Author’s Note: This blog post uses person-first (students with a disability) and identity-first (disabled student) language to honor and acknowledge the contrasted preferences of persons with disabilities.
As enthusiastic supporters of disability inclusion in medicine, it can be disheartening when we witness disabled students struggle. Regrettably, faculty are almost never taught how to appropriately approach remediation for students with disabilities. Traditional methods of remediation alone are insufficient, leading to inappropriate student failure, potential dismissal, or failure to fail for fear of legal repercussions.
When the origin of the difficulty is unknown, faculty may misattribute the cause of the student’s struggle to disability alone and use standard academic remediation versus evaluating the potential for revised accommodations. Therefore, we feel it is vital to have the assessment of a disability resource professional involved in the process to complement the faculty’s evaluation.
What should happen when a student with a disability struggles?
When working with a struggling student who also has a disability, an additional step needs to be added to any root cause analysis of the deficit—a review of the effectiveness of disability accommodations. In addition to academic remediation, the need for new or adjusted accommodations must be considered.
What is required under the law?
The Americans with Disabilities Act of 19901 and Section 504 of the Rehabilitation Act of 19732 mandate that postsecondary education institutions conduct an individualized assessment of the particular barriers faced by the student to determine what, if any, academic adjustments and/or auxiliary aids may be appropriate to remove barriers for “otherwise qualified” students with disabilities.
How did we address this?
To address disabled students’ struggles in the clinical setting, we designed a model that includes a specialized objective structured clinical examination (OSCE) to simulate the areas in which they were struggling. A team comprised of both a disability resource professional and content expert observed the student’s performance in multiple OSCE scenarios to identify any disability-related barriers and academic deficits, as outlined in our recent Academic Medicine article.3
How can we keep this process student centered?
Through this process we learned how important it is to engage the student for feedback on the process and to conduct check-ins throughout the experience. This iterative and transparent approach fostered trust and teamwork.
In our case, the disability resource professional had multiple phone calls and in-person meetings with the student before, during, and after the process to make sure that all strategies the student was using to prepare for the OSCEs were noted and to check in about the student’s health condition and perceived barriers—in our case, the student was experiencinga degenerative disease and their functioning was steadily declining. This process also provided an opportunity to discuss the potential outcomes, including retention-oriented outcomes as well as ones involving withdrawal from the program.
Were there any lessons learned from using the diagnostic OSCE or during the formalization process?
Struggling students with disabilities have unique needs, which must be addressed individually. Our model allowed us to focus our remediation and accommodation plans to the student’s specific needs, whether they were disability related or academic. Our team, in partnership with our student, agreed that this facilitated the most equitable and informed decision about next steps (i.e., remediation or withdrawal from the program).
What advice can we share with others who are interested in implementing this kind of program?
DO IT! If your goal is to retain and graduate your student, this is an ideal way to approach the process. Our model uses on campus resources and engages the student with a disability, relevant clinical faculty or staff, and the disability resource professional.
Is this process cost-effective?
Yes! The total cost in our case was under $900 for over 3 OSCE sessions. This included rental of the simulation lab and the cost of the standardized patient and scribe. The disability office paid for the process, following best practices for funding student accommodation needs, including assessment to determine or refine accommodations.4
Are there any additional benefits to this process?
The goal of this model is to remain student centered and to increase the likelihood of finding a reasonable accommodation, yet for some cases, no reasonable accommodations to remove the disability-related barriers will exist, and students may be found to not be “otherwise qualified.” In these cases, the students will therefore not be able to meet the academic and technical standards of the program. When schools follow and document the process outlined in our model it demonstrates a good faith effort to engage in a robust interactive process. Having engaged in this process shows that the school met its obligation under the law and supported the student to the fullest extent.4
By: Lisa M. Meeks, PhD, Rahul Patwari, MD, and Marie Ferro-Lusk, MBA, MSW, LSW
L.M. Meeks is assistant professor of family medicine, University of Michigan Medical School, Ann Arbor, Michigan, and Researcher, Center for Workforce Diversity, The University of California, Davis, School of Medicine, Sacramento, CA.
R. Patwari is associate professor of emergency medicine and associate dean for curriculum,
Rush Medical College, Chicago, Illinois.
M. Ferro-Lusk is director, Office of Student Accessibility Services, Rush University, Chicago, Illinois.
References and Further Reading
- Americans with Disabilities Act, 42 USC § 12101, et seq (1990).
- Department of Health, Education, and Welfare Office for Civil Rights. Section 504 of the Rehabilitation Act of 1973: Fact Sheet: Handicapped Persons Rights Under Federal Law. Washington, DC: Department of Health, Education, and Welfare Office for Civil Rights; 1978.
- Patwari R, Ferro-Lusk M, Finley E, Meeks LM. Using a diagnostic OSCE to discern deficit from disability in struggling students [published online ahead of print April 21, 2020]. Acad Med. doi: 10.1097/ACM.0000000000003421.
- Mehta L, Meeks LM, Lusk M, Swenor BK, Taylor NL. Creating a program within a culture of inclusion. In: Meeks LM, Neal-Boylan, eds. Disability as Diversity: A Guidebook for Inclusion in Medicine, Nursing, and the Health Professions. Cham, Switzerland: Springer; 2020;49–82.