Testing was defined as extra time used for school-based examinations (including time and a half and double time), use of low-distraction or private environments, and testing breaks. Facilitated learning was defined as flexible attendance, note takers, Livescribe pen, recorded lectures, and preferential seating. Ergonomic was defined as ergonomic evaluation and equipment. Assistive technology was defined as textbooks in alternate formats and text-to-speech and speech-to-text computer programs. Housing was defined as living accommodations such as single-room housing, release from housing, assistance animal (eg, therapy dogs), service animal, and reserved parking. Clinical was defined as clinical placement, deferred clinical year, leave of absence, and release from overnight call. Hearing-related was defined as use of transcriptionist, Communication Access Realtime Translation, sign language interpreter, specialized phone, and specialized pager.
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Meeks LM, Herzer KR. Prevalence of Self-disclosed Disability Among Medical Students in US Allopathic Medical Schools. JAMA. 2016;316(21):2271–2272. doi:10.1001/jama.2016.10544
Studying the performance of medical students with disabilities requires a better understanding of the prevalence and categories of disabilities represented.1-4 It remains unclear how many medical students have disabilities; prior estimates are out-of-date and psychological, learning, and chronic health disabilities have not been evaluated.5 This study assessed the prevalence of all disabilities and the accommodations in use at allopathic medical schools in the United States.
From December 2014 through February 2016, an electronic, web-based survey was sent to institutionally designated disability administrators at eligible allopathic medical schools who have a federally mandated duty to assist qualified students with disabilities. Eligible schools were identified through a registry maintained by the Association of American Medical Colleges (AAMC); new schools and those with probationary accreditation or on probation were excluded. Participation was maximized through direct emails to disability administrators, AAMC outreach to students affairs deans at eligible schools encouraging participation, and phone calls to nonresponding schools after 6 and 9 months.
The survey was designed by experts in medical school disability administration based on provisions of the Americans with Disabilities Act and prior research. The survey was pilot tested by 5 schools and refined. The survey assessed the following domains: (1) total number of self-disclosed or registered students with disabilities receiving accommodations, (2) demographic characteristics of students with disabilities, (3) categories of disabilities, and (4) approved accommodations. Disability categories included attention-deficit/hyperactivity disorder (ADHD), learning disability, psychological disability (adjustment disorder, anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, bipolar disorder, depressive disorder, eating disorder, cognitive disorder, autism spectrum disorder, schizophrenia, other psychotic disorders), deaf and hard of hearing, visual impairment, mobility disability, chronic health, and other functional impairment.
Survey results were linked to the AAMC’s Organizational Characteristics Database, which provided additional information about regional, ownership, and financial characteristics of the medical schools. Descriptive statistics were used to summarize survey results. The study was deemed exempt by the University of California, San Francisco, institutional review board because school-level data were analyzed in a deidentified manner.
One hundred forty-five schools were identified; 12 were excluded. Of the 133 eligible schools, 91 completed the survey (68.4%) and 89 reported complete data and were included in the analysis. Most schools were located in the south (32.6%) and were publicly owned (57.3%) (Table). Responding schools were similar to nonresponding schools on geographic region, public vs private ownership, community-based status, research intensity, and financial relationship with the parent university.
Respondents identified 1547 students with disabilities (43.3% male), representing 2.7% of the total enrollment and ranging from 0% to 12%. Of these students, 97.7% received accommodations (Table). ADHD was the most common disability (33.7%), followed by learning disabilities (21.5%) and psychological disabilities (20.0%). Mobility and sensory disabilities were less common. School-based testing accommodations were most frequently used (97.8%); clinical accommodations were less frequently used (Figure).
This study identified a higher prevalence of disability among students in US allopathic medical schools—2.7%—than prior studies (0.3% to 0.6%).3,5 These results underscore the limitations of studying isolated subtypes of disabilities (ie, only mobility impairments), which may underestimate this population. The preponderance of students with ADHD, learning disabilities, and psychological disabilities suggests that these disability subtypes should be included in future research efforts, such as studies assessing the performance of appropriately accommodated students.
Schools reported incomplete student demographic data, precluding analysis. Also, students who did not self-disclose were not captured, nor was severity of disability—however, medical documentation is required for disability registration. Given the stigma surrounding psychological disabilities, it is plausible that these disabilities were underrepresented. Schools responding to the survey may not be representative of all allopathic medical schools, and the results may not generalize to osteopathic schools. Finally, these prevalence estimates rely on the accuracy of the data reported by schools; however, schools are under a federal mandate to document communication and decision making regarding students with disabilities, supporting the accuracy of these data.
Corresponding Author: Lisa M. Meeks, PhD, Department of General Internal Medicine, University of California, San Francisco, School of Medicine, 533 Parnassus Ave, U266, PO Box 0454, San Francisco, CA 94143 (firstname.lastname@example.org).
Author Contributions: Drs Meeks and Herzer had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: All Authors.
Acquisition, analysis, or interpretation of data: All Authors.
Drafting of the manuscript: All Authors.
Critical revision of the manuscript for important intellectual content: All Authors.
Statistical analysis: Herzer.
Administrative, technical, or material support: Meeks.
Study supervision: Meeks.
Conflict of Interest Disclosures: Both authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
Funding/Support: This work was supported by grant T32GM007309-41 from the National Institute of General Medical Sciences’ Medical Scientist Training Program (Dr Herzer) and grant R36AG051727 from the National Institute on Aging (Dr Herzer).
Role of the Funders/Sponsors: The funding agencies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, and approval of the manuscript; or decision to submit the manuscript for publication.
Additional Contributions: We thank Matthew Smith, PhD (Northwestern University Feinberg School of Medicine), for help with survey development and recruitment; Jayme Bograd, BA (Association of American Medical Colleges), and the Association of American Medical Colleges Group on Student Affairs for their help with recruitment; Neera Jain, CRC, MS (University of California, San Francisco), for contributions to the construction of the database and data collection; Judith Wentz, MA (University of California, San Francisco), for assisting with data collection and data checking; and Lauren Nicholas, PhD (Johns Hopkins University), for suggestions on the article. We also thank the disability administrators from the responding medical schools for their attention to detail and time commitment to completing the survey. No compensation was provided for any contributors.
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