Coalition Corner

The Coalition Corner is our award-winning quarterly column in Disability Compliance in Higher Education (DCHE). The column features concise discussions relevant to disability inclusion the health science context.

 

Call for Articles

We welcome column submissions or expressions of interest with the following specifications:

  • 500-word maximum

  • Subject must be specific to disability and health science

  • Subject must not have been covered previously (see below)

  • Submission of an article does not guarantee acceptance

  • Editing assistance is available

Please contact Neera Jain for more information.

 

Coalition Corner Archive

To access full text of articles, you must be a DCHE subscriber. Your University library may already hold a subscription.

 

Work with psychological services to support self‐advocacy in the health professions (June 2020)

Cheryl Porter Marshall Ph.D., Neera R. Jain M.S., C.R.C.

https://doi.org/10.1002/dhe.30855

 

Self‐advocacy skills are important for individuals with disabilities and crucial for those who plan to enter health professions education. Although positive changes are occurring, some resistance in health professions education persists surrounding full inclusion of individuals with disabilities. As our students navigate this shifting culture, they will encounter leaders who are well‐versed in disability rights and those who are not informed. It is in interactions with the latter where self‐advocacy is most crucial.

 

Considerations at the intersection of race, ethnicity, and disability (March 2020)

William Eidtson Ed.D., Alicia J. Brandon M.Ed.

https://doi.org/10.1002/dhe.30802

 

Underrepresented racial and ethnic students in the health sciences may face unique barriers to accessing disability services due to compounding, socially stigmatizing factors. Disability resource providers must be aware of these potential barriers and be prepared to address them.

Leaves of absence in health science programs: Not a catch‐all solution (December 2019)

Lisa M. Meeks Ph.D., Joseph F. Murray M.D.

https://doi.org/10.1002/dhe.30754

 

Health science students with disabilities may experience a worsening of symptoms that can fluctuate and impact their functioning. A myopic response to these flares is to suggest a leave of absence. In these cases, the message to the student is “Take some time off and get this fixed. Then return when you are well.” The flaw in this approach is the idea that students must be 100% well to engage in the program. Functioning occurs on a spectrum from low functioning (where a student may legitimately require a leave) to high functioning (where no limitations exist). Many students experiencing a flare fall in the middle, able to continue in the program with the aid of accommodations.

 

 

Consider how the intention of a service influences equal access assessments: The case of health science learning resource programs (September 2019)

Jamie Axelrod

https://doi.org/10.1002/dhe.30705

 

As highly competitive programs in health sciences add greater levels of academic support to boost student success, what does equitable access to support programs look like for students with disabilities? Considering the core principles informing our work, this question often creates a conundrum for many disability resource professionals.

 

It's all about process! (June 2019)

Linda Sullivan M.A., Enjie Hall M.R.C., P.C.

https://doi.org/10.1002/dhe.30653

 

Grievance, complaint, appeal … words that make a disability services provider's blood pressure rise. As students become more aware of their rights and the availability of academic accommodations, complaints at colleges and universities around the country have increased substantially. This is particularly true for health science programs due to the high‐stakes nature of these programs.

 

Support deaf students pursuing health care internships (May 2019)

Tia Ivanko, Lore Kinast, Dave Litman, Stephanie Zito

https://doi.org/10.1002/dhe.30635

 

Deaf students are actively pursuing careers in health care professions. As a result, postsecondary institutions are navigating the complexities of accommodations during internships. Institutions are required to make decisions on a case‐by‐case basis and should involve the student in the decision‐making process. Understanding legal responsibilities for accessibility is essential for equitable internship experiences

 

The new normal: Disability inclusion in health science education (April 2019)

Lisa M. Meeks Ph.D.

https://doi.org/10.1002/dhe.30614

 

Last year, we witnessed tremendous growth toward the inclusion of persons with disabilities in health science programs. A major report from the Association of American Medical Colleges, in partnership with the University of California, San Francisco School of Medicine examined the lived experiences of learners with disabilities and offered considerations for improving policy and practice.

The case for comprehensive case notes in health sciences (March 2019)

Lisa M. Meeks Ph.D., Enjie Hall

https://doi.org/10.1002/dhe.30597

 

In the world of health science education, the stakes get very high very fast. A simple delay in services can make the difference between success and failure in a course. Unlike other undergraduate education where a student can easily retake a failed course, two failed courses in an undergraduate or graduate health science program may result in dismissal from the program. Additionally, experiential learning requirements and high‐stakes examinations required in health science programs present a unique, multi‐layered aspect to the coordination of disability‐related accommodations. In other words, multiple moving parts make an accurate recollection of each element very challenging, so documentation of decisions and actions is critical.

 

Working with students who stutter: Considering oral exams, clinical settings (February 2019)
Neera R. Jain M.S., C.R.C.

https://doi.org/10.1002/dhe.30581

 

Health science programs frequently list “effective communication” as a core competency or technical standard. Therefore, concerns may arise about how students who stutter will meet associated program requirements. Remembering that strong communication entails much more than fluency in oral speech is key to approaching these concerns. Students who stutter can be excellent communicators.

 

Appropriately staffing DS offices in health science education (January 2019)

Lisa M. Meeks Ph.D., Linda Sullivan M.A.

https://doi.org/10.1002/dhe.30564

 

Health science students navigate a complex system of didactic, practical, simulated, and clinical experiences. In addition to students' multifaceted program experiences, they also engage with high‐stakes testing agencies and licensing boards. Disability services providers, to effectively and proactively address student needs, must develop expertise on curriculum, pedagogy, and clinical settings and must be assured sufficient time to perform the full scope of their duties.

 

Why we need specialization in health science disability services (November 2018)

Jean Haverstick

https://doi.org/10.1002/dhe.30535

 

For 10 years, I have worked with the University of Vermont's Larner College of Medicine. Throughout this time, I tried many approaches to advocating for and accommodating students but was unfamiliar with the nuances of the curriculum. With only a handful of students per year, none requesting clinical accommodations, I also had limited opportunity to engage with the LCOM administrators.

 

The rights of students with hepatitis B in clinical settings (October 2018)

Elisa Laird‐Metke J.D., Martha Lee Sullivan M.Ed.

https://doi.org/10.1002/dhe.30519

 

When a student enrolled in a health science program has a diagnosis of hepatitis B (or other transmissible blood‐borne pathogen), the school must balance the right of the student to equal educational opportunities with the patient safety demands of the clinical settings in which the student will work. The federal government has offered schools clear guidance on the matter.

 

Misconception, misinformation, and myths: Advising pre‐health students with disabilities (September 2018)

Lisa M. Meeks Ph.D., Gail G. Glicksman Ph.D.

https://doi.org/10.1002/dhe.30500

 

Pre‐health students with disabilities often receive misinformation about their competitiveness and candidacy for professional school programs. Misconceptions about the requirements for medical, nursing, and other professional programs are often at the core of prevailing myths. Public campaigns like #DocsWithDisabilities and #NursesWithDisabilities on Twitter are working to change public perception of health care providers with disabilities. In this article, we address these widespread beliefs in an effort to develop a budding pipeline of qualified students in health science programs.

AT in the classroom and clinic (August 2018)

Clay Littrell M.A.

https://doi.org/10.1002/dhe.30486

 

Determining appropriate assistive technology for the classroom and clinical settings differs from determining other accommodations. To effectively assess barriers and determine appropriate AT, disability services providers need to be familiar with, and trained on, the most common AT solutions.

 

Challenges and barriers to advocacy: A student perspective (July 2018)

Samantha Kennedy

https://doi.org/10.1002/dhe.30469

 

The word “disability” carries multiple definitions across contexts, which are often at odds. While I am disabled according to the Americans with Disabilities Act, I have never considered myself a person with a disability. I was nudged to advocate for myself as a child, even though I was resentful being asked to disclose my disability to strangers, while I was still struggling to accept the label myself.

 

An in‐house disability compliance workshop for health science programs (June 2018)

William Eidtson Ed.D., Glenda Shoop Ph.D., M.Ed., Cori Stebbins B.S., Alicia J. Brandon M.Ed., Amanda Albright M.S.

https://doi.org/10.1002/dhe.30452

 

Health science disability services is a complex and rapidly evolving landscape. Faculty and staff with other professional duties often find it challenging to stay informed of the most current legal, instructional, and technological advances in disability compliance. The Geisel School of Medicine at Dartmouth's Office of Student Accessibility Services recently tackled this challenge through two three‐hour workshops that addressed key areas of disability compliance.

 

Accommodating chronic health conditions in medical education (May 2018)

Lisa M. Meeks Ph.D., Neera R. Jain M.S., C.R.C.

https://doi.org/10.1002/dhe.30432

 

Many students with chronic health conditions successfully attend and graduate from medical school. The barriers students encounter are often related to symptom flares, which may occur suddenly and can be brought on by multiple factors. Flares may include a period of symptoms such as joint pain and stiffness, fatigue, headache, slowed cognitive processing, and gastrointestinal disruption. Students also live with the potential for disease progression that further impacts their health and functioning, creating uncertainty about future accommodation needs.

 

Flip, don't flop: Ensuring accessibility of the flipped classroom (April 2018)

Linda Sullivan M.A.

https://doi.org/10.1002/dhe.30417

 

Health science students need solid foundational knowledge to be successful in their chosen profession. However, knowledge alone does not make a health care professional successful; there is an art to medicine as well. Artistry takes practice. In health science programs, this practice is conducted using the application of knowledge in simulated or clinical settings. In an effort to provide learners with more application time, many health science programs have begun using flipped classrooms.

 

Big solutions for small groups in health science programs (March 2018)

Linda Sullivan M.A., Lisa M. Meeks Ph.D.

https://doi.org/10.1002/dhe.30397

 

Small group learning and instructional design play a significant role in the educational process for health education students. Small groups in health science curricula provide learners with opportunities to engage as a team, learn through observation and collaboration, hone communication skills, develop higher‐order thinking, synthesize information, and develop group consensus. Team‐based care (the standard in many health fields) necessitates that learners acquire these essential skills prior to entering the clinic. In health science education, faculty members present the “case” and facilitate small groups. The groups then engage in deductive reasoning to arrive at a diagnosis, and in some cases a treatment plan.

 

Apple Watch breaking barriers for students with disabilities (February 2018)

Clay Littrell M.A.

https://doi.org/10.1002/dhe.30390

 

Students with autoimmune diseases may face additional barriers in the clinical setting. Their symptoms can be intermittent and could include chronic fatigue, arthritic joint pain, and swelling in their extremities. A number of high‐ and low‐tech solutions can address one of the largest complaints for students — pain in the hands — impacting their ability to type and to grip the equipment needed to perform in clinic or on the wards.

 

Use of an intermediary as reasonable accommodation for medical education (January 2018)

Barbara Blacklock M.A., L.I.S.W.

https://doi.org/10.1002/dhe.30380

 

As an increasing number of talented students with disabilities are being reasonably accommodated in postsecondary schools, more students with disabilities are admitted to medical school. This increase in inclusion supports one of the stated goals of the Association of American Medical Colleges to “expand the diversity of health care providers.”

 

A systemwide review of technical standards (December 2017)

Marie Ferro‐Lusk M.B.A., M.S.W., L.S.W.

https://doi.org/10.1002/dhe.30370

 

Technical standards are the criteria used by health science programs to assess the nonacademic qualifications of applicants and students with disabilities. An example would be the ability to conduct a complete physical examination of the patient. The concept of technical standards comes from the regulations enacting Section 504 of the Rehabilitation Act of 1973, which define a qualified individual as one “who meets the academic and technical standards requisite to admission or participation in the [school's] education program or activity.”

Accommodate learners with ASD in a clinical setting (November 2017)

Lisa M. Meeks Ph.D., Jane Thierfeld Brown Ed.D., Jonathan Warczak M.A.

https://doi.org/10.1002/dhe.30356

 

An increasing number of learners with autism spectrum disorder are attending health science programs. When the curriculum includes clinical placements, learners often find they require additional supports.

 

Accommodating students on anatomy and other lab practical exams (October 2017)

Lisa M. Meeks Ph.D., Neera R. Jain M.S., C.R.C.

https://doi.org/10.1002/dhe.30347

 

Determining accommodations for anatomy and other lab exams (often referred to as “practicals”) takes coordination, a team effort, and a commitment to full access. Faculty may believe that accommodations are not possible in complex lab environments. Logistical challenges and questions about fundamental alteration are often at the crux of these concerns.

 

Memory, retention, and retrieval: Using Livescribe smartpen as an accommodation (September 2017)

Jan Serrantino Ed.D., Joshua Hori
https://doi.org/10.1002/dhe.30340

 

Students facing challenges in clinical settings may benefit from audio recording of the patient interview as an accommodation. For learners whose functional limitations include difficulty with auditory processing, concentration, short‐term memory, and writing, the Livescribe smartpen may remove barriers on the wards and in the clinic.

 

Access in surgery: CART as a method of inclusion for deaf and hard‐of‐hearing learners (August 2017)

Joshua Hori, Lisa M. Meeks Ph.D.

https://doi.org/10.1002/dhe.30331

 

Providing full access to deaf and hard‐of‐hearing learners in sterile environments such as surgical suites has posed a challenge to disability services providers in health science programs.

 

Admissions as a facilitator of inclusion — not a gatekeeper (July 2017)

Lina Mehta M.D., Grace Clifford M.A.Ed.

https://doi.org/10.1002/dhe.30320

 

Although the percentage of medical students with disabilities is increasing, it continues to lag behind that of individuals with disabilities in other graduate programs. One mechanism for increasing the number of students with disabilities in medicine is through the admissions pathway. Medical school admissions is historically viewed as the gatekeeper for students with disabilities in entering the medical profession.

Ensuring an accessible orientation: Purposeful planning (June 2017)

Lisa M. Meeks Ph.D., Elisa Laird‐Metke J.D.

https://doi.org/10.1002/dhe.30310

 

Campus disability offices are well‐versed in serving students in classes, but orientation events for incoming students who may not yet have self‐identified their disabilities are sometimes overlooked. To ensure that orientation activities are accessible to students with apparent and nonapparent disabilities, disability counselors should make a concerted effort to partner with orientation stakeholders for a proactive approach.

 

See Spot in the clinic: Service animals in clinical rotations (May 2017)

Elisa Laird‐Metke J.D.

https://doi.org/10.1002/dhe.30300

 

Although it is now well accepted that students with disabilities have a right to bring service animals to campus, what about service animals accompanying health science students in clinical rotations?

 

Summative and formative assessments: Do we accommodate both? (April 2017)

Lisa M. Meeks Ph.D., Neera R. Jain M.S., C.R.C.

https://doi.org/10.1002/dhe.30287

 

Disability services providers and faculty often ask whether accommodations should be provided for informal or formal formative assessments. Formative assessments are intended to provide students with feedback to guide improvement in skills or knowledge and may be collected and recorded as benchmarks for performance. Unlike summative assessments, which are usually graded and thus interpreted as high stakes (e.g., exams, the Objective Structural Clinical Examination), formative assessments are thought to carry low or no stakes for students. For this reason, some suggest that accommodations are not needed. However, accommodations are provided to address a barrier in the educational environment, and as such should not be limited to summative activities.

 

Be ready to address disability microaggressions in medicine (March 2017)

Alison L. May Ph.D.

https://doi.org/10.1002/dhe.30280

 

Most disability services practitioners agree that the medical model of disability, with its focus on curing the individual's intrinsic problem , is problematic for students with disabilities and academia more broadly. This is especially salient for medicine. The few medical students with disabilities who matriculate and self‐identify may be relegated to the medical model of disability, being viewed as flawed and limited in their potential for practicing medicine. Leslie Neal‐Boylan and colleagues suggested in 2012 that this model is the reason medical providers with invisible disabilities frequently choose not to self‐identify.

 

Privacy, disability, and health science students (February 2017)

Lisa M. Meeks Ph.D.,  Neera R. Jain M.S., C.R.C.

https://doi.org/10.1002/dhe.30270

 

We are often asked to address students' concerns about confidentiality and privacy related to their disability status in high‐stakes health professions programs. Some students may have expectations about confidentiality practices based on their experience in health care settings. Stigma can also be a barrier to seeking accommodations in these programs as students often describe concerns about who will know about their disability and who will have access to their disability documentation. As future health professionals, students are understandably concerned that their documentation and disability status could be used against them in their career (e.g., inability to get malpractice insurance, inability to get licensed, concern with documentation being accessed in malpractice suits).

 

Changing the practice: The synergy of the Coalition (January 2017)

Lisa M. Meeks Ph.D., Tim Montgomery, Greg Moorehead

https://doi.org/10.1002/dhe.30260

 

Three years ago, three disability services providers connected with a simple idea — let's share what we know and in exchange learn from our peers as part of a formal network. This group has been infinitely more powerful than the sum of the individuals in it. Individually we are singular providers restricted to the autonomy and authority prescribed by our institutions, but together — as part of the coalition — we create a superior reservoir of education and grow our resources exponentially through the listserv, articles, books, research, and networking during the symposium. The Coalition for Disability Access in Health Science and Medical Education was formed — and thrives — under this idea of synergy.

 

Learners with ADHD: Concerns and coping mechanisms in the clinic (December 2016) 

Zoe Brown‐Weissmann M.Ed., M.S., Allison Carli M.Ed.

https://doi.org/10.1002/dhe.30249

 

ADHD often manifests as distractibility, lack of awareness of surroundings, inadequate organizational skills, and the inability to adapt to the new routines. This is especially difficult when trying to manage the responsibilities of a fast‐paced and challenging health science curriculum. Unmanaged ADHD symptoms can also lead to concern over professionalism (e.g., tardiness, keeping appointments, missing deadlines, and the inability to focus on the task). The aforementioned cognitive activities require excellent executive functioning and are essential for medical and other health science learners in the clinic.

 

Accommodating standardized patient exams: The OSCEs (November 2016)

Lisa M. Meeks Ph.D., Neera R. Jain M.S., C.R.C.

https://doi.org/10.1002/dhe.30239

 

We are often asked whether students should receive accommodations on standardized patient or “practical” exams, sometimes referred to as OSCEs, or Objective Structured Clinical Examinations. Programs are often concerned about the reasonable nature of these requests and transferability of accommodations in the clinical setting. However, it is important to engage in the interactive process for all disability requests — including those with a clinical component.

 

Empowering medical students with disabilities: The student perspective (October 2016)

Kurt R. Herzer Ph.D., M.Sc.

https://doi.org/10.1002/dhe.30229

 

Medical school can be a stressful and high‐stakes experience. For medical students with disabilities, that experience may be even more stressful as students navigate the accommodations process, worry about possible discrimination if they disclose their disabilities, and fear being viewed as inferior compared to their peers. Disability services providers play a vital role in supporting students through the medical school experience.

 

Accommodations in the clinical setting: The what, who, where, how, and why (September 2016)

Jan Serrantino Ed.D.

https://doi.org/10.1002/dhe.30219

 

Determining accommodations in the clinical setting begins with advanced planning that includes collaboration, investigation, and creativity. During the early stages of any health science program, DS providers should anticipate and discuss the students' future needs in the clinical portion of the program. DS providers will need to think of who to involve and why, what accommodation or equipment is needed, when to disclose disability information, where students will intern, and how needs will be met. Finally, effective DS providers understand the overall requirements of health science programs, the core competencies and technical standards, and the culture and nuance of the clinic sites. Plus, they have established relationships with clerkship coordinators and directors.

 

Support students requesting accommodations on USMLE (August 2016)

Neera R. Jain, M.S., C.R.C.

https://doi.org/10.1002/dhe.30208

 

The United States Medical Licensing Exam is critical to the advancement of medical students. Passing the various Step exams is linked to students' ability to move forward in their training, while scores on Step 1 are often used as gatekeeping for competitive residency placements. Students with disabilities must make a comprehensive request for accommodations on these exams directly to the National Board of Medical Examiners. Given the already full schedules of medical students, this process can be daunting.

 

Support medical students with psychological disabilities (July 2016)

Joseph F. Murray M.D., Lisa M. Meeks Ph.D.

https://doi.org/10.1002/dhe.30198

 

Medical school is hard for everyone, but it is especially difficult for students with psychological disabilities. In a 2008 study, Lotte Dyrbye and colleagues found that burnout affects up to 50 percent of medical students and that 10 percent of students had experienced suicidal ideation within the past year. The suicide rate among medical students is higher than among the age‐matched population, as are rates of depression. The unique qualities of medical school — and the age of the average medical student — may result in worsening mental health and well‐being.

 

Understand technical standards in health science and medical education (June 2016)

Barbara Blacklock M.A., L.I.S.W., Timothy Montgomery M.A.

https://doi.org/10.1002/dhe.30188

 

Facilitating access for students enrolled in health science and medical education requires a more nuanced process. One key difference is the existence of specific skills that students must meet for admissions, progression and graduation.

 

Enhancing access in medical and health science programs: The college model (May 2016)

Barbara Blacklock M.A., L.I.S.W.

https://doi.org/10.1002/dhe.30178

 

Creating access for medical students and students in other graduate health science programs can be both challenging and stimulating. Campuses with health science programs are seeing an increase in the enrollment of qualified students with disabilities. It is important to proactively reach out to these programs to evaluate access and create collaborative relationships that can facilitate enhanced access instead of waiting and addressing individual accommodation needs as they emerge.

 

Helping faculty find the balance: Communicating with students with disabilities (April 2016)

Lisa M. Meeks Ph.D.,  Neera R. Jain M.S., C.R.C.

https://doi.org/10.1002/dhe.30167

 

Last month's Coalition Corner discussed possible consequences when students with disabilities lack effective communication skills, but what happens when the fault lies with faculty communication? To avoid situations that adversely affect students, communication around disability matters requires clarity and understanding of basic principles. Disability services providers can assist their faculty through training and written guidance. Here are our top four strategies for improving faculty and administrator communication.

 

Supporting health science students' communication skills: Avoiding pitfalls (March 2016)

Neera R. Jain M.S. C.R.C, Lisa M. Meeks, Ph.D.

https://doi.org/10.1002/dhe.30157

 

Communication is an area fraught with difficulty, particularly in the health science arena, where communication is central to patient safety and student progress. Indeed, the ability to communicate effectively is one of the mandatory curricular content areas for medical students as outlined by the Liaison Committee on Medical Education's 2016–17 accreditation standards, “7.8 Communication Skills: The faculty of a medical school ensure that the medical curriculum includes specific instruction in communication skills as they relate to communication with patients and their families, colleagues, and other health professionals.”

 

Disability decisions by committee: An increase in risk and decrease in student well‐being (February 2016)

Elisa Laird‐Metke J.D.

https://doi.org/10.1002/dhe.30148

 

When reviewing student accommodation requests, schools — particularly specialized graduate programs such as medical or other health science schools — sometimes rely on a committee consisting of faculty, deans, administrators, learning or disability specialists, and legal counsel. Committees are often used to ensure faculty are involved in the accommodations decision‐making, due to the specialized nature of the curriculum. However, there are numerous drawbacks to the use of a committee.

 

Transitioning from undergraduate studies to medical education: The top 5 things students with disabilities want (and need) to know (January 2015)

Katherine Fahey, & Joseph Murray, M.D.

https://doi.org/10.1002/dhe.30136

 

Transitioning from an undergraduate program to medical school can present challenges to students with disabilities. Whether you work with undergraduates preparing for medical school or with new medical students, sharing the following tips with them can help make the transition easier.

 

Support students with disabilities in medicine and health care programs (October 2015)

Lisa M. Meeks Ph.D., Joan Bisagno Ph.D., Neera Jain C.R.C., M.S., & Kurt Herzer M.Sc.

https://doi.org/10.1002/dhe.30103

 

According to the U.S. Department of Education National Center for Educational Statistics, the number of students with disabilities enrolled in undergraduate degree programs is growing — from 6 percent in 1995–96 to 11 percent in 2011–12. These figures are also increasing in professional and graduate degree programs. The 2010 DOE‐NCES data showed that 7.6 percent of students in such programs self‐reported a disability. Anecdotally, disability services providers understand that these numbers continue to grow. Qualified college graduates with disabilities, like many of their peers, are applying to graduate programs in the health sciences. Current research out of the University of California, San Francisco School of Medicine seeks to determine the prevalence of students with disabilities studying medicine in the United States. Preliminary data analysis suggests that between 1 and 12 percent of students currently enrolled in these programs identify as students with disabilities. Providers with disabilities remain an underrepresented minority in the health care workforce, with the numbers being disproportionate to the magnitude of disabled people in the U.S. population.

docs with disabilities, doctors with disabilities, medical science for people with disabilities, disabled doctors, disabled med students, students with disabilities, hsm coalition, listserv, books on students with disabilities, research help, medical student resources, lisa meeks

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