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. 

 

Blog Response – February 19, 2025:

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?

Yes, technical standards are essential and important; however, they must be written so they are not exclusionary.  For example, instead of using the sensory words like “hear” and “see” the tech standards should say “communicate” or “observe”; in other words, the TS should say what needs to be accomplished without stating how the task should be accomplished.  Also include that TS can be accomplished with accommodations when the accommodations do not equal a fundamental alteration. 

1. How can medical educators and advisors become better equipped to support students with disabilities in rigorous and fast-paced programs?

Partner with your disability services office; attend disability related professional development sessions/workshops; invite experts (including disabled students) to speak to faculty and staff.  Invite in doctors with disabilities to speak about strategies that were important for them to progress through med ed. 

1. What are the potential long-term benefits of having more DHoH doctors in the healthcare workforce for both the medical community and patients?

Understanding a person’s lived experiences is important to provide the best possible care.  Having lived those or similar experiences gives a doctor an advantage in treating patients by allowing a level of knowledge others without such experiences may not have.  As human beings live longer, the population of those with hearing loss will continue to grow.  The long term positive impact of D/d/HH doctors is essential to address the needs of these individuals. 

Note:  “D” is for those who  consider deafness their culture and don’t consider themselves disabled.  “d” is those who are deaf, but don’t consider deafness their culture.  HH is hard of hearing.  Important terminology to include when speaking about these populations.

Cindy Poore-Pariseau, Ph.D.; Director, Office of Disability Services, Rutgers Health