of your education compared to your peers.
   1. After you apply for accommodations, keep track of the exams, quizzes, practicals, or other program requirements you must complete before your accommodations take effect.
3. If you feel that the accommodations process is taking an unreasonable amount of time and is impacting your ability to participate in your program or the university’s available activities, check the state and national resource sections below on how to report the issue and seek assistance.

If I do not feel that the accommodations granted by my institution are adequate, can I change my requested accommodations?

1. Yes! If your approved accommodations are not providing the support you need or are ineffective in any way, you can request to alter your accommodations.
2. Reach out as soon as possible to minimize the time you spend without the appropriate accommodations.
3. Your need for accommodations may shift as your expectations and responsibilities in your program change. (e.g., the transition from didactic to clinical years).

Resources at a State Level

Unfortunately, there may be situations where you cannot reach a solution within your university. Individual states may have laws regarding disability protections in education and grievance processes for potential rights violations. For example, some states have an office of civil rights that investigates complaints of disability discrimination.

What are some steps at the state level that I can take to advocate for my rights?

1. If you feel that you have been discriminated against based on disability, check if your state has a complaint or grievance process as soon as possible.
   1. There may be a required timeline for you to file a complaint from the date of the potential violation.
2. Methods of filing grievances and complaints vary by state.
   1. Methods can include filing complaints in person at an agency office, over the phone, or online forms
   2. Legal experts in your state can help ensure you follow the proper claims process.
3. You may be able to receive free legal assistance through various programs and organizations.
   1. Consult your state’s Protection and Advocacy (P&A) Systems and Client Assistance Programs (CAP) agency.
      1. The National Disability Rights Network has a database that can be searched by state for legally based advocacy services for people with disabilities.
   2. Under federal law, P&A agencies have the authority to provide legal representation and other advocacy services to all people with disabilities.
   3. Using legal assistance can help ensure that you have all of the necessary documents and evidence to support your claim.
4. Reference an example of the complaint process for disability and accessibility claims in California
   1. This website has details specific to the state of California, but it provides a general overview of the complaint process and some federal resources. Your state may also have a similar resource.

Resources on the National level

There are numerous avenues at the federal level to report disability-based discrimination and accommodations concerns at your institution. Importantly, individuals do not need a lawyer to file complaints and requests for an investigation. However, as a reminder, the following is not legal advice, and you should seek out legal counsel (such as via your state or U.S. territory’s P&A/CAP agency or another qualified legal agent) for individualized legal advice or assistance at any point throughout this process.

What should I do if my school or institution is not appropriately providing me with a needed accommodation?

In this case, there are two different options for filing a complaint:

1. Via the U.S. Department of Educations’ Office for Civil Rights, which investigates complaints about discrimination on the basis of disability (in addition to race, color, national origin, age, or sex)
   1. This report must be filed within 180 days of the act of discrimination.
   2. If there is an internal investigation within your institution regarding the same issue, this report must be filed within 60 days of the internal investigation’s completion.
2. Through the U.S. Department of Justice’s Civil Rights Division, which investigates civil rights law violations, including denial of accommodations
   1. There is no time limit on when the report must be filed by.
   2. This office also covers complaints regarding private institutions/businesses that do not receive public funds.

What steps can I take if I believe my institution has violated my right to privacy and confidentiality regarding my disability or health information?

There are two options for filing a grievance based on your unique situation:

1. If you believe that your school or institution has violated your right to privacy of your disability as protected under FERPA you can file a grievance with the U.S. Department of Education’s Student Privacy Policy Office.
2. If you believe that your institution or its administrators have inappropriately used your medical information, you can file a complaint with the U.S. Department of Health and Human Services’ Office for Civil Rights (select option 3 – Violation of Privacy or Security of Health Information (HIPAA)).

I believe I have been wrongfully dismissed from my institution on account of my disability or my acceptance was rescinded because my institution claimed they could not accommodate me and I could not meet their technical standards. What can I do next?

One step you can take is to file a complaint with the U.S. Department of Justice’s Civil Rights Division. As a reminder, you can also consult your state or U.S. territory’s P&A/CAP agency for free legal advice or another qualified legal agent for individualized legal advice or assistance at any point throughout this process.

What should be included in a complaint related to disability discrimination and accommodations?

While each complaint or grievance filed is unique, here is an example of a recent complaint filed with the U.S. Department of Justice’s Civil Rights Division by a medical student on account of “disability-based discrimination and failure to accommodate, in violation of Title II of the Americans with Disabilities Act and Section 504 of the Rehabilitation Act.” The Docs with Disabilities Initiative has also compiled a collection of legal cases, complaints, and other resources (scroll down to “Technical Standards-Publications”) related to technical standards and unlawful dismissal from institutions on account of disability status and accommodations.

For more information on your rights and resources:

1. National Disability Rights Network – provides general disability rights and law information for many domains of public life, including education and employment.
2. Bazelon Center For Mental Health Law – provides specific information and resources on rights and laws related to mental health and psychiatric disability.
3. Association of American Medical Colleges (AAMC) “Disability and Accessibility in Academic Medicine” Resource Page – provides a collection of resources related to disability and accessibility in medical education and healthcare.
4. Docs with Disabilities Initiative – provides information on disability, accommodations, and technical standards for disabled learners and professionals in health careers and resources specific to accommodations and technical standards in various settings.

Conclusions

Overall, this guide is intended to provide general advice and initial next steps for you to advocate for yourself in the setting of disability-based discrimination. Each person’s circumstances are unique, and this guidance may not be entirely applicable to or all-encompassing of your unique situation. We encourage you to continue advocating for yourself and your rights, seek legal advice as needed, and lean on your community’s support.

If you want to be more involved in disability advocacy efforts and connect with other students going through similar experiences, join the MSDCI community!

Sign up for the MSDCI national email list

Check out the MSDCI website