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      Disability and Ableism in Medicine: A Curriculum for Medical Students

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          Abstract

          Introduction

          Individuals with disabilities (approximately 20% of the population) experience discrimination and health disparities. Medical school must equip students with expertise to care for patients with disabilities and to identify ableism. Yet, few schools provide curricula that offer a sociopolitical lens for understanding this topic. We developed a disability and ableism curriculum to address this gap.

          Methods

          We developed a mandatory 2-hour session for first-year medical students at University of California San Francisco. Activities included: privilege awareness, student-led discussions, and intervention brainstorming for overcoming health care barriers/biases. The session was evaluated through pre/postsurveys, as well as a follow-up survey 1 year later.

          Results

          In feedback collected during 2018 and 2019, students described the session as meaningful and relevant. Faculty facilitators reported that the session provoked powerful student-centered learning, leadership, and widespread participation. On average the students rated the session 4.6 on a 5-point scale. Pre- and postsession data analysis indicated significant increases in students' self-reported understanding of ableism ( p < .001) and confidence in assessing barriers to care for patients with disability ( p < .001). One year later, students reported that the session had influenced their conceptualization of providing care to patients with disabilities.

          Discussion

          Through innovative and participatory activities, this small-group session introduced students to important topics such as ableism, the social model of disability, disability history and culture, and health disparities. Our work suggested that creating curricula to equip students with structural frameworks for understanding disability—a topic underrepresented in medical curricula—stimulated student interest and commitment.

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          Most cited references22

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          The problem with the phrase women and minorities: intersectionality-an important theoretical framework for public health.

          Intersectionality is a theoretical framework that posits that multiple social categories (e.g., race, ethnicity, gender, sexual orientation, socioeconomic status) intersect at the micro level of individual experience to reflect multiple interlocking systems of privilege and oppression at the macro, social-structural level (e.g., racism, sexism, heterosexism). Public health's commitment to social justice makes it a natural fit with intersectionality's focus on multiple historically oppressed populations. Yet despite a plethora of research focused on these populations, public health studies that reflect intersectionality in their theoretical frameworks, designs, analyses, or interpretations are rare. Accordingly, I describe the history and central tenets of intersectionality, address some theoretical and methodological challenges, and highlight the benefits of intersectionality for public health theory, research, and policy.
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            Structural competency: Theorizing a new medical engagement with stigma and inequality

            This paper describes a shift in medical education away from pedagogic approaches to stigma and inequalities that emphasize cross-cultural understandings of individual patients, toward attention to forces that influence health outcomes at levels above individual interactions. It reviews existing structural approaches to stigma and health inequalities developed outside of medicine, and proposes changes to U.S. medical education that will infuse clinical training with a structural focus. The approach, termed “structural competency,” consists of training in five core competencies: 1) recognizing the structures that shape clinical interactions; 2) developing an extra-clinical language of structure; 3) rearticulating “cultural” formulations in structural terms; 4) observing and imagining structural interventions; and 5) developing structural humility. Examples are provided of structural health scholarship that should be adopted into medical didactic curricula, and of structural interventions that can provide participant-observation opportunities for clinical trainees. The paper ultimately argues that increasing recognition of the ways in which social and economic forces produce symptoms or methylate genes then needs to be better coupled with medical models for structural change.
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              Eliminating health and health care disparities among the growing population of people with disabilities.

              Fifty-four million people in the United States are now living with disabilities. That number will grow substantially in the next thirty years, as the "baby-boom" generation ages and many of today's children and young adults mature and experience complications related to overweight and obesity. This reality poses a major challenge to the health care and policy communities. People with disabilities confront disadvantages from social and environmental determinants of health, including lower educational levels, lower incomes, and higher unemployment, than people without disabilities. Those with disabilities are also much more likely to report being in fair or poor health; to use tobacco; to forgo physical activity; and to be overweight or obese. People with disabilities also experience health care disparities, such as lower rates of screening and more difficulty accessing services, compared to people without disabilities. Eliminating these multifaceted disadvantages among people with disabilities should be a critical national priority.
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                Author and article information

                Journal
                MedEdPORTAL
                MedEdPORTAL
                mep
                MedEdPORTAL : the Journal of Teaching and Learning Resources
                Association of American Medical Colleges
                2374-8265
                2021
                25 January 2021
                : 17
                : 11073
                Affiliations
                [1 ] Fourth-Year Medical Student, University of California, San Francisco School of Medicine
                [2 ] Assistant Professor, Department of Medicine, University of California, San Francisco School of Medicine; Associate Chief, Division of Hospital Medicine, San Francisco Veterans Affairs Medical Center
                Author notes
                Corresponding author: hannah.borowsky@ 123456ucsf.edu
                Article
                11073
                10.15766/mep_2374-8265.11073
                7830755
                33511270
                60883df7-149e-4de8-8aa5-c8f96485acd1
                © 2021 Borowsky et al.

                This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial license.

                History
                : 15 April 2020
                : 29 September 2020
                Page count
                Tables: 3, References: 23, Pages: 8
                Categories
                Original Publication

                diversity and inclusion,health equity,health policy/health care reform,reflection/narrative medicine,flipped classroom,problem-based learning,disability,health care disparities,prejudice,ableism,privilege,bias,intersectionality

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