Disability services providers often feel challenged when faced with unique accommodation requests from students in graduate health science and medical education programs. And it’s no wonder.
Providing accommodations in the clinical environment calls for expertise in a multitude of specialized topics, such as clinical curriculum, medical equipment, clinical hierarchy, professional communication, assistive/adaptive technology, electronic medical record systems, and program technical standards. It also requires a clear understanding of board and licensing exams and agencies, as these vary widely in their criteria for applicants with disabilities; the Americans with Disabilities Act Amendments Act; and Office for Civil Rights guidance and determinations of complaints involving accommodations in clinical settings.
Students in graduate and professional programs often favor litigation to resolve issues when they withdraw or when they are dismissed, adding a high-stakes element to accommodation challenges. And DS providers who serve students in these programs may work independent of other DS providers on campus, so there’s no exchange of ideas and advice.
Compounding these challenges is the unique nature of each program with regard to academic and technical standards. Essential learning components are highly varied, leaving DS providers with the daunting task of accommodating students in multiple performance-based settings, such as rotations, clerkships, internships, preceptorships, and objective structured clinical examinations and other standardized patient exams.
In particular, programs like medicine, physical therapy, nursing, dentistry, pharmacology, radiation oncology, and prosthetics and orthotics present unique and specific clinical environments, each with inimitable solutions to address accommodating students with disabilities. The specificity of technical standards between programs results in varied thresholds of reasonableness.
Patient safety also helps to dictate the thresholds of reasonableness for any given program. Accommodation requests that impact patient safety are often denied, as such requests tend to modify academic and/or technical standards. Because reasonable accommodations must not compromise patient safety, DS providers must carefully consider if and how accommodating students might impact patient care.
DS providers, in concert with program faculty members, must work through an interactive process to reasonably accommodate students while upholding the academic and technical standards of each program. It is through these partnerships and relationships that institutions can effectively determine what can be accommodated, what is reasonable, and what constitutes a fundamental alteration of their academic and technical standards — all while exercising the necessary care to ensure patient safety.
This highly nuanced working environment and the need for targeted and specialized student support, compounded with the independent nature of this work, led to the creation of a listserv and steering committee for disability providers tasked with accommodating students in graduate health science and medical education. DS providers from the University of California, San Francisco; Northwestern University; and The University of Chicago worked together to develop a coalition of similarly situated colleagues to network with and support each other.
Called “The Coalition for Disability Access in Health Sciences and Medical Education,” the group’s mission is to “develop best practices for facilitating access within graduate, professional and health science programs; to advance these practices to ensure equitable access within these programs; and to disseminate these practices within the fields of disability services, as well as graduate, professional, and health sciences.”
The listserv acts as a forum for exchanging ideas and eliciting the collective wisdom of the group. It has been well received and highly successful as virtual support for other health science and medical DS providers. One benefit is the quick response and access to information. This targeted support for highly specialized disability work is also a conduit for expanding on best practices.
And yearly meetings provide listserv members with an opportunity to further cultivate relationships with their peers at other institutions and work together on larger projects. This past April, a small steering committee met in Chicago to exchange ideas, discuss best and promising practices, and work on a handbook for students with disabilities entering the health sciences.
Disability services providers who work with other highly specialized populations should consider starting similar groups. For example, we know the population of students with autism spectrum disorder is growing exponentially on all of our campuses. Specialists in ASD or those who work with large numbers of students on the spectrum could benefit from participation in a group like ours, but targeted to their specific, ASD-related issues. Other possible special-interest groups may center on issues such as serving student-veterans with disabilities, increasing access to underrepresented minorities, and working through shrinking budgets and expending responsibilities. Through such groups, collective wisdom is only an email away.