Disability is often neglected in medical school curricula, new study finds

Doctors in the U.S. have reported feeling unprepared to care for people with disabilities and have revealed significant negative bias about this population, according to previous research. Now, a new Northwestern Medicine study has found much of this could be rooted in their medical school training.

Why it matters

Medical school curricula often view disability as a problem, leading medical trainees to make negative assumptions about people with disabilities’ health and quality of life, the study found. A lack of sufficient medical school training about disabilities and disability-related care across settings perpetuates ableism and leaves medical trainees inadequately prepared, said corresponding author Carol Haywood, assistant professor of medical social sciences at Northwestern University Feinberg School of Medicine.

“Doctors do not know how to care for people with disabilities because they never learned,” Haywood said. “Ultimately, our work reveals how medical education may be playing a critical role in creating and perpetuating ideas that people with disabilities are uncommon and unworthy in health care.”

How Northwestern is addressing gaps in training

Advancing disability-related medical education will require systemic reform, the scientists said. There has increasingly been a push for “disability-competent” and “ableism-aware” medical education.

At Feinberg, Dr. Leslie Rydberg, associate professor of physician medicine and rehabilitation and of medical education, has been charged with transforming how medical trainees learn about disability.

For example, medical students elicit a history from individuals with a disability, focusing on asking about the patient’s disability and their function; learn directly from guest speakers who are individuals with a disability who share their journey in the medical system; learn from various rehabilitation team members including a physical therapist, occupational therapist and speech language pathologist, who discuss their roles in the assessment and treatment of people with disabilities; and work with an inpatient rehabilitation team and participate in the medical care of people with disabilities, including inpatient rounds, physical exams, clinical decision making, documentation in the medical record and more.

Negative attitudes, inaccessible exam rooms

More than one in four U.S. adults have some type of disability, according to the U.S. Centers for Disease Control and Prevention. People with disabilities experience significant disparities in their health care quality, access and outcomes, such as negative attitudes from physicians, inaccessible exam rooms and a lack of appropriate communication methods.

“Often, physicians think of disability as something important to certain specialties (e.g., physical medicine and rehabilitation), but if this isn’t their specialty, they assume they do not have to think about disability access and quality of care for their patient panel,” Haywood said.

“While we have known about physician bias and discrimination against people with disabilities in health care for some years now, this new work emphasizes the need for medical schools and regulating bodies such as the ACGME (Accreditation Council for Graduate Medical Education) and LCME (Liaison Committee on Medical Education) to take on the responsibility of educating future physicians about the care of people with disabilities,” said co-author Dr. Tara Lagu, adjunct professor of medicine and medical social sciences at Feinberg.

Critical shortfalls in medical education

Interviews with faculty and students from medical schools across the U.S. between September 2021 and February 2022 revealed the following prominent themes related to critical shortfalls in medical education:

• Disability is often neglected in medical education curricula.
• Disability being framed as a “problem” within individuals.
• Negative ideas about disability have a direct, negative effect on workforce diversity in medicine.
• Overreliance on ad hoc, faculty and student-led efforts to cultivate curricular change.