Dear Liaison Committee on Medical Education,
We write to you urgently as healthcare trainees committed to increasing disability inclusion and representation in allied health education and the practice of medicine itself. We are members of Medical Students with Disability and Chronic Illness (MSDCI), a national student-led organization for students with disabilities and chronic illness and their allies with chapters in medical and other health professional schools across the country. As the National Council on Disability (NCD) has previously brought to your attention in multiple correspondences (1,2), the lack of training for treating people with disabilities (PWD) in medical education is a significant barrier to quality healthcare for PWD and contributes to the marked health inequities experienced by this demographic (3,4). These disparities have been exacerbated by the ongoing COVID-19 pandemic which has revealed undercurrents of ableism in medicine and strong bias against PWD among physicians (4). We write to express our concern that ableism and its effects remain unaddressed in the majority of medical curricula (1-4). Section 5307 of the Patient Protection and Affordable Care Act passed in 2010 specifically required the development, evaluation, and dissemination of model disability curricula for inclusion of such training in health professional schools (5), however recent research suggests that less than one quarter of medical schools provide any disability-focused training (6). The lack of physician training on disability has been well-documented in the literature for more than twenty years despite the passage of civil rights protections and anti-discrimination laws mandating such training (8-10). This is concerning given that 26% of Americans, more than 60 million people, live with disability (11). We urge the LCME to recognize that the absence of disability training in medical education is a human rights and social justice issue that jeopardizes the health of the largest minority group in the U.S. We advise the LCME to use their influence on medical education and formally integrate requirements for disability training in the standards of accreditation.
The language of standard seven, ‘curricular content’, in the LMCE’s “Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the MD Degree” does not include disability training, nor does it recognize that disability is not equivalent to illness (12). Echoing the NCD in their previous letter to the LCME, “we strongly believe that the facts argue for inclusion of specific language; if specific language is not included in these Elements to require medical schools to incorporate disability specific cultural competency training, it is more than likely that schools will continue not to incorporate such training” (2). We strongly advise the LCME to unequivocally integrate a requirement for disability curricula in the “Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the MD Degree”.
Our recommendations are as follows (recommended changes are bolded).
1. Change Element 7.5 ‘societal problems’ to: “The faculty of a medical school ensure that the medical curriculum includes instruction in the diagnosis, prevention, appropriate reporting, and treatment of the medical consequences of common societal problems. The faculty of a medical school ensure that the medical curriculum includes instruction on cultural and socioeconomic barriers to care for patients with disabilities and chronic illnesses.”
2. Change Element 7.6 ‘cultural competence and healthcare disparities’ to: “The diverse manner in which people perceive health, disability, and illness and respond to various symptoms, diseases, and treatments”
3. Change Element 7.8 ‘communication skills’ to: “The faculty of a medical school ensure that the medical curriculum includes specific instruction in communication skills as they relate to communications with patients and their families, colleagues, and other professionals, as well as communications with and about patients with disabilities and chronic illnesses.”
Moreover, institutions are not required to report the structure or outcome of disability training on the data collection instrument for accreditation. Given this, we also advise the LCME to include disability curricula on the ‘Data Collection Instrument for Full Accreditation Surveys’:
4. Change Table 7.1-3 “curricular content”: include ‘disability training’.
5. Change Element 7.6 Narrative Response to: “Provide three examples of how the curriculum prepares medical students to be aware of their own gender, disability, and cultural biases and those of their peers and teachers.”
MSDCI is rooted in the shared belief that people living with disabilities and chronic illness – including ourselves – have intersectional identities worthy of inclusion and deserving of equal rights and opportunities. Students with disabilities are substantially underrepresented in medicine by design even if not by intention. Yet, we can be pivotal in addressing inequities arising from ableism. As members of the medical profession and, at times, patients ourselves, we have the ability to distinguish superior from inferior care for PWD. We demand to be represented and understood in all aspects of our lives, but especially in healthcare. We, the undersigned, believe that the most important means to educate physicians about disability is inclusion of disability curricula and disabled people in medical education. We believe that LCME has a vested interest in the preparedness of the next generation of physicians and the health of the nation, and will therefore carefully consider our recommendations.
Thank you in advance for your consideration of this critical issue. Please address correspondence to: msdcinational@gmail.com.
Sincerely,
Medical Students with Disability and Chronic Illness
Please address correspondence to: msdcinational@gmail.com
