Department of Speech-Language Pathology, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.
Department of Occupational Science and Occupational Therapy, The University of British Columbia, Vancouver, British Columbia, Canada.
Med Educ. 2024 Sep;58(9):1107-1116. doi: 10.1111/medu.15365. Epub 2024 Mar 6.
Despite legislation mandating accommodation policies in postsecondary education, support for students with disabilities is often not implemented within health and human services (HHS) education programs, particularly in fieldwork settings. As part of a Canada-wide study exploring the experiences of disabled students in 10 HHS programs, we examined how HHS students described their experiences accessing accommodations in fieldwork to understand how conceptions of disability relate to students' fieldwork experiences. Using a critical disability studies framework, we explored how HHS fieldwork education understands disability, accommodations and professional competence and what those understandings reveal about the discrepancy between mandated accommodations and what happens in practice.
Thirty-five students requiring accommodations in HHS fieldwork education participated in interviews. Through a critical interpretive analysis of interview data, we developed first-person composite narratives to show the richness and complexity of the students' diverse, yet similar, subjective experiences with fieldwork accommodations.
Two composite narratives demonstrate how conceptions of disability incommensurate with professional competence expectations influenced student experiences with disclosing disability and obtaining accommodations in fieldwork. Fear of stigma and having one's competence questioned, or having accommodation requests denied for being misaligned with professional expectations, demonstrate how HHS fieldwork education and practice are upheld by ableist systemic structures.
The dominant medical model of disability in HHS education creates institutional barriers that require students to constantly (re)construct their 'professional' identity in relation to their 'patient' identity. This patient-professional identity construction relates to HHS professional competency standards and assumptions about what makes a 'good' professional. Suggestions include reworking competency standards and implementing critical pedagogical approaches to teach future and current HHS professionals to question both personal and practice assumptions. With institutional backing, such changes may support diversity within HHS and a culture shift toward more equitable education and health care.
尽管高等教育法规规定了住宿政策，但在健康和人类服务（HHS）教育计划中，对残疾学生的支持往往没有得到落实，尤其是在实地工作环境中。作为一项探索加拿大 10 个 HHS 项目中残疾学生经历的全国性研究的一部分，我们研究了 HHS 学生如何描述他们在实地工作中获得住宿的经历，以了解残疾观念如何与学生的实地工作经历相关。我们使用批判残疾研究框架，探讨了 HHS 实地工作教育如何理解残疾、住宿和专业能力，以及这些理解如何揭示法规要求的住宿与实践中发生的情况之间的差距。
35 名需要在 HHS 实地工作教育中获得住宿的学生参加了访谈。通过对访谈数据的批判性解释分析，我们开发了第一人称综合叙述，以展示学生在实地工作住宿方面丰富而复杂的、多样化但相似的主观经历。
两个综合叙述展示了与专业能力期望不一致的残疾观念如何影响学生在实地工作中披露残疾和获得住宿的体验。对污名的恐惧和对能力的质疑，或者因为与专业期望不符而拒绝住宿请求，都表明 HHS 实地工作教育和实践是由歧视性的制度结构支持的。
HHS 教育中占主导地位的残疾医学模式造成了制度障碍，要求学生不断（重新）构建他们的“专业”身份与他们的“病人”身份的关系。这种病人-专业身份的构建与 HHS 专业能力标准以及关于什么构成“好”专业人员的假设有关。建议包括重新制定能力标准，并实施批判性教学方法，以教导未来和现任 HHS 专业人员质疑个人和实践假设。在机构的支持下，这些变化可能会支持 HHS 内部的多样性，并推动向更公平的教育和医疗保健文化转变。
