Theall Alexandra C P, Crandall Joanne E, Gamboa Haley N, Chichioco Michael, Hughes Sarah E, Gruppen Larry, Hung Erick
Acad Med. 2025 Oct 1;100(10S Suppl 1):S84-S91. doi: 10.1097/ACM.0000000000006148. Epub 2025 Jun 23.
The inclusion of people with disabilities in medicine is imperative to ensuring a diverse, culturally adept physician workforce. Despite increasing representation in U.S. medical schools, medical students with disabilities (MSWD) continue to face considerable challenges in pursuing medical education due to systemic discrimination, entrenched biases, and insufficient support and program accessibility. To systematically address the disparities and challenges faced by MSWD, there is a pressing need for a comprehensive framework to design, implement, and evaluate the breadth of initiatives employed across learning contexts needed to promote disability equity, inclusion, and belonging. Here, the authors expand on Gruppen and colleagues' existing conceptual framework of the learning environment (LE) in the health professions by considering the role of societal influence on students' educational experiences. The authors offer this updated conceptualization of the LE as an approach to perform detailed assessments of the broader educational climate, identify areas for improvement, implement interventions that advance equity and inclusion, and evaluate these important initiatives.The framework conceptualizes the LE as consisting of 2 dimensions-the material, which includes physical and virtual components, and the psychosocial, which adds personal, social, organizational, and societal components. These 6 components profoundly affect medical students' educational opportunities and learning outcomes. By thoughtfully considering these factors, medical schools can assess the LE in a dynamic, iterative manner. Furthermore, medical schools can foster disability equity and inclusion through the development of interventions that strategically address a spectrum of LE domains. This framework can be applied in real-world settings to support the design, implementation, and evaluation of accessibility and equity initiatives across diverse institutional contexts. By leveraging this systems-oriented framework to guide these efforts, medical schools can thoughtfully create inclusive environments that support the success of all learners.
将残疾人纳入医学领域对于确保拥有一支多元化、具备文化适应能力的医生队伍至关重要。尽管美国医学院中残疾人的代表性有所增加，但残疾医学生（MSWD）由于系统性歧视、根深蒂固的偏见以及支持和项目可及性不足，在追求医学教育过程中仍面临诸多重大挑战。为了系统地解决MSWD所面临的差距和挑战，迫切需要一个全面的框架来设计、实施和评估在不同学习环境中为促进残疾公平、包容和归属感而采取的广泛举措。在此，作者通过考虑社会影响对学生教育经历的作用，对Gruppen及其同事现有的健康职业学习环境（LE）概念框架进行了拓展。作者提供了这个更新后的LE概念化内容，作为一种对更广泛教育氛围进行详细评估、确定改进领域、实施促进公平和包容的干预措施以及评估这些重要举措的方法。该框架将LE概念化为由两个维度组成——物质维度，包括物理和虚拟组成部分；心理社会维度，增加了个人、社会、组织和社会组成部分。这六个组成部分深刻影响着医学生的教育机会和学习成果。通过深思熟虑地考虑这些因素，医学院可以以动态、迭代的方式评估LE。此外，医学院可以通过制定有策略地解决一系列LE领域问题的干预措施来促进残疾公平和包容。这个框架可以应用于现实世界的环境中，以支持在不同机构背景下设计、实施和评估无障碍和公平举措。通过利用这个以系统为导向的框架来指导这些工作，医学院可以精心营造包容的环境，以支持所有学习者的成功。
