The Performance and Trajectory of Medical Students With Disabilities: Results From a Multisite, Multicohort Study

Meeks, Lisa M.; Plegue, Melissa; Swenor, Bonnielin K.; Moreland, Christopher J.; Jain, Sharad; Grabowski, Christina J.; Westervelt, Marjorie; Case, Ben; Eidtson, William; Patwari, Rahul; Angoff, Nancy R.; LeConche, Jack; Temple, B; Poullos, Peter D.; Sanchez-Guzman, Mijiza; Coates, Caitlyn; Low, Christine; Henderson, Mark C.; Purkiss, Joel; Kim, Michael

doi:10.1097/acm.0000000000004510

Cited by 28 publications

(34 citation statements)

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“…(It is counterintuitive that a group more likely to fail are just as likely to complete the course successfully, but this juxtaposition does not take into account the length of time taken to complete the course.) Another recent study has documented poorer performance in students with cognitive/learning disability compared with matched controls, as well as a measurable impact of accommodation on academic performance 29…”

Section: Discussionmentioning

confidence: 99%

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Factors associated with declaration of disability in medical students and junior doctors, and the association of declared disability with academic performance: observational study using data from the UK Medical Education Database, 2002–2018 (UKMED54)

Murphy

Dowell²,

Smith

2022

BMJ Open

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ObjectivesTo examine factors associated with declaration of disability by medical students and doctors, and the association of declared disability with academic performance.DesignObservational study using record-linked data collected between 2002 and 2018.SettingUK Medical Education Database is a repository of data relating to training of medical students and doctors. Disability and other data are record-linked.ParticipantsAll students starting at a UK medical school between 2002 and 2018 (n=135 930).Main outcome measuresDeclared disability was categorised by the Higher Education Statistics Authority. Outcomes related to undergraduate academic performance included scores in the educational performance measure (EPM), prescribing safety assessment and situational judgement test. Performance in postgraduate examinations was studied, as well as prior attainment in school examinations and aptitude tests.ResultsSpecific learning disability (SLD) was the most commonly declared disability (3.5% compared with the next most commonly declared disability at 1.0% of n=129 345 all cases in the study), and during the period covered by the data, SLD declarations increased from 1.4% (n=6440 for students starting in 2002) to 4.6% (n=8625 for students starting in 2018). In a logistic regression, the following factors predicted recording of SLD on entry to medical school ((exp(B)±95% CI), p<0.0001 unless otherwise stated): attendance at a fee-paying school (2.306±0.178), graduate status (1.806±0.205), participation of local areas quintile (1.089±0.030), age (1.034±0.012). First year medical students were less likely to declare SLD if they were from a non-white ethnic background (Asian/Asian British 0.324±0.034, black/black British 0.571±0.102, mixed 0.731±0.108, other ethnic groups 0.566±0.120), female (0.913±0.059; p=0.007) or from a low index of multiple deprivation quintile (0.963±0.029); p=0.017. In univariate analysis with Bonferroni corrections applied for multiple tests, no significant difference was observed in the recording of SLD according to socioeconomic class (χ2=5.637, p=1), whether or not a student’s parents had a higher education (χ2=0.140, p=1), or whether or not a student had received a United Kingdom Clinical Aptitude Test (UKCAT) bursary (χ2=7.661, p=0.068). Students who declared SLD at some point in medical school (n=4830) had lower EPM normalised deviate values (−0.390) than those who did not (−0.119) (F=189.872, p<0.001). Those for whom SLD was recorded were as likely to complete the course successfully as those who did not declare disability (93.0% successful completion by those for whom SLD declared from year 1 (n=2480), 92.2% by those for whom SLD declared after year 1 (n=2350), 91.6% by those for whom SD not declared at any point (n=85 180)) (χ2=6.905, p=0.032). Of 3580 first year students who declared SLD, 43.1% had not sat the UKCAT Special Educational Needs aptitude test (which gives extra time for those with special educational needs), while 28% of 2400 registrants for whom SLD was recorded as medical students did not declare it at General Medical Council registration.ConclusionsSubstantial increases in declaration of SLD may reflect changes in the social and legal environment during the period of the study. Those who declare SLD are just as likely to gain a primary medical qualification as those who do not. For some individuals, disability declaration appears to depend on context, based on differences in numbers declaring SLD before, during and after medical school.

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Section: Discussionmentioning

confidence: 99%

“…Another recent study has documented poorer performance in students with cognitive/learning disability compared with matched controls, as well as a measurable impact of accommodation on academic performance. 29 …”

Section: Discussionmentioning

confidence: 99%

Factors associated with declaration of disability in medical students and junior doctors, and the association of declared disability with academic performance: observational study using data from the UK Medical Education Database, 2002–2018 (UKMED54)

Murphy

Dowell²,

Smith

2022

BMJ Open

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“…19 The 'State' of disability inclusion can be measured by systemic barriers to access, which lead to disparate outcomes for trainees with disabilities compared to their non-disabled peers. 20 These barriers are present in several domains, including: admissions, 3,21,22 instruction, 18 process, 16 access to accommodation in medical training and licensure exams, 23,24 lack of knowledge regarding reasonable and appropriate accommodation/ adjustments 3,16 and discriminatory practices for physician licensure. 24,25 In the context of an ableist and historically hostile environment.…”

Section: Deming's Point 3: Cease Dependence On Inspection To Achieve ...mentioning

confidence: 99%

Disability inclusion in medical education: Towards a quality improvement approach

Singh

Meeks

2022

Medical Education

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The Issue The shift to a more diverse workforce that includes physicians with disabilities has gained considerable international traction. Indeed, disability inclusion is experiencing a renaissance in medical education. However, the philosophy of disability inclusion must be adjusted from one where disabled trainees are viewed as problematic and having to ‘overcome’ disability to one where institutions anticipate and welcome disabled trainees as a normative part of a diverse community. Observations Most trainees with disabilities will enter an unregulated, uninformed system leaving them vulnerable to under‐accommodation, systems barriers and lack of informed support. Further, the perception of the super human good doctor creates disincentives for candidates to disclose their disability, creating structural barriers that the system needs to address. A less often discussed contributor to health care inequities is the inadequate training of health professional educators on disability rights and disability competencies. Indeed, the lack of education, coupled with minimal exposure to disability outside of the hierarchical patient‐provider relationship, perpetuates to stereotypes and biases that impact clinical care. Approach Disability inclusion has not been reviewed through the lens of quality improvement. To close this gap, we examine the state of the science through the lens of disability inclusion and offer considerations for a quality improvement approach in medical education that addresses the global revised trilogy of World Federation for Medical Education standards of quality improvement at all three levels of education, training and practice. Conclusion We propose a vision of systems‐based disability‐inclusive, accessible and equitable medical education using 9 of Deming's 14 points as applicable to medical education.

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“…A study2 of the Membership of the Royal College of Surgeons Part A and B examinations from the United Kingdom showed that candidates with disabilities had similar pass rates to their none-disabled colleagues in clinical examinations (part B) but had significantly lower pass rates on formal, written examinations (part A). This is particularly concerning, given findings from Meeks et al 3 that suggest poor academic performance of medical students with disabilities is associated with a lack of academic accommodations. Given these findings, it is reasonable to question whether the current structures related to academic accommodations are adequate and whether current examinations truly reflect clinical acumen among this population.…”

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confidence: 98%

Reimagining disability accommodations in medical education

Clarke

2022

Postgraduate Medical Journal

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The Performance and Trajectory of Medical Students With Disabilities: Results From a Multisite, Multicohort Study

Abstract: Supplemental Digital Content is available in the text.

Cited by 28 publications

References 38 publications

Factors associated with declaration of disability in medical students and junior doctors, and the association of declared disability with academic performance: observational study using data from the UK Medical Education Database, 2002–2018 (UKMED54)

Factors associated with declaration of disability in medical students and junior doctors, and the association of declared disability with academic performance: observational study using data from the UK Medical Education Database, 2002–2018 (UKMED54)

Disability inclusion in medical education: Towards a quality improvement approach

Reimagining disability accommodations in medical education

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