Risking Capability for Access: Disabled Students Negotiating the Capability Imperative in Medical Education

• In Event: 47.039 - Promoting Disability Equity Across Health Professions Education: Considering U.S. and Canadian Students' Lived Experiences

Abstract

The disability activist Stella Young asserted, “We’ve been sold the lie that disability is a Bad Thing” (2014, 2:53). In the medical education context, this ableist notion perpetuates the view that disability amounts to inability (Bulk et al., 2017). For medical students with disabilities, then, claiming disability can feel like a liability. This is somewhat paradoxical given claims that including disabled students in medical education adds value to the medical field (Iezzoni, 2016).

I explore how disabled students navigate medical school, drawing from a constructivist grounded-theory study (Charmaz, 2014). The study encompasses data generated from 45 semi-structured interviews with 19 disabled students and 27 faculty and administrators across four U.S. medical schools. I conducted interviews on site or via video conference, lasting one to three hours. I analyzed transcribed interviews using open coding and the constant comparative method to construct theory about how these schools enacted disability inclusion.

A core finding is that medical schools are premised upon a faulty dichotomous cultural logic. The physician is positioned as a healthy, intelligent, and supremely able healer; the disabled person receives care, is unable, and unwell. To move fluidly through medical school and proceed to a medical career, students must perform a role of “good medical student” (Stergiopoulos, Fernando, & Martimianakis, 2018). Disability, then, poses a risk to fulfilling this role, creating a threat to students’ career trajectories. Through interview data, I demonstrate how, despite rhetoric of valuing diversity in medicine, disabled students negotiated this chasm between “good medical student” and “disabled” to survive in medical education.

The accommodations process is situated as the mechanism to overcome this dichotomous logic, to enact inclusion of disabled students in medicine. I find, however, that students negotiated this boundary to maintain their status as “good medical student.” Students interpreted whether seeking recognition as disabled to access accommodations was worth the risk to their perceived capability. This risk assessment then informed whether they discussed issues stemming from inaccessible environments and pursued institutional changes to support their inclusion. Students, thus, balanced their successful participation in educational environments with their reputation as a capable professional and, for some, the collective reputation of disabled students.

I argue that such dilemmas can be attributed to ableist discourses (Campbell, 2001) that saturate medical school culture. The primary method of inclusion, the accommodation process, constitutes an after-the-fact adjustment that costs time, money, and labor, and often visibly marks the person as “other” (Dolmage, 2017). The approach requires that each individual student, who possesses relatively little power, seeks recognition and asks for change to be included in the educational environment. Alongside other responsive mechanisms to provide access, the accommodations process situates the “problem” of access with the student. Rather than reimagining medical education in a manner that anticipates diverse students’ needs, current structural arrangements include disabled students only to the extent that they can approximate the “good medical student.” This analysis suggests that such institutional-level solutions will be of limited value unless the underlying culture of ableism within medical education is addressed.

Author

• Neera R. Jain, University of Auckland