Change in Prevalence of Disabilities and Accommodation Practices Among US Medical Schools, 2016 vs 2019

Abstract

This survey study assesses the prevalence of students with disabilities and types of accomodation provided at US allopathic medical schools in 2019, and compares the numbers with those of a 2016 survey to characterize 3-year changes.

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.

Methods

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.

Table 1. Reported Disabilities, Overall and by Category, 2016 (Benchmark) vs 2019^a.

Category as Identified in Survey	No. (%) of Students With Disabilityb		Absolute Difference, % (95% CI)c	Relative Difference, %d
	2016	2019
Overall disabilities	1142 (2.7)	2028 (4.6)	1.9 (1.8 to 2.3)	69
Attention-deficit/hyperactivity disorder	369 (32.3)	617 (30.4)	−1.9 (−5.3 to 1.6)	−5.9
Learning disability	245 (21.4)	371 (18.3)	−3.1 (−6.1 to −0.2)	−14.5
Psychological disabilitye	233 (20.4)	655 (32.3)	11.9 (8.7 to 15.1)	58.3
Chronic health disabilities	152 (13.3)	365 (18.0)	4.7 (2.0 to 7.3)	35.3
Mobility disability	38 (3.3)	74 (3.6)	0.3 (−1.1 to 1.7)	9.1
Visual disabilities	34 (3.0)	46 (2.3)	−0.7 (−2.0 to 0.5)	−23.3
Deaf or hard of hearing	20 (1.8)	25 (1.2)	−0.6 (−1.5 to 0.4)	−33.3
Other functional impairment	51 (4.5)	49 (2.4)	−2.0 (−3.5 to −0.6)	−47

^aData are reported for 64 schools that responded in both years and reported complete data for disability type. Total enrollment in these schools was 39 286 students in 2016 and 41 019 in 2018.

^bPercent values may sum to more than 100% due to several schools reporting more than 1 disability among students.

^cCalculated as the difference in percent of students with disability in each category; 2019 minus 2016 values. The associated P value is less than .05 for the learning disability category, less than .01 for other functional impairment, and less than .001 for psychological disability and chronic health disabilities.

^dCalculated as the percent change between the 2 years; 2019 values divided by 2016 values minus 1.

^ePsychological disabilities included adjustment disorder, anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, bipolar disorder, depression, eating disorder, cognitive disorder, schizophrenia or other psychotic disorder, and other psychological disability.

Table 2. Accommodations Provided Within Medical Schools, 2019^a.

	No. (%) of Schoolsb
Didactic accommodation
Testingc	84 (100.0)
Facilitated learningd	65 (77.4)
Ergonomice	30 (35.7)
Programmatic accommodationf	19 (22.9)
Housingg	25 (30.9)
Clinical accommodation
Testingh	63 (75.0)
General clinicali	57 (68.7)
Modified clinical procedurej	31 (36.9)
Hearing relatedk	8 (9.5)
Other	23 (27.7)

^aData are reported for 84 schools (88.7%) from which an institutionally designated disability professional reported complete accommodation data.

^bValues do not sum to 100% because each school provides several different types of accommodation.

^cExtra time given to complete examinations, use of low distraction or private environments, and testing breaks.

^dFlexible attendance, note takers, Live Scribe Pen, recorded lectures, textbooks in alternate formats, and text-to-speech and speech-to-text computer programs.

^eErgonomic evaluation and equipment.

^fException from program structure, such as decelerated curriculum.

^gLiving accommodations, such as single-room housing, release from housing, assistance or service animal, and reserved parking.

^hExtra examination time within clinic or an examination given in a reduced-distraction environment.

ⁱClinical placement, decelerated clinical year, release from clinic to attend appointments, and release from overnight call.

^jIncludes assistive technology, use of a scribe, ability to perform procedural skill or clinical competency in simulation laboratory, and intermediary or assistant to facilitate patient examination.

^kUse of transcriptionist, Communication Access Real-time Translation (CART), sign language interpreter, specialized phone, and specialized pager.

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.

Results

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 (2.7%) in 2016 to 2028 (4.6%) 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%]).

Discussion

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.^4,5,6 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.

Section Editor: Jody W. Zylke, MD, Deputy Editor.