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Meeks LM, Case B, Herzer K, Plegue M, Swenor BK. Change in Prevalence of Disabilities and Accommodation Practices Among US Medical Schools, 2016 vs 2019. JAMA. 2019;322(20):2022–2024. doi:10.1001/jama.2019.15372
In 2016, a survey found that 2.7% of US allopathic medical students disclosed a disability, which exceeded prior estimates.1 Data from a follow-up survey, using the same methodology, were used to compare the prevalence of disability and accommodation practices between 2016 and 2019.
Between September 2018 and March 2019, a web-based survey was administered to disability professionals at eligible schools, defined as having full accreditation through the Liaison Committee on Medical Education and excluding schools on probation. The survey assessed the prevalence of students with disabilities, the category of disabilities (Table 1), and types of accommodations (Table 2). Survey results were linked to the 2018 Association of American Medical Colleges Organizational Characteristics Database. Descriptive statistics were used to summarize results. Characteristics of nonresponding and responding schools were compared using χ2 and t tests.
Comparison between identical items on the 2016 and 2019 surveys were conducted for schools that responded with data for both years. Differences in the proportions of students with disabilities and by disability type were compared using z tests specifying a 2-sided significance level of .05. All statistical analyses were conducted in R version 3.5.1. The study was exempt by the University of Michigan Medical School institutional review board.
In 2019, 140 US allopathic schools were eligible for participation, and 87 (62.1%) completed the survey. Responding schools were similar to nonresponding schools in all characteristics examined (public vs private ownership, community-based status, research intensity, and financial relationship with the parent university), except for geographic region (P < .001). Compared with nonrespondents, responding institutions had a lower percentage of schools in the South (22%% vs 58%), a higher percentage of schools in the West (18% vs 4%), and a higher percentage of schools in the Central region (30% vs 15%). Schools in the Northeast were more similarly distributed (30% responding vs 23% nonresponding).
Of the 87 schools participating in 2019, respondents reported 2600 students with disabilities, representing 4.6% (95% CI, 4.4%-4.8%) of the total enrollment of 56 217 students. Psychological disabilities, attention-deficit/hyperactivity disorder, and chronic health disabilities were reported most frequently. Of the 84 schools providing data on accommodations practices, 93.3% of students received accommodations (Table 2).
Of the 64 schools that responded in both years, the total number of students reporting disabilities increased from 1142 (2.9%) in 2016 to 2028 (4.9%) in 2019 (difference, 1.9% [95% CI, 1.8%-2.3%]; relative increase, 69%) (Table 1). Psychological disabilities increased from 20.4% to 32.3% (difference, 11.9% [95% CI, 8.7%-15.1%]) and chronic health conditions increased from 13.3% to 18.0% (difference, 4.7% [95% CI, 2.0%-7.3%]). Learning disabilities decreased from 21.4% to 18.3% (difference, −3.1% [95% CI, −6.1% to −0.2%]).
In 2019, 4.6% of medical students reported disabilities, a 69% relative increase from 2016. Despite the stigma surrounding psychological and chronic health disabilities, these categories showed the largest increase.
Though not possible to capture from this survey, the increase in disability prevalence may be a result of more applicants with disabilities being admitted to medical school, more existing students disclosing disability, better reporting of disability data, or increased development of psychological disability while attending medical school.2,3
Limitations include potential underestimates resulting from students who did not disclose their disability; inability to examine the distribution of disability by student characteristics, including year in program, due to aggregate reporting of data; and limited generalizability to osteopathic schools. Additionally, schools with a greater percentage of students with disabilities may have been more likely to respond to the survey, leading to potential overestimates. However, medical schools are required under federal law to engage in a robust process for determining disabilities and accommodations and documenting these decisions, increasing the accuracy of the data.
The inclusion of individuals with disabilities is an important contribution to diversity in medicine.4-6 Although an increase in disability was observed, these data do not provide information about the culture that these students experience or their retention in the training and career pipeline. Therefore, further research is needed, as documenting representation is only a first step toward enhancing the inclusion of persons with disabilities in medicine.
Accepted for Publication: September 4, 2019.
Correction: This article was corrected on February 18, 2020, to fix incorrect percent values in the text and in Table 1.
Corresponding Author: Lisa M. Meeks, PhD, University of Michigan, Department of Family Medicine, 1018 Fuller St, Ann Arbor, MI 48104-1213 (firstname.lastname@example.org).
Author Contributions: Dr Meeks and Mr Case 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: Meeks, Case, Herzer, Swenor.
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: Meeks, Herzer, Plegue, Swenor.
Administrative, technical, or material support: Case, Swenor.
Supervision: Meeks, Case, Herzer, Swenor.
Conflict of Interest Disclosures: None reported.
Additional Contributions: We are grateful to the designated disability professionals from the responding medical schools for their attention to detail and time commitment to completing the survey. We are equally indebted to Tal Jarus, PhD, University of British Columbia–Vancouver Department of Occupational Science and Occupational Therapy; Pam Laio, MD, University of Toronto Department of Family and Community Medicine; and Neera Jain, MS, CRC, University of Auckland Faculty of Education and Social Work, who provided feedback on the 2018-2019 survey. No compensation was received for their feedback.