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• W3011468939 abstract "Recognition of the need for equitable health care for people with disabilities and the need to appropriately educate the health-care workforce has emerged over the past few decades.1Silver JK Bean AC Slocum C et al.Physician workforce disparities and patient care: a narrative review.Health Equity. 2019; 3: 360-377Crossref PubMed Scopus (81) Google Scholar, 2Institute of Medicine Committee on Institutional and Policy-Level Strategies for Increasing the Diversity of the US Health Care Workforce Smedley BD Stith Butler A Bristow LR In the nation's compelling interest: ensuring diversity in the health-care workforce. National Academies Press, Washington, DC2004Google Scholar, 3McColl MA Jarzynowska A Shortt SE Unmet health care needs of people with disabilities: population level evidence.Disabil Soc. 2010; 25: 205-218Crossref Scopus (68) Google Scholar Although people with disabilities experience the same general health-care needs as other people, they are more likely to experience health-care inequities due to the inadequate skills and knowledge of health-care providers and inaccessible health-care facilities.4WHOWorld report on disability.http://www.who.int/disabilities/world_report/2011/en/index.htmlDate: 2011Date accessed: December 21, 2020Google Scholar In 2009, an art of medicine essay in The Lancet by Tom Shakespeare and colleagues5Shakespeare T Iezzoni LI Groce NE Disability and the training of health professionals.Lancet. 2009; 374: 1815-1816Summary Full Text Full Text PDF PubMed Scopus (138) Google Scholar posited that “perhaps the most dramatic learning can come when it is a peer who is disabled, rather than a patient”. Medical schools are beginning to consider students with disabilities as a constituent part of their diversity, equity, and inclusion agenda, and several organisations and academic leaders from around the world are now offering formal guidance to medical schools, with the goal of fully realising the value that people with disabilities bring to medical education.6General Medical CouncilWelcomed and valued: Supporting disabled learners in medical education and training.https://www.gmc-uk.org/ablemedicsDate: 2019Date accessed: February 10, 2020Google Scholar, 7Meeks LM Jain NR Accessibility, inclusion, and action in medical education. lived experiences of learners and physicians with disabilities. Association of American Medical Colleges, 2018https://store.aamc.org/accessibility-inclusion-and-action-in-medical-education-lived-experiences-of-learners-and-physicians-with-disabilities.htmlDate accessed: February 10, 2020Google Scholar, 8Singh S Medical Council of India's new guidelines on admission of persons with specified disabilities: unfair, discriminatory and unlawful.Indian J Med Ethics. 2019; 4: 29-34Crossref PubMed Scopus (5) Google Scholar, 9Kezar LB Kirschner KL Clinchot DM Laird-Metke E Zazove P Curry RH Leading practices and future directions for technical standards in medical education.Acad Med. 2019; 94: 520-527Crossref PubMed Scopus (15) Google Scholar We share The Lancet's commitment to promoting diversity in medicine10The LancetThe Lancet Group's commitments to gender equity and diversity.Lancet. 2019; 394: 452Summary Full Text Full Text PDF PubMed Scopus (45) Google Scholar, 11Choo EK Introducing The Penumbra.Lancet. 2019; 394: 453-454Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar and concerns about the structural biases that negatively impact patient care. Health-care disparities for patients with disabilities are universal, and while efforts towards inclusion of more health-care providers with disabilities have been made, there is a global under-representation of clinicians with disabilities (appendix). The barriers to health care for people with disabilities are ingrained. The United Nations 2018 Flagship Report on Disability and Development maintains that “attitudinal barriers have compromised access to health services for persons with disabilities, as health professionals often have little experience interacting with or providing services to persons with severe and/or complex disabilities, or have negative, stigmatizing attitudes towards these patients”.12United Nations General AssemblyUnited Nations 2018 flagship report on disability and development: realization of the Sustainable Development Goals by, for and with persons with disabilities, UN Doc. A/73/220.https://www.un.org/development/desa/disabilities/publication-disability-sdgs.htmlDate: 2018Date accessed: February 10, 2020Google Scholar This segregation of patient and provider, healthy and disabled, has adverse impacts on the wellbeing of people with disabilities and constitutes a barrier to health-care services and education. The inclusion of more health-care providers with disabilities offers one way to improve understanding about the needs of patients with disabilities.13Meeks LM Herzer K Jain NR Removing barriers and facilitating access: increasing the number of physicians with disabilities.Acad Med. 2018; 93: 540-543Crossref PubMed Scopus (53) Google Scholar Further progress will require attention to several different dimensions of disability inclusion. Health professions programmes could reassess the criteria by which they evaluate applicants for admission to focus on the core skills and perspectives that are vital for competent care.14McKee M Case B Fausone M Zazove P Ouellette A Fetters MD Medical schools' willingness to accommodate medical students with sensory and physical disabilities: ethical foundations of a functional challenge to “organic” technical standards.AMA J Ethics. 2016; 18: 993-1002Crossref PubMed Scopus (19) Google Scholar, 15Kezar LB Kirschner KL Clinchot DM Laird-Metke E Zazove P Curry RH Leading practices and future directions for technical standards in medical education.Acad Med. 2019; 94: 520-527Crossref PubMed Scopus (3) Google Scholar Medical schools and their affiliated clinical institutions must be able to determine and provide, with appropriate support, the optimal reasonable accommodations or adjustments for equal access to the curriculum, while ensuring competence for health professions practice. Changes to institutional culture are needed to ensure that all students and health-care providers are able to practise in inclusive environments.16Jain NR Political disclosure: resisting ableism in medical education.Disabil Soc. 2019; (published online Aug 9.)https://doi.org/10.1080/09687599.2019.1647149Crossref Scopus (15) Google Scholar, 17Stergiopoulos E Fernando O Martimianakis MA “Being on both sides”: Canadian medical students' experiences with disability, the hidden curriculum, and professional identity construction.Acad Med. 2018; 93: 1550-1559Crossref PubMed Scopus (34) Google Scholar Some organisations have addressed the need to improve inclusion and have translated this into actionable guidance (table).6General Medical CouncilWelcomed and valued: Supporting disabled learners in medical education and training.https://www.gmc-uk.org/ablemedicsDate: 2019Date accessed: February 10, 2020Google Scholar, 18Medical Deans Australia and New Zealand IncInherent requirements for studying medicine in Australia and New Zealand.https://gamsat.acer.org/files/MedicalDeansInherentRequirements.pdfDate: July 2017Date accessed: February 10, 2020Google Scholar What is now needed is an international voice, combining guidance from individual countries, to create an international benchmark for disability inclusion that will provide a roadmap for countries seeking to create accessible health professions programmes and practice.TableInternational organisations' guidance on inclusion of learners with disabilitiesYearGuidanceAssociation of American Medical Colleges2018Accessibility, inclusion, and action in medical education: lived experiences of learners and physicians with disabilities7Meeks LM Jain NR Accessibility, inclusion, and action in medical education. lived experiences of learners and physicians with disabilities. Association of American Medical Colleges, 2018https://store.aamc.org/accessibility-inclusion-and-action-in-medical-education-lived-experiences-of-learners-and-physicians-with-disabilities.htmlDate accessed: February 10, 2020Google ScholarGeneral Medical Council of the UK2018Welcomed and valued: supporting disabled learners in medical education and training6General Medical CouncilWelcomed and valued: Supporting disabled learners in medical education and training.https://www.gmc-uk.org/ablemedicsDate: 2019Date accessed: February 10, 2020Google ScholarAustralian Medical Council; Medical Deans Australia and New Zealand Inc2017Inherent requirements for studying medicine in Australia and New Zealand18Medical Deans Australia and New Zealand IncInherent requirements for studying medicine in Australia and New Zealand.https://gamsat.acer.org/files/MedicalDeansInherentRequirements.pdfDate: July 2017Date accessed: February 10, 2020Google Scholar Open table in a new tab Several global developments are underway for 2020 to address the inequities in health science education and develop international benchmarks for inclusion, including the formation of an International Council on Disability Inclusion in Medical Education, which will hold its first meeting at the London offices of the General Medical Council in the UK, on Sept 11, 2020, and the Inaugural Meeting of the International Congress on Disability Health and Inclusion, which will be hosted by the Department of Family Medicine, University of Michigan Medical School, in Ann Arbor, MI, USA, on Oct 9–10, 2020. The International Council will aim to develop shared principles regarding the support of qualified individuals with disabilities in the medical profession that will serve as a benchmark for countries where guidelines on inclusion do not exist. The International Congress will bring together delegates from across the globe to envision and create a more inclusive environment for students, providers, and patients. Inequity and lack of diversity in educational programmes come at a high cost to patient outcomes and a loss of potential medical innovation. The health professions need to represent the population they serve. Under this wider principle, the inclusion of physicians, nurses, therapists, and other health-care providers with disabilities could help promote the care of patients with disabilities and their nuanced needs. It is our hope that the next decade will include further international cooperation and initiatives towards an accessible and inclusion environment for students, providers, and our patients. We declare no competing interests. Download .pdf (.12 MB) Help with pdf files Supplementary appendix" @default.
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