The number of medical students reporting disabilities to their schools increased by more than 25% during the COVID-19 pandemic, according to the study.
The percentage of students reporting attention deficit hyperactivity disorder or chronic health or psychological disorders increased between 2015 and 2021.
Despite the increase in medical students reporting these symptoms, requests for more comprehensive preclinical trial accommodations, such as more time to complete studies or less distracting environments, decreased between 2019 and 2021 as the pandemic continued.
Remote curriculum delivery during the pandemic allowed students to create optimal learning and testing environments, potentially reducing the need for accommodations, according to the authors of a new study published in JAMA Network Open.
“Medical education has been the most flexible during the COVID-19 pandemic,” said Dr. Lisa Meeks, clinical associate professor in the departments of learning, health sciences and family medicine at the University of Michigan Medical School.
She added that this may have reduced the need for exam accommodations, but it was unclear whether the need for accommodations would increase again following the recent resumption of in-person lectures and exams.
Record the rise
The findings are part of a long-term research project led by Meeks that is tracking the rates at which U.S. medical students disclose disabilities to their schools.
This study of disability disclosure in healthcare was the first large-scale study of its kind to encompass all types of disabilities, including psychological, learning, sensory, physical and chronic health conditions.
The researchers found that since 2015, there has been an increase in medical students reporting disorders to their institutions, from 2.8% in 2015 to 4.7% in 2019 and 5.9% in 2021.
When asked why there has been such a surge in the population of medical students with disabilities, Meeks speculated that “this increase in the population may mean that prejudice and stigma is decreasing, so people who are already in medicine may be more willing to disclose their disability.”
“It’s also possible that our study will spark discussion of policy change and encourage people with disabilities who didn’t think they could get into medical school to choose to apply to these universities.”
Doctors with disabilities improve patient care
Meeks said there is still significant work to be done to increase the proportion of doctors with disabilities in the medical field.
While only 5.9% of medical students report having a disability, 27% of adults in the United States currently live with some type of disability.
As the population ages, this number is expected to increase.
“Physicians in the United States and many other countries report that they are not confident they can provide the same quality of care to patients with disabilities as they provide to patients without disabilities,” said Dr. Karina Pereira Lima, a research scientist in the Department of Neurology at Michigan Medicine.
“Incorporating professionals with disabilities into healthcare will greatly improve care for patients with disabilities and the health of the population as a whole.”
Recruiting medical trainees with disabilities
Increasing the number of physicians with disabilities requires both recruitment and retention of medical trainees.
“An anonymous survey of medical trainees with disabilities found that roughly one in five medical students and more than half of residents don’t request accommodations when they need them,” Pereira Lima said.
The two main reasons given for not requesting needed accommodations were fear of stigma and prejudice and the lack of a clear institutional process.
“Access to programs, or the ability to obtain accommodations if needed, improves residents’ examination and patient care performance with disabilities. They are also less likely to report depression and burnout,” Pereira Lima added.
Meeks called for “standardizing support for students with disabilities in medical education.”
“Medical education strives for equity and continuity between medical schools, but there is zero standardization when it comes to disability services and reasonable accommodations,” Meeks said.
“One school may have a qualified disability resource specialist running the office and have fantastic specialist disability support services, while another school may not have specialist disability support services at all.”
“Waves of change”
The researchers note that ongoing culture change in health care is needed to address the second common barrier to getting the disability support people need: fear of stigma and prejudice.
“Disability is still very discriminated against, and ableism is rampant in medicine and medical education. At the same time, I think the work of our laboratory, the Association of American Medical Colleges, the Accreditation Council for Graduate Medical Education and others in the medical community has started a very powerful wave of change,” Meeks said.
The research is bolstered by the enrollment in medical school of what Meeks calls the “post-Americans with Disabilities Act generation.”
“This generation is proud to be disabled. They’ve had disability support their whole lives, they know the law, they know their rights and they’re not ashamed of being disabled,” Meeks said.
Next steps
As this longitudinal study continues, the research team plans to evaluate how other identities interact with disability identity.
“People with disabilities come from different racial and ethnic backgrounds, sexual orientations and socioeconomic statuses, and we want to learn more about how the interplay of these different identities affects the academic performance and mental health of medical students with disabilities,” Pereira Lima said.
Meeks added that thanks to new funding from the Robert Wood Johnson Foundation, the DocsWithDisabilities team is doing just that.
“We are also developing ways to measure the effectiveness of accommodation. We need to look more at the quality of the accommodation received and how easy the process was to receive the accommodation they needed,” Pereira Lima added.
“Investing in a culture that recognizes disability as a valuable form of diversity will improve patient care.”
In addition to Pereira Lima and Meeks, the Michigan research team included Melissa A. Pregg (MA), Ben Case (MPH), Riley Bechcal (BA), and BonnieLyn Swener (Ph.D.) of the Johns Hopkins University Center for Disability and Health Research, and Kurt Helzer (MD, Ph.D., M.Sc.) of the Johns Hopkins University School of Medicine.
Cited paper: “Prevalence of Disabilities and Use of Accommodations Among U.S. Allopathic Medical Students Before and During the COVID-19 Pandemic” JAMA Network Open. DOI: 10.1001/jamanetworkopen.2023.18310