Physician, Heal Thy Double Stigma — Doctors with Mental Illness and Structural Barriers to Disclosure

Haque, Omar Sultan; Stein, Michael Ashley; Marvit, Amelia

doi:10.1056/nejmp2031013

Cited by 14 publications

(37 citation statements)

References 3 publications

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“…When uninformed structures are in place, students face additional burdens. 1 , 3 , 7 - 9 Indeed, studies show that students with disabilities often avoid disclosing their disability and requesting accommodations for fear of bias, stigma, and misperceptions about performance. 7 , 8 , 10 - 14 These concerns are fueled by the need to substantiate requests with confidential documentation.…”

Section: Introductionmentioning

confidence: 99%

“… 7 , 8 , 10 - 14 These concerns are fueled by the need to substantiate requests with confidential documentation. 1 , 9 This is especially concerning when students are subject to support structures that foster conflicts of interest and uninformed decision-making, which may erode trust in the process. 1 , 3 , 9 …”

Section: Introductionmentioning

confidence: 99%

“… 1 , 9 This is especially concerning when students are subject to support structures that foster conflicts of interest and uninformed decision-making, which may erode trust in the process. 1 , 3 , 9 …”

Section: Introductionmentioning

confidence: 99%

“… 1 , 17 One mechanism for conflict of interest occurs when individuals who hold an evaluative role, or a role in student promotion, review student’s primary documentation as part of the request for accommodations. 1 , 7 , 9 Those who participate on committees that adjudicate disability determination may also have a conflict of interest 1 , 18 and may not have a full knowledge of best practices or relevant laws related to the provision of appropriate accommodations for students with disabilities. 19 In these scenarios, students may hesitate to disclose a disability, fearing potential bias or discrimination in the evaluative process.…”

Section: Introductionmentioning

confidence: 99%

“… 19 In these scenarios, students may hesitate to disclose a disability, fearing potential bias or discrimination in the evaluative process. 1 , 3 , 7 - 10 , 12 Students may also have heightened concerns when the medical school Dean of Students serves as the arbiter of accommodation determination. In these cases, students may elect non-disclosure, knowing that the dean of students is involved in evaluations critical to the students’ future, including the Medical School Performance Evaluation (MSPE).…”

Section: Introductionmentioning

confidence: 99%

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Structural Barriers to Student Disability Disclosure in US-Allopathic Medical Schools

Meeks

Case

Stergiopoulos

et al. 2021

Journal of Medical Education and Curricular Development

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Introduction: Leaders in medical education have expressed a commitment to increase medical student diversity, including those with disabilities. Despite this commitment there exists a large gap in the number of medical students self-reporting disability in anonymous demographic surveys and those willing to disclose and request accommodations at a school level. Structural elements for disclosing and requesting disability accommodations have been identified as a main barrier for students with disabilities in medical education, yet school-level practices for student disclosure at US-MD programs have not been studied. Methods: In August 2020, a survey seeking to ascertain institutional disability disclosure structure was sent to student affairs deans at LCME fully accredited medical schools. Survey responses were coded according to their alignment with considerations from the AAMC report on disability and analyzed for any associations with the AAMC Organizational Characteristics Database and class size. Results: Disability disclosure structures were collected for 98 of 141 eligible schools (70% response rate). Structures for disability disclosure varied among the 98 respondent schools. Sixty-four (65%) programs maintained a disability disclosure structure in alignment with AAMC considerations; 34 (35%) did not. No statistically significant relationships were identified between disability disclosure structures and AAMC organizational characteristics or class size. Discussion: Thirty-five percent of LCME fully accredited MD program respondents continue to employ structures of disability disclosure that do not align with the considerations offered in the AAMC report. This structural non-alignment has been identified as a major barrier for medical students to accessing accommodations and may disincentivize disability disclosure. Meeting the stated calls for diversity will require schools to consider structural barriers that marginalize students with disabilities and make appropriate adjustments to their services to improve access.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Structural Barriers to Student Disability Disclosure in US-Allopathic Medical Schools

Meeks

Case

Stergiopoulos

et al. 2021

Journal of Medical Education and Curricular Development

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How Should We Build Disability-Inclusive Medical School Admissions?

Meeks

Moreland

2021

AMA Journal of Ethics

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Students with disabilities add rich diversity to medical education and help motivate health equity. Unjust obstacles faced by many of these students along pathways to medicine begin during medical school admissions. Deeply embedded ableist notions of what it means to be a physician keep archaic practices in place that serve as systemic barriers to the admission of members of this population. This article summarizes the prominent obstacles for applicants with disabilities and suggests ways in which thoughtful, inclusive admission policies and practices can ultimately contribute to a clinical workforce that is more appropriately diverse and prepared to provide just and patient-centered health care. Diversity and DisclosurePhysicians of the 21st century need the skills and knowledge that are fostered in diverse learning and work environments. 1 Research shows that diversity contributes to creativity and development of problem-solving skills, with more diverse groups outperforming more homogeneous ones, 2,3,4 a fact that should influence how we select members of medical school classes. In 2016, 25.7% of the US adult population included persons with a disability. 5 Medical students with disabilities, training among diverse faculty and colleagues, would positively contribute to the preparedness of physicians and their colleagues to meet the unique needs of patients with disabilities, facilitate shared decision making, and contribute to innovation-and do so with greater empathy.

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Making emergency medicine accessible for all: The what, why, and how of providing accommodations for learners and physicians with disabilities

Poffenberger

Coates

Backster

et al. 2022

AEM Education and Training

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Individuals with disabilities comprise a substantial portion of the U.S. population but make up only a small subset of medical students and health care providers. Both the Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education have called for increased diversity in the physician workforce, to more closely represent the U.S. patient population and provide culturally effective care. Yet the barriers to disclosure and inclusion for individuals with disabilities in health care are significant, including attitudinal barriers such as stigma and bias, organizational barriers in policies and procedures, and environmental barriers such as resources and physical space. Lack of experience providing accommodations and a lack of knowledge of both what is legally required and what is possible also prevent programs from creating access. Realizing inclusion for individuals with disabilities in a diverse workforce requires emergency medicine programs to be proactive and deliberate in their approach to recruiting, accommodating, and retaining students, residents, and faculty with disabilities. Such efforts are likely to provide benefits that extend beyond those who receive the accommodations.

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Physician, Heal Thy Double Stigma — Doctors with Mental Illness and Structural Barriers to Disclosure

Cited by 14 publications

References 3 publications

Structural Barriers to Student Disability Disclosure in US-Allopathic Medical Schools

Structural Barriers to Student Disability Disclosure in US-Allopathic Medical Schools

How Should We Build Disability-Inclusive Medical School Admissions?

Making emergency medicine accessible for all: The what, why, and how of providing accommodations for learners and physicians with disabilities

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