Inclusion & accessibility for disabled doctors: a public health issue

 

Disabled people constitute up to 15-20% of the world’s population; but the proportion of disabled doctors is low globally. There is a need to move away from traditional narratives of disability to rights-based perspectives, which offer respect, dignity, equity and inclusion for disabled medical students and doctors.

While global estimates of proportion of disabled doctors or medical students is not known, data from the United States suggests that only 4.5% of students in medical degree (DO and MD) programs are disabled, while this number is around 9% in the UK.  Among disabled doctors in the UK who are legally entitled to accommodations, only 55% of them have been able to obtain them, making access to medical education difficult. Despite these barriers, disabled doctors provide exemplary care to their patients. What’s more: many disabled medical personnel are fighting to remove obstacles in medical education for other disable people.

For example, in India, there have been significant attempts to make medical education more accessible, but the path to progress has been slow. The Rights of Persons with Disabilities Act (RPwD) (2016) enshrines the right to education in India by reserving 5% of medical college seats for disabled people. The Medical Council of India has outlined guidelines to achieve this benchmark, but the implementation of these quotas has been fraught with challenges. For example, people with specific disabilities like dyslexia, dwarfism, and thalassemia  are not allowed to enroll as disabled candidates, despite having recognized disabilities and the right to education under Article 24 of the UN Convention on the Rights of Persons with Disabilities (UN CRPD). Students with certain types of impairments are still barred from applying, and, until 2018, only those with locomotor impairments were considered for reserved admission slots.

In India, there has been a recent directive that makes the Dean of a Medical School responsible for implementing accommodations. The National Institutional Ranking Framework (NIRF) outlines the requirements for accessibility at institutions, yet many lack accessible infrastructure and services to meet the needs of disabled students. In 2019, UK has promised more flexibility and tools for doctors and practical advice to medical schools to provide better support but there has been problem when medical students are detected with disability later while studying.  Though laws mandating universal design and accessibility exist in many countries, only few countries have successfully implemented it. These examples illustrate the policy-implementation gap despite the internationally recognized right to education under UN CRPD.

Despite these challenges, there are three main ways to improve and value medical students with disabilities. We must promote diversity and inclusion and, focus on removing barriers and encouraging accessibility.

First, medical education should be accessible to all. Campuses and administrations have a responsibility to accommodate all students. Building accessibility into medical education ultimately improves the accessibility of the health system. All aspect of the life of a medical student have to be accessible: entrance exams, interviews, admissions, classrooms, communication, libraries, toilets, residences, and in hospitals for clinical experiences. This is a crucial first step.

Secondly, medical schools should adopt the common trope “nothing about us, without us”. Medical colleges can actively include disability advocates and doctors with disabilities for accurate advice on developing curricula, guidelines, and protocols.  Not developing the right guidelines could lead to more marginalization, through inadequate services, stigma, additional barriers, and litigations.

Third, encourage disabled doctors, medical students, paramedical staff and others to share their experiences, so it can foster a supportive environment and reinforce the need for accessibility in medicine. Creative approaches to inclusion, such as personal anecdotes, best practices, and stimulating discussion on inclusion can shift perceptions about disabled people for the better. Bringing young health professionals and alumni into these conversations is also critical, since many received their education and training through the old curriculum that lacked a holistic view of disability.

Ultimately, including disabled students bring unique perspectives to the medical profession, though all cadres of health professionals and institutions will benefit from inclusion. Disabled healthcare workers play an important role in delivering effective, quality care, especially for other disabled people who face barriers to accessing care. Better inclusion—particularly for disabled people—can set the pace for a more fair, diverse and equitable health care system.

About the authors

Shubha Nagesh is a medical doctor and a global health consultant with the Latika Roy Foundation, Dehradun, India.

Poorvaprabha Patil is a medical student at Kasturba Medical College, Manipal and the President of the Medical Students’ Association of India

Sara Rotenberg is a Rhodes Scholar and DPhil Student in the Nuffield Department of Primary Health Care at the University of Oxford

Conflicts Statement: The authors declare no competing interests.

Acknowledgements: The authors would like to acknowledge Dr Satendra Singh, Dr Ifeanyi Nsofor, and Radhika Arora for their comments and in-sights in previous drafts.

Handling Editor: Soumyadeep Bhaumik

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