Singh Satendra, Meeks Lisa M
University College of Medical Sciences, University of Delhi, Delhi, India.
Departments of Learning Health Sciences and Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Med Educ. 2023 Jan;57(1):102-107. doi: 10.1111/medu.14878. Epub 2022 Jul 24.
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.
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.
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.
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.
向更加多元化的劳动力队伍转变，其中包括残疾医生，这在国际上已获得了相当大的关注。事实上，在医学教育中，包容残疾人士正经历复兴。然而，包容残疾人士的理念必须从将残疾学员视为有问题且必须“克服”残疾的观念，调整为机构预期并欢迎残疾学员成为多元化群体的正常组成部分的观念。
大多数残疾学员将进入一个缺乏规范且信息不足的体系，这使他们容易面临住宿不足、系统障碍以及缺乏明智支持的问题。此外，对超级优秀医生的认知使得候选人不愿透露自己的残疾情况，从而造成了该体系需要解决的结构性障碍。医疗保健不平等现象中一个较少被讨论的因素是，健康专业教育工作者在残疾权利和残疾能力方面的培训不足。事实上，缺乏教育，再加上除了等级分明的医患关系之外很少接触残疾问题，使得影响临床护理的刻板印象和偏见长期存在。
尚未从质量改进的角度审视包容残疾人士的问题。为了弥补这一差距，我们从包容残疾人士的角度审视科学现状，并针对医学教育中的质量改进方法提出一些考虑因素，该方法要在教育、培训和实践的所有三个层面解决世界医学教育联合会全球修订的质量改进三部曲标准问题。
我们提出了一种基于系统的、包容残疾人士、无障碍且公平的医学教育愿景，采用了戴明14点中的9点，适用于医学教育。
