National data needs for medical trainees with disabilities
Data relating to medical trainees with disabilities in Canada is lacking. Medical school administrators and other stakeholders may be hesitant to address the needs of this population in the absence of an understanding of the scope of this need. Unfortunately, few data are available to characterize the demographics of medical trainees with disabilities. For the purpose of this article, disability is defined as a product of the interaction between the social environment and an individual's health condition, in which a person with an impairment cannot fully participate in society due to an environment which is structured to favour able-bodied individuals.
Recent data from the Canadian Medical Association's 2021 National Physician Health Survey (1) suggested that the prevalence of disability among Canadian physicians and medical trainees was 22%. Medical residents were found to be more likely to identify as disabled as compared to practicing physicians (25% vs 22%). (1) The most common disabilities identified were chronic or long-term conditions (i.e. diabetes, multiple sclerosis, heart conditions, epilepsy, chronic pain, others) and mental health conditions. (1) Unfortunately, the majority of the survey’s sample included practicing physicians (3,489; 90.3%), with only 375 respondents (9.7%) identifying as medical residents. (1)
There are clear data needs in the Canadian medical education context to evaluate the demographics of Canadian medical trainees living with disabilities. Recent studies by Nouri et al. (2) and Meeks et al. (3,4) in the United States have effectively elucidated the situation in that country. However, there are significant differences between the United States and Canada that prevent extrapolation from those statistics. Notably, the presence of theAmericans with Disabilities Act, which provides explicit requirements for public institutions to accommodate individuals with disabilities, has led to greater support and protections for trainees with disabilities in the US.
Part of the alleged barrier to action by Canadian medical organizations in ensuring accessibility for Canadian medical trainees is due to the lack of prevalence rates characterizing this population. However, the lack of meaningful accessibility provided by these stakeholders is also a reflection of an absence of knowledge on the heterogeneity of disability and the corresponding accommodations that accompany them.
In order to better understand how to best accommodate and advocate for Canadian medical trainees with disabilities, better data is needed reflecting the prevalence and nature of disabilities experienced by this population. Specifically, information on the type of disability experienced, the trainee’s need for accommodations and/or any obstacles encountered in accessing these accommodations, their educational institution, and their experience in navigating medical school with a disability are essential data needed to adequately characterize and resource plan to support this population.
To fully understand the barriers that trainees with disabilities face, prevalence data among applicants must be collected and compared longitudinally to that of matriculated students. This is the only way to determine if students with disabilities are being excluded from medical education at the admissions level. Furthermore, many students with disabilities report being dissuaded from applying due to lack of awareness of the existence of trainees with disabilities and the capacity for accommodations, and reporting data on this may encourage these students to consider medicine as a career.
There is also value in understanding the intersectional identities of this population. Collecting information on the race/ethnicity of medical trainees with disabilities could provide us with broader insight into disability justice and help us address relevant concerns, such as whether the cumulative barriers for entry to medical school for BIPOC and disabled students preclude the admission of BIPOC students with disabilities. Equally important is data on the visibility of the trainee’s disability. This information would allow us to answer questionsrelated to differences between the experiences of those with visible and invisible disabilities.
There are significant barriers to collecting this data. Notably, the ableist culture of the medical community places medical trainees in a particularly vulnerable position when asked to self-disclose this information via surveys or other data collection tools. Furthermore, privacy laws, which are necessary and certainly beneficial to students, make institutions reluctant to share any collected information related to this topic with researchers.
An ideal study would follow these students longitudinally to assess their experience broadly throughout undergraduate and postgraduate medical education. A longitudinal study could assess access to accommodations in medical school, medical school performance, MCCQE Part I access to accommodations, MCCQE Part I pass rates, CaRMs match rates, and Royal College exam performance.
Efforts have been made through the Canadian Medical Association's National Physician Health Survey to include a question on disability status. While this question is valuable and provides an indicator of disability prevalence, it does not provide the granularity needed to answer the questions posed earlier in this article.
One method to collect this data would be by obtaining this information from the various disability accommodation offices at universities across Canada. These offices should be collecting much of the aforementioned information. While this method of estimating medical trainees with disabilities would be an underestimate; as recent estimates from Meeks et al. (5) suggests that 19% of US medical students who require accommodations do not access them; the data would provide a more accurate signal than previous measures.
Alternatively, detailed demographic data can easily be collected during the admissions process; for example, the Ontario Medical School Application Service (OMSAS) Demographic Survey (6) is completed by all applicants to Ontario medical schools and contains a set of questions asking about self-identified disability. However, this information is currently not publicly disseminated and thus does not provide accountability for schools to take action to reduce admissions barriers and increase enrollment of students with disabilities.
Once this data is collected, it should be made publicly available and inform initiatives related to wellness and equity, diversity, inclusion, and accessibility. Ideally, this data will underscore the need for focused initiatives to address the needs of students with disabilities.
Hopefully, the collection, analysis, and dissemination of more recent and detailed data on medical trainees with disabilities will ameliorate the complacency of Canadian medical institutions in addressing accessibility barriers and ableism in their organizations and medical training programs.
Dr. Quinten K. Clarke is a resident physician in the Department of Psychiatry at the University of British
Columbia.
Shira Gertsman is a medical student at the Michael G. DeGroote School of Medicine.
Aliza Sandino-Gold is a medical student at McGill University’s Faculty of Medicine and Health Sciences.
References
1. Canadian Medical Association. CMA 2021 National Physician Health Survey [Internet]. Canadian Medical Association; 2022 Aug p. 122. Available from: https://www.cma.ca/sites/default/files/2022-08/NPHS_final_report_EN.pdf
2. Nouri Z, Dill MJ, Conrad SS, Moreland CJ, Meeks LM. Estimated Prevalence of US Physicians With Disabilities. JAMA Netw Open. 2021 Mar 12;4(3):e211254.
3. Meeks LM, Herzer KR. Prevalence of Self-disclosed Disability Among Medical Students in US Allopathic Medical Schools. JAMA. 2016 Dec 6;316(21):2271–2.
4. 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 Nov 26;322(20):2022.
5. Meeks LM, Pereira-Lima K, Plegue M, Stergiopoulos E, Jain NR, Addams A, et al. Assessment of Accommodation Requests Reported by a National Sample of US MD Students by Category of Disability. JAMA. 2022 Sep 13;328(10):982.
6. OMSAS - Demographic Survey [Internet]. Ontario Universities’ Application Centre. [cited 2022 Sep 14]. Available from: https://www.ouac.on.ca/guide/omsas-demographic-survey/