Acad Med. 2024 Nov 1;99(11):1221-1233. doi: 10.1097/ACM.0000000000005842. Epub 2024 Aug 8.
Students with disabilities have inequitable access to medical education, despite widespread attention to their inclusion. Although systemic barriers and their adverse effects on medical student performance are well documented, few studies include disabled students' first-person accounts. Existing first-person accounts are limited by their focus predominantly on students who used accommodations. This study bridged these gaps by analyzing a national dataset of medical students with disabilities to understand their perceptions of disability inclusion in U.S. medical education.
The authors analyzed 674 open-text responses by students with disabilities from the 2019 and 2020 Association of American Medical Colleges Year Two Questionnaire responding to the prompt, "Use the space below if you would like to share anything about your experiences regarding disability and medical school." Following reflexive thematic analysis principles, the authors coded the data using an inductive semantic approach to develop and refine themes. The authors used the political-relational model of disability to interpret themes.
Student responses were wide-ranging in experience. The authors identified key dimensions of the medical education system that influenced student experiences: program structure, processes, people, and culture. These dimensions informed the changes students perceived as possible to support their access to education and whether pursuing such change would be acceptable. In turn, students took action to navigate the system, using administrative, social, and internal mechanisms to manage disability.
Key dimensions of medical school affect student experiences of and interactions with disability inclusion, demonstrating the political-relational production of disability. Findings confirm earlier studies on disability inclusion that suggest systemic change is necessary, while adding depth to understand how and why students do not pursue accommodations. On the basis of student accounts, the authors identify existing resources to help medical schools remedy deficits in their systems to improve their disability inclusion practice.
尽管人们普遍关注残疾学生的融入问题，但残疾学生获得医学教育的机会仍不平等。尽管系统障碍及其对医学生表现的不利影响已得到充分记录，但很少有研究包括残疾学生的第一人称叙述。现有的第一人称叙述主要局限于使用住宿的学生，因此存在局限性。本研究通过分析全国残疾医学生的数据集，了解他们对美国医学教育中残疾包容的看法，从而弥补了这些差距。
作者分析了美国医学协会 2019 年和 2020 年二年级问卷中 674 名残疾学生的 674 份开放文本回复，该问卷的提示是：“如果您想分享有关残疾和医学院的任何经验，请在此处使用空间。”作者遵循反思性主题分析原则，使用归纳语义方法对数据进行编码，以开发和完善主题。作者使用残疾的政治关系模型来解释主题。
学生的反应在经验上是多种多样的。作者确定了影响学生体验的医学教育系统的关键维度：课程结构、流程、人员和文化。这些维度为学生认为可能支持他们接受教育的机会的改变提供了信息，以及他们是否会接受这种改变。反过来，学生采取行动来驾驭系统，利用行政、社会和内部机制来管理残疾。
医学院的关键维度影响学生对残疾包容的体验和互动，展示了残疾的政治关系产生。研究结果证实了早期关于残疾包容的研究，表明需要进行系统变革，同时更深入地了解为什么学生不寻求住宿。基于学生的叙述，作者确定了现有的资源，以帮助医学院弥补其系统中的缺陷，从而改善其残疾包容实践。
