Toward a Disability Affirming Model of Medicine in the United States and Beyond.

Abstract

Despite increased attention and advocacy around disability in academia, both health professions trainees and Disabled people seeking healthcare in the US continue to report shortcomings in the providers' preparedness to care effectively for Disabled patients. Some of these shortcomings have historical roots in flawed theories of disability and ableism, but even with advancements in Disability Studies and the adoption of the biopsychosocial model of disability, trainees continue to receive insufficient exposure to disability theory and Disabled people. When graduates become independent providers and clinical directors, their educational shortcomings persist, and Disabled patients pay the price in the form of universally worse healthcare outcomes. We focus this article on the need for improved training; in part, we offer a student response to the health equity policy recommendation from the National Council on Disability to require "…comprehensive disability clinical-care curricula in all US medical, nursing and other healthcare professional schools," a platform also reflected in the American Medical Association's Organizational Strategic Plan to Advance Health Equity. A group of medical students and educators at a large health institution in Philadelphia, PA, formed a working group inspired by an institutional review process around disability in their medical curriculum. Alongside a Disabled advocate and licensed clinical social worker (LCSW) in the same community, students imagined steps they would take to pursue a Disability Affirming Model of Medicine. We begin this article by reflecting on the progress made in academic and clinical medicine on the national level and at our institution, examining persistent failures in disability curricula in undergraduate medical education and discussing elements of wisdom gleaned from allied fields like social work. Our LCSW coauthor reflects on his experiences as a Disabled provider and as an educator within a medical field that remains largely inaccessible. Student coauthors consider their meaningful experiences with disability in educational and personal spheres, focusing on how learning from Disabled people like their coauthor has shaped their approach to disability in healthcare. Reflecting on these lessons and drawing on wisdom from their experience with curricular reform around Disability Studies, students conclude with recommendations for pedagogical redesign to facilitate comfort and proficiency in trainees' delivery of care to Disabled patients. We hope to galvanize efforts toward building a Disability Affirming Model of Medicine by calling upon peer advocates at every level of medical education, at home in the US and internationally.