Abstract
In March of 2020, the rapid onset of the COVID‐19 pandemic halted the gears of undergraduate medical education programs in the U.S. and in many locations across the globe. Disruptions to usual practice provided the impetus for educators to creatively re‐envision medical education with approaches that shared a common feature: flexibility. Out of the chaos of the pandemic rose a collective willingness to think creatively and adapt (see https://bit.ly/3x91Y8H). Although this type of creativity had been used prior to the pandemic to develop accommodations for individual students with disabilities, these changes occurred on a larger scale and increased flexibility for entire cohorts and programs.
Here we share examples of large‐scale, pandemic‐related changes at our institutions that illustrate increased flexibility with lectures, clinical experiences, and assessment; we also share a new video on the topic we created as part of the Access In Medicine working group (see https://bit.ly/3wOOLSd). We encourage medical educators to reflect on changes that were made at their institutions during the pandemic and consider what lessons may be applied in the future to realize the mission of greater accessibility for all students.
Lectures
In the wake of social distancing and insufficient PPE, students were forced out of traditional classrooms and into virtual instructional settings, where video conferencing platforms (e.g., Zoom, WebEx) became the new norm. This shift resulted in numerous benefits, including a reduction in commute time (which students could instead devote to sleep, exercise, or other self‐care), greater ability to regulate the learning environment (to increase comfort, adjust temperature, and create reduced distraction space), and more accessible content (increased access to real‐time captioning, and more asynchronous content).
This shift to a remote format during the pandemic raised several critical questions for medical educators, like:
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What content is truly essential in this course?
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Must the delivery of content be in person?
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How might the learning goals of this course be achieved in an alternative delivery format?
These questions have been fundamental to determining disability‐related accommodations. Therefore, flexible remote format options that became widely used during the pandemic may be retained to optimize learning for groups of students. For example, during one Interprofessional Education session at the Carle Illinois College of Medicine, faculty found it more conducive to bring together students from multiple locations using breakout rooms on a virtual platform. There have been conversations about continuing to hold this session remotely post‐pandemic given that a virtual format was more conducive to meeting session goals.
Clinical experiences
While some content was relatively easy to translate into a remote format, clinical education required even more flexible and creative thinking during the pandemic. Remote rounding was already a potential accommodation for medical students with chronic health or physical disabilities. Given its multiple benefits, including reduced mobility barriers and the ability to scale bedside learning to larger groups with greater efficiency, remote rounding was made more broadly available to students during the pandemic. In addition to expanding access to clinical learning, remote rounding provided valuable telehealth experiences, an increasingly common mechanism for patient care (see https://bit.ly/3uLod1o).
Additional strategies for remote clinical learning included virtual small groups, which facilitated opportunities for peer‐to‐peer support and greater individualized attention. Some schools also shortened clerkships and added novel supplementary education, such as virtual case modules (see https://bit.ly/3iTY7DO). These changes to clinical instruction during the pandemic exemplify changes that can be sustained to enable students with disabilities to maintain their course of education and achieve clinical competencies.
Assessment
Prior to the pandemic, remote testing was uncommon, partially due to concerns related to the cost of implementation, academic integrity, and the National Board of Medical Examiners’ use of in‐person proctoring. During the pandemic, however, the NBME approved remote proctoring for all students and thus removed significant barriers to student assessment (see https://bit.ly/3iTYq1q).
Although extended testing time and reduced distraction testing environments are among the most frequently utilized accommodations for students with disabilities, these accommodations also introduce additional challenges to coordinate. For example, administrators must marshal resources such as testing space and proctors. When extended exam time is coupled with additional commute time, students with accommodations are often forced to miss educational activities. Remote assessment options paired with consideration for student accommodations in the academic/clinical schedule may be a solution to these co‐existing challenges and may improve student confidentiality. The shift to remote assessment gave students more control over their environment, similar to the aforementioned benefits of remote lectures, thereby enhancing the experience and reducing the anxiety often heightened by traditional testing settings.
Conclusion
When assessing equity, it is critical for medical educators to address all barriers, beyond those for disabled learners. While positive opportunities arose from these changes to instruction and assessment, pandemic‐related solutions highlighted other inequities, including disparate access to high‐quality internet and variable home environments. These experiences emphasize that optimal conditions for learning remain items of privilege. We propose that institutions consider intersectionality in equity practices, considering multiple and intersecting axes of privilege and marginalization created by current conditions. Retaining practices such as the on‐campus provision of ample quiet study/testing spaces, access to technology, and internet exemplify additional routes toward ensuring access for all learners.
Medical education touts a commitment to diversity (see https://bit.ly/3iTZHFK), yet we often fail to fully demonstrate this commitment to learners with disabilities. Although many yearn for a post‐pandemic return to “normal,” the pandemic has highlighted that normal isn't always best. To realize a more inclusive learning environment, we propose that educators should identify and retain beneficial shifts borne of the pandemic, including flexible curriculum and assessment delivery. As we collectively return to normal, we encourage medical educators to heed lessons from the pandemic and instead create a new normal that realizes the goal of developing universally accessible structures for all students, including students with disabilities.
ABOUT THIS COLUMN.
Disability Compliance for Higher Education has partnered with The Coalition for Disability Access in Health Science and Medical Education to bring the readers a quarterly column.
A guest writer from the Coalition brings tested and sage advice to the readers from some of the most experienced disability services providers in the country.
Learn more at https://www.hsmcoalition.org/ and on Twitter: @hsmcoalition.
ABOUT THE AUTHORS.
Robert C. Wallon, Ph.D., is Associate Director of Academic Skills Support and Teaching Assistant Professor, Carle Illinois College of Medicine, Department of Biomedical and Translational Sciences.
Jennifer Gossett, M.S., is Director of the Office for Student Access at the Oregon Health & Science University.
Lisa M. Meeks, Ph.D., is an Assistant Professor of Family Medicine at the University of Michigan.