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  • Diversity

    Hear Me Out! Inclusion also Includes Deaf and Hard-of-Hearing Medical Students

    Sticking with the theme of our previous MedEdChat blog last month, diversity in the health care workforce in general and undergraduate medical education needs constant attention. Although this is a topic that has been well-researched, one crucial aspect of diversity often remains under-addressed: the inclusion of individuals with disabilities. This blog post explores in general terms why actively training individuals with disabilities is important and specifically focuses on deaf and hard-of-hearing individuals in medicine. 

    In 2018, Meeks and colleagues (1) reported that nearly 20 percent of the US population has a disability. Many of these individuals face healthcare disparities due to a lack of understanding of their challenges by their providers. One example noted that many primary care settings lack appropriate exam tables, weight scales, and restrooms for patients with disabilities (2). Although studies have identified the benefits of a workforce that embraces diverse healthcare providers, relatively few individuals with disabilities work in medicine. Moreso, only 2.7% of medical students disclose disabilities, 10% of which have apparent disabilities and 90% do not (2). 

    To be totally transparent about why this blog focuses on deaf and hard-of-hearing (DHoH) individuals entering medicine, I was a sign language interpreter for nearly 25 years and also have a prominent hearing loss. The most obvious benefit for more DHoH providers in medicine is the ability to communicate directly with patients. As McKee and colleagues (3) also point out, DHoH physicians enrich the medical education experience by fostering greater disability awareness among their peers and faculty. Increased awareness translates to a better understanding of how to interact with and care for DHoH patients and their families, ultimately improving patient care and outcomes (1). Furthermore, DHoH professionals offer unique perspectives and lived experiences that can lead to innovative approaches in UME, patient care and healthcare delivery (3). They can also serve as role models and advocates for their community, fostering greater trust and engagement between healthcare providers and DHoH patients (4).

    Despite the clear benefits, DHoH individuals remain underrepresented in medical schools and the physician workforce (4). This underrepresentation is often attributed to systemic barriers, including biases in application processes, a lack of inclusive educational opportunities, and insufficient accessibility support (5,6). As Meeks et al. (5) note, disability is often an “unexamined diversity,” with many institutions lacking comprehensive policies and practices to support students with disabilities. Although universities provide central disability resources, the unique demands of medical education programs challenge these offices (6).

    Additionally, the Liaison Committee on Medical Education standards stipulate every school has technical standards (7). Even in light of the Americans with Disabilities Act, the Standards are often written in ways that do not take into consideration individuals with disabilities. If a school expects that all students, for example, can use a stethoscope and appreciate rales and murmurs, what accommodations are made for someone with profound hearing loss? If the school expects all students to perform “inspection” as part executing a physical exam, how can one accommodate a blind person?

    The inclusion of DHoH individuals in medicine has far-reaching benefits. It not only improves healthcare access and quality for the DHoH community but also strengthens the medical field as a whole. A diverse physician workforce brings unique perspectives, problem-solving skills, and lived experiences that enhance medical training and research (8). By embracing diversity, the medical field can better reflect the communities it serves and provide more equitable and effective care for all.

    What do readers think? How can we address the following questions?

    1. How does inclusion of DHoH individuals in medical education programs challenge admission and accreditation standards for medical schools? Specifically, are technical standards essential for the practice of medicine truly essential? Can they be modified?
    2. How can medical educators and advisors become better equipped to support students with disabilities in rigorous and fast-paced programs?
    3. What are the potential long-term benefits of having more DHoH doctors in the healthcare workforce for both the medical community and patients?

    Give us your thoughts!

    References

    1. Meeks LM, Herzer K, Jain NR. Removing Barriers and Facilitating Access: Increasing the Number of Physicians With Disabilities. Acad Med. 2018 Apr;93(4):540-543. doi: 10.1097/ACM.0000000000002112.
    2. Mudrick NR, Breslin ML, Liang M, Yee S. Physical accessibility in primary health care settings: results from California on-site reviews. Disabil Health J. 2012 Jul;5(3):159-67. doi: 10.1016/j.dhjo.2012.02.002.
    3. McKee MM, Smith S, Barnett S, Pearson TA. Commentary: What are the benefits of training deaf and hard-of-hearing doctors? Acad Med. 2013 Feb;88(2):158-61. doi: 10.1097/ACM.0b013e31827c0aef.
    4. Moreland CJ, Latimore D, Sen A, Arato N, Zazove P. Deafness among physicians and trainees: a national survey. Acad Med. 2013 Feb;88(2):224-32. doi: 10.1097/ACM.0b013e31827c0d60.
    5. Meeks LM, Case B, Stergiopoulos E, Evans BK, Petersen KH. Structural Barriers to Student Disability Disclosure in US-Allopathic Medical Schools. J Med Educ Curric Dev. 2021 May 26;8:23821205211018696. doi: 10.1177/23821205211018696.
    6. Meeks LM, Case B, Herzer K, Plegue M, Swenor BK. Change in Prevalence of Disabilities and Accommodation Practices Among US Medical Schools, 2016 vs 2019. JAMA. 2019 Nov 26;322(20):2022-2024. doi: 10.1001/jama.2019.15372.
    7. Liaison Committee on Medical Education. Functions and Structure of a Medical School, 2025-26. Available at https://lcme.org/publications/. Accessed February 19, 2025.
    8. Meeks LM, Plegue M, Swenor BK, Moreland CJ, Jain S, Grabowski CJ, Westervelt M, Case B, Eidtson WH, Patwari R, Angoff NR, LeConche J, Temple BM, Poullos P, Sanchez-Guzman M, Coates C, Low C, Henderson MC, Purkiss J, Kim MH. The Performance and Trajectory of Medical Students With Disabilities: Results From a Multisite, Multicohort Study. Acad Med. 2022 Mar 1;97(3):389-397. doi: 10.1097/ACM.0000000000004510.

    Blog Author: Gary L. Beck Dallaghan, Ph.D.; Administrative Director, Alliance for Clinical Education. 

  • Diversity

    Diversity and Inclusion in #MedEd

    Medical education is facing many serious challenges. Specific to diversity, equity and inclusion (DEI), as some states are passing legislation limiting discussions related to DEI, attempts to educate medical students about the spectrum of patients they may see faces scrutiny. What has caused this backlash towards DEI initiatives? 

    As a key aspect of helping students develop (or enhance) their cultural humility, DEI programs encompass broad concepts aimed at fostering inclusive environments where all individuals feel respected and valued. Diversity encompasses representation of different identities and backgrounds, including race, gender, ethnicity, age, and more. However, diversity is not limited to ethnic or racial groups but extends to all aspects of individual identity and experience [1,2]. Equity is the process of ensuring fair treatment, access, and opportunities by acknowledging and addressing systemic disparities that disadvantage certain groups [Coulter et al]. Inclusion is the practice of creating environments where diverse individuals are fully integrated and empowered to participate. In healthcare education, for instance, DEI principles are integral for promoting culturally responsive care [3].

    Evidence does, however, suggest that overly narrow definitions of DEI can inadvertently lead to exclusion. One major criticism is that focusing on specific groups can consequently neglect other marginalized communities, such as those with disabilities, those from low socioeconomic backgrounds, or sexual and gender minorities [1,2]. For example, in educational settings, when curricula focus on race but fail to integrate discussions on class or gender, certain students may feel marginalized or excluded from the conversation. This limitation is a reminder that inclusivity must be intersectional and address the diversity within groups. The very definition of intersectionality recognizes the interconnectedness of social categories, such as race, disability, gender, socioeconomic background, etc.

    There is also concern that DEI efforts can sometimes unintentionally reinforce stereotypes, particularly when diversity is taught as static characteristics of groups rather than acknowledging the dynamic nature of individual identities [2]. This may lead to historically majority groups feeling excluded and unwelcome in conversations [4].

    Research suggests that well-designed DEI initiatives positively impact learning environments by enhancing cultural competence, reducing bias, and preparing students for diverse patient populations. Studies indicate that the integration of anti-racism education in medical curricula leads to increased student awareness of health inequities and promote critical thinking about the social determinants of health [5,6]. Students who undergo such training are more likely to recognize their innate biases and demonstrate greater empathy in patient care [1,3]. 

    However, DEI initiatives currently face resistance in municipalities, states and even the Federal government. The attacks on DEI impact the learning environment where students feel defensive or disengaged [6,7]. Ultimately this resistance may result in even worse patient outcomes due to inadequate training.  

    To truly foster an inclusive learning or work environment, institutions must promote dialogue that brings together contrasting viewpoints in a psychologically safe setting, maintaining respect and empathy. One strategy is to create safe spaces for open discussions, where students and faculty can critically reflect on their biases without fear of judgment. For instance, some studies have shown that integrating cultural humility and critical consciousness frameworks into curricula encourages lifelong learning and introspection [3,8].

    Additionally, engaging diverse stakeholders, including students, faculty, and community members, can ensure that multiple perspectives are considered when designing DEI initiatives [4,6]. Continuous faculty development is also critical for ensuring that educators have the skills and confidence to address complex social issues in the classroom [7]. Embedding DEI principles throughout the curriculum, rather than treating them as stand-alone add-ons, helps normalize discussions around diversity and equity in everyday practice [2].

    DEI, when implemented thoughtfully, has the potential to transform learning environments by promoting inclusion, reducing bias, and fostering a culture of empathy. However, for DEI initiatives to be truly inclusive, they must be intersectional and comprehensive, addressing the needs of ALL groups while ensuring that no one feels excluded. Ongoing reflection, stakeholder engagement, and faculty development are critical to ensuring these initiatives have a lasting and positive impact on the learning and work environment.

    What do you readers think?  How can we address the following questions?

    1. How can medical education strike a balance between promoting inclusive environments through DEI initiatives while ensuring that NO groups feel alienated in the process?
    2. As DEI initiatives face increasing resistance due to political and cultural shifts, what strategies should medical educators adopt to create open, respectful dialogue on DEI issues without violating institutional or state restrictions?

    References

    1. Coulter E, McQueen C, Abu-Jurji Z, Chan-Emery I, Rukavina M, Solecki R, Wojkowski S, Dhir J. Development and delivery of justice, equity, diversity, inclusion, and anti-oppression concepts in entry-level health professional education: A scoping review: BEME Guide No. 88. Med Teach 2024:1-13. doi: 10.1080/0142159X.2024.2387147.
    2. Dogra N, Reitmanova S, Carter-Pokras O. Twelve tips for teaching diversity and embedding it in the medical curriculum. Med Teach 2009; 31(11):990-993. doi: 10.3109/01421590902960326. 
    3. Van Liew JR, Lai C, Streyffeler L. Twelve tips for teaching culturally and socially responsive care to medical students. Med Teach 2024; 46(10):1278-1283. doi: 10.1080/0142159X.2024.2322713.
    4. Livingston R. The Conversation: How Seeking and Speaking the Truth about Racism Can Radically Transform Individuals and Organizations. New York: Currency, 2021.
    5. Nathan AS, Del Campo D, Garg PS. Where are we now? Evaluating the one year impact of an anti-racism curriculum review. Med Teach 2024:1-6. doi: 10.1080/0142159X.2024.2316852.
    6. Binda DD, Kraus A, Gariépy-Assal L, Tang B, Wade CG, Olveczky DD, Molina RL. Anti-racism curricula in undergraduate medical education: A scoping review. Med Teach 2024:1-11. doi: 10.1080/0142159X.2024.2322136.
    7. Racic M, Roche-Miranda MI, Fatahi G. Twelve tips for implementing and teaching anti-racism curriculum in medical education. Med Teach 2023;45(8):816-821. doi: 10.1080/0142159X.2023.2206534. 
    8. Dogra N, Bhatti F, Ertubey C, Kelly M, Rowlands A, Singh D, Turner M. Teaching diversity to medical undergraduates: Curriculum development, delivery and assessment. AMEE GUIDE No. 103. Med Teach 2016; 38(4):323-37. doi: 10.3109/0142159X.2015.1105944. 

    Blog Author: Gary L. Beck Dallaghan, Ph.D.; Administrative Director, Alliance for Clinical Education.