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                  <text>Disability Policies Among Medical Education Programs and Organizations</text>
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                <text>Technical Standards: Biases and a Movement for Reform</text>
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                <text>&lt;p&gt;Technical standards, itemized physical and mental capacities that medical schools require students meet, represent a particularly trenchant and slow-to-change manifestation of medical school disability exclusion—and discrimination.&lt;/p&gt;&#13;
&lt;p&gt;Medical schools nationwide produced and instituted technical standards after a 1979 recommendation by the Association of American Medical Colleges (AAMC) that programs outline a “universal skill set among applicants to ensure success in any specialty” (Joy, 2017, np). Idealization of the “undifferentiated physician”—capable of carrying out all medical tasks and diagnoses and of administering any treatment—might have made sense for country doctors isolated from any medical facilities but the codification of this ideal in technical standards poses an insurmountable and likely illegal barrier for many prospective medical students with disabilities. As medicine became increasingly specialized, the expectation of absolute and independent capacity did not diminish and many institutions’ technical standards have not been reworked to reflect changing realities of medical practice (ibid).&lt;/p&gt;&#13;
&lt;p&gt;A growing number of medical schools are changing their technical standards to use less disability-excluding language and to explicitly permit accommodations. For example, a technical standard might use terminology like “perceive” rather than “see.” The University of Michigan Medical School (Ann Arbor), a leader in disability inclusion, adjusted their technical standards in 2016, prompting an inquiry from the Association of American Medical Colleges (AAMC) asking whether they should promote similar revisions among other medical schools and requesting further information on the process (ibid). Many schools’ technical standards still exclude many people with disabilities—barring accommodations or requiring particular physically specific tasks like CPR. Current precedent from post-Americans with Disabilities Act court rulings holds that a program may only be deemed to be discriminating against disabled students (when it comes to accommodations that allow students to meet school requirements) if the accommodation does not involve “substantial changes to its curriculum [such as removing CPR or a similar task as a technical standard requirement] as a disability accommodation” (Laird-Metke, Elisa et al., 2016). (It remains unclear how—and if—a technical standard like CPR that requires particular physical abilities and thus likely excludes only disabled candidates comports with the ADA.)&lt;/p&gt;&#13;
&lt;p&gt;Changes are occurring now and more are visible on the horizon: Stanford is preparing to revamp its technical standards (after already doing so around 2017) while the University of Washington at St. Louis recently overhauled their technical standards as part of a larger curriculum review (Martin-Lockhart, 2022).&lt;/p&gt;&#13;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;</text>
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                <text>&lt;p&gt;Joy, K. (2017, October 10). &lt;em&gt;‘A Seat at the Table’: Why U-M’s Medical School Wants More Students with Disabilities&lt;/em&gt;. University of Michigan. https://labblog.uofmhealth.org/med-u/a-seat-at-table-why-u-ms-medical-school-wants-more-students-disabilities&lt;/p&gt;&#13;
&lt;p&gt;Laird-Metke, Elisa, Serrantino, J., &amp;amp; Culley, J. L. (2016). The Process for Determining Disability Accomodations. In L. Meeks &amp;amp; N. R. Jain (Eds.), &lt;em&gt;The guide to assisting students with disabilities: Equal access in health science and professional education&lt;/em&gt; (pp. 53-???????). Springer Publishing Company.&lt;/p&gt;&#13;
&lt;p&gt;Martin-Lockhart, Z. (2022). &lt;em&gt;Disabled Doctors Dissertation Fieldwork [manuscript in preparation]&lt;/em&gt;.&lt;/p&gt;</text>
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                  <text>Theory and History of Universal Design</text>
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                  <text>This collection includes various aspects of Universal Design theory as well as a brief historicization of Universal Design. It also addresses practices of Universal Design in healthcare environments (as established currently).</text>
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                <text>The 7 Principles of Universal Design</text>
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                <text>&lt;p&gt;&lt;span&gt;&lt;strong&gt;The 7 Principles of Universal Design:&lt;/strong&gt;&lt;/span&gt;&lt;/p&gt;
&lt;ol&gt;
&lt;li&gt;Equitable in Use&lt;/li&gt;
&lt;li&gt;Flexibility in Use&lt;/li&gt;
&lt;li&gt;Simple and Intuitive Use&lt;/li&gt;
&lt;li&gt;Perceptible Information&lt;/li&gt;
&lt;li&gt;Tolerance for Error&lt;/li&gt;
&lt;li&gt;Low Physical Effort&lt;/li&gt;
&lt;li&gt;Size and Space for Approach and Use&lt;/li&gt;
&lt;/ol&gt;
&lt;strong&gt;References:&lt;br /&gt;&lt;/strong&gt;&lt;br /&gt;Baida, L., &amp;amp; Ivanova, O. (2019).&lt;i&gt;Universal Design in Healthcare Manual&lt;/i&gt;. (M. Konova, Trans.).&lt;strong&gt;&lt;br /&gt;&lt;/strong&gt;</text>
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                  <text>This collection includes various aspects of Universal Design theory as well as a brief historicization of Universal Design. It also addresses practices of Universal Design in healthcare environments (as established currently).</text>
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                <text>&lt;p&gt;&lt;span&gt;&lt;strong&gt;The Benefits of Universal Design:&lt;/strong&gt;&lt;/span&gt;&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;Creates an inclusive society which acknowledges human diversity, ensures quality and social inclusion on equal terms, and promotes respects for the abilities of every person.&lt;/li&gt;
&lt;li&gt;Improves the quality of all people, leaving no one behind&lt;/li&gt;
&lt;li&gt;Reduces stigma and discrimination, providing more opportunities for vulnerable groups&lt;/li&gt;
&lt;li&gt;Promotes independence, mobility, and social inclusion&lt;/li&gt;
&lt;li&gt;Reduces the economic burden of special programs and services which aim to assist specific persons and groups&lt;/li&gt;
&lt;/ul&gt;
&lt;span&gt;&lt;br /&gt;&lt;strong&gt;References:&lt;/strong&gt;&lt;br /&gt;Baida, L., &amp;amp; Ivanova, O. (2019). &lt;/span&gt;&lt;i&gt;Universal Design in Healthcare Manual&lt;/i&gt;&lt;span&gt;. (M. Konova, Trans.).&lt;/span&gt;</text>
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                <text>A plethora of podcasts covering disability in medicine from many angles emerged since the late 2010s, corresponding with the increasing profile of disabled doctors and issues of inclusivity in medicine broadly.&lt;br /&gt;&lt;br /&gt;The &lt;em&gt;Docs With Disabilities&lt;/em&gt; podcast was created by Lisa Meeks and collaborators after success of a 2018 hashtag campaign, also started by Meeks, with the same moniker, #DocsWithDisabilities. Docs With Disabilities, launched in July 2019, features interviews with disabled healthcare professionals and students that focus on these individuals’ experiences in medicine – successes, failures, recommendations for other people with disabilities in the health sciences (Docs With Disabilities Podcast, 2019; Panzer et al., 2020) . Meeks and colleagues describe their podcast as “asynchronous mentoring” (Panzer et al., 2020).&lt;br /&gt;&lt;br /&gt;Other podcasts that concentrate on the intersection of disability, medicine, and health sciences include:&lt;br /&gt;&lt;br /&gt;• &lt;em&gt;Able Medics Podcast&lt;/em&gt;, hosted by Ioanna Maraki is a UK-based podcast similar to Docs with Disabilities and started at the same time in mid-2019 (Maraki, 2019).&lt;br /&gt;&lt;br /&gt;• &lt;em&gt;Disability Visibility&lt;/em&gt;, hosted by Alice Wong launched in 2017 (Wong, 2017).&lt;br /&gt;&lt;br /&gt;• &lt;em&gt;Included: The Disability Equity Podcast&lt;/em&gt;, hosted by Dr. Bonnielin Swenor and Dr. Nicholas Reed from Johns Hopkins University’s Disability Health Research Center started (Swenor &amp;amp; Reed, n.d.).&lt;br /&gt;&lt;br /&gt;• &lt;em&gt;Both Sides of the Stethoscope&lt;/em&gt; is hosted by Dr. Alin and Dr. Colby Salerno and began in 2021 (Gragossian &amp;amp; Salerno, n.d.).&lt;br /&gt;&lt;br /&gt;Collectively, these podcasts—which boast a varied, extensive listener-ship—serve to form disability community in medicine and educate those in the health sciences about the value and methods of disability inclusion (Martin-Lockhart, 2022; L. Meeks, personal communication, April 7, 2022). However, while these podcasts document improving inclusion of disability content in medical curricula and of disabled doctors, they also enumerate the biases and barriers that it is still common for students and physicians with disabilities to encounter.</text>
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                <text>&lt;p&gt;Gragossian, A., &amp;amp; Salerno, C. (n.d.). &lt;em&gt;Both Sides of the Stethoscope&lt;/em&gt;. Buzzsprout. Retrieved May 3, 2022, from https://www.buzzsprout.com/1801906&lt;/p&gt;&#13;
&lt;p&gt;Maraki, I. (2019, July 17). &lt;em&gt;Able medics podcast&lt;/em&gt;. General Medical Council. https://www.gmc-uk.org/education/standards-guidance-and-curricula/guidance/welcomed-and-valued/welcomed-and-valued-resources/able-medics-podcast&lt;/p&gt;&#13;
&lt;p&gt;Martin-Lockhart, Z. (2022). &lt;em&gt;Disabled Doctors Dissertation Fieldwork &lt;/em&gt;[manuscript in preparation].&lt;/p&gt;&#13;
&lt;p&gt;Meeks, L. (2022, April 7). &lt;em&gt;Personal communication&lt;/em&gt; [Personal communication].&lt;/p&gt;&#13;
&lt;p&gt;Panzer, K. V., Maraki, I., Cross, T., &amp;amp; Meeks, L. M. (2020). Podcast possibilities: Asynchronous mentoring for learners with disabilities. &lt;em&gt;Medical Education&lt;/em&gt;, &lt;em&gt;54&lt;/em&gt;(5), 448–449. https://doi.org/10.1111/medu.14084&lt;/p&gt;&#13;
&lt;p&gt;Swenor, B., &amp;amp; Reed, N. (n.d.). &lt;em&gt;Included: The Disability Equity Podcast&lt;/em&gt;. The Johns Hopkins Disability Health Research Center. Retrieved May 3, 2022, from https://disabilityhealth.jhu.edu/included/&lt;/p&gt;&#13;
&lt;p&gt;Wong, A. (2017, September 13). &lt;em&gt;Ep 1: Activism and the Disability Community&lt;/em&gt;. Disability Visibility Project. https://disabilityvisibilityproject.com/2017/09/13/disability-visibility-podcast-ep-1-activism-and-the-disability-community/&lt;/p&gt;</text>
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                  <text>Television, being present in almost every home across the globe has immense potential to impact the way ideas are shared in the public imagination and how due to positive or negative representations, it can shape how the layman thinks about individuals having certain identities and the same goes for disabled doctors. Representations of doctors with disabilities on the small screen have been sparse and unidimensional and even though progress has been made, there is still a long way to do.&amp;nbsp;</text>
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                <text>The first Disabled doctor on TV? Dr. Kerry Weaver on &lt;em&gt;ER&lt;/em&gt;</text>
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                <text>&lt;p&gt;Debuting on the medical drama “ER” in its second season in 1995, Dr Kerry Weaver was one of the first representations of disabled doctors on primetime television. Having a limp in her gait and using a forearm crutch, the character was played by a non disabled actor. Infact, an actress who does have a disability, Christopher Templeton, was denied an audition for the part. (Parsi, 2001) According to archives, the actor Laura Innes was involved in the decision to use a crutch as a prop for the role.&lt;/p&gt;&#13;
&lt;p&gt;&lt;strong&gt;Chet Cooper: When you read for the role of Dr. Kerry Weaver on ER, did you know going in that you would play a person with a disability?&lt;/strong&gt;&lt;/p&gt;&#13;
&lt;p&gt;&lt;strong&gt;Innes: Yes, when I read for the part, the character was described as having a limp and using a cane. She was written with that intention. I never asked John Wells—the show’s executive producer—but I heard it through the grapevine that when he was observing hospitals, he saw a doctor who had a cane and he thought, “Oh, that’s kind of interesting.”&lt;/strong&gt;&lt;/p&gt;&#13;
&lt;p&gt;&lt;strong&gt;Johnson: You knew Weaver had a limp, but did they tell you the back story?&lt;/strong&gt;&lt;/p&gt;&#13;
&lt;p&gt;&lt;strong&gt;Innes: No. When I asked, “Well, what’s her malady or injury?” they said, “We haven’t decided yet.” They wanted to keep it open, and not have it be something that was an issue. We discussed what kind of crutch or cane I should use, and I actually suggested the cuff crutch, because I thought with all the moving around and concerns with cleanliness, that a doctor wouldn’t always want to be grabbing onto a cane or setting it down. With a cuff crutch, it could always be on my arm, and if I was at a trauma table I could have it for support and still use my hands. So that’s how that choice was made. When I got the part and the character was described as having a limp, I didn’t really think about it in terms of the impact as a disability.&lt;/strong&gt;&lt;/p&gt;&#13;
&lt;p&gt;(Innes, 2008)&lt;/p&gt;&#13;
&lt;p&gt;Eventually, in Season 11, we learned that Weaver's limp was caused by congenital hip dysplasia, and in the following season, she had corrective surgery that allowed her to walk without use of the crutch. Ironically, the surgery was, at least in part, driven by Innes' real life health issues caused by using a cane for so many years on the series. As a result we see that disability was both used and eliminated casually.&lt;/p&gt;</text>
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                <text>Innes, L. (2008). Laura Innes - From Acting to Calling Action! (P. Johnson, &amp;amp; C. Cooper, Interviewers) Parsi, K. (2001, December ).&lt;br /&gt;&lt;br /&gt;Doctors in Balck and White on the Big and Small Screens . From AMA Journal of Ethics : https://journalofethics.ama-assn.org/article/doctors-black-and-white-big-and-small-screens/2001-12</text>
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                <text>&lt;p&gt;The Good Doctor, first aired in 2017 and created by David Shore who interestingly also produced House M.D. follows a surgeon Dr Shaun Murphy who has autism and savant syndrome as he juggles his duties as a doctor and his personal life. &lt;br /&gt;Though a great step forward in disability representation in the field of medicine, especially when compared to previous examples, The Good Doctor still has a long way to go. For example, when autistic adults reviewed the show, David Moloney, Autism Ontario Board Member and Mutual Fund Indexer with CIBC said “All in all, I find that it plays the autism card a little too heavily.” He found the show’s lead actor and writers tried to show autism as a “broad concept or a construct.” He thought this was too general an approach and much was lost this way. “It doesn’t really portray the positivity exuded by people on the spectrum.” (Cnudde, 2021) According to some reviewers, the show does a good job of representing all people who are marginalized (Nguyen, 2017) generalizing the context to other “outsiders” based on race, gender or sexuality, others are of the opinion that the show is too sentimental, using the age old trope of inspiration porn and The doctor who's good at medicine but bad with people is a trope making that doctor a person with autism verging on gimmickry. (Lawler, 2017)&lt;/p&gt;</text>
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                <text>Cnudde, M. (2021, April 19). Autistic Adults Review The Good Doctor. From Austism Ontario: https://www.autismontario.com/news/autistic-adults-review-good-doctor&lt;br /&gt;&#13;
&lt;p&gt;Lawler, K. (2017, September 22). &lt;em&gt;Review: ‘The Good Doctor’ is a too-sentimental portrait of doctor with autism&lt;/em&gt;. From USA Today: https://www.usatoday.com/story/life/tv/2017/09/22/review-the-good-doctor-too-sentimental-portrait-doctor-with-autism/688744001/&lt;br /&gt;&lt;br /&gt;&lt;/p&gt;&#13;
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                <text>The inspirational doctor paralyzed from the waist who can still perform surgeries thanks to remarkable stand-up wheelchair. (2013, November 27). &lt;em&gt;Daily Mail&lt;/em&gt;. https://www.dailymail.co.uk/news/article-2513994/Paralyzed-doctor-performs-surgery-thanks-stand-wheelchair.html</text>
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                <text>This 2013 &lt;em&gt;Daily Mail&lt;/em&gt; report on Dr. Ted Rummel, who is paralyzed, offers an example of the merging of person and technology in media depictions of disabled medical professionals. While acknowledging Rummel's personal determination, the article explicitly focuses on the role of wheelchair technology in enabling his return to surgery after becoming paralyzed. Rummel is depicted as inseparable from his chair in a manner that exposes how technology makes disability situational. The absence or availability of his wheelchair has the power to create or remove exclusion, marginalization, or disenfranchisement.</text>
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                <text>&lt;p&gt;Finkelmeyer, T. (2010, June 2). Tim Cordes one of few sightless doctors in U.S. &lt;em&gt;The Capital Times&lt;/em&gt;. &lt;a href="https://captimes.com/news/local/health_med_fit/tim-cordes-one-of-few-sightless-doctors-in-u-s/article_b968b027-0789-52f3-81a0-5cbcaf69c719.html"&gt;https://captimes.com/news/local/health_med_fit/tim-cordes-one-of-few-sightless-doctors-in-u-s/article_b968b027-0789-52f3-81a0-5cbcaf69c719.html&lt;/a&gt;&lt;/p&gt;</text>
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                <text>This feature on Dr. Tim Cordes, who is blind, published in 2010 by Madison, Wisconsin, newspaper &lt;em&gt;The Capital Times&lt;/em&gt;, describes how assistive technology enables Cordes to satisfy his productive role as a psychiatrist. By focusing exclusively on professional applications of technology, the article reinforces accepted cultural assumptions that equate physical and economic autonomy with social inclusion. The story briefly mentions Cordes' contribution to the development of software that uses varying musical tones to explain protein structures, but does so primarily to highlight his work ethic and tireless determination to overcome barriers related to his visual impairment. Defining this technology based on the intended purpose of assisting individuals with visual impairments creates a barrier that restricts consideration of its possible contributions to medical practice in general.</text>
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&lt;p&gt;&lt;span&gt;&lt;strong&gt;Universal Design in Environment and Facilities:&lt;/strong&gt; &lt;/span&gt;&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;Ensure an accessible public transport stop is built according to the standard and is not far away from the facility&lt;/li&gt;
&lt;li&gt;Provide parking spaces, including accessible parking spots for persons with Disabilities marked with the International Symbol of Access&lt;/li&gt;
&lt;li&gt;Install bicycle parking racks&lt;/li&gt;
&lt;li&gt;Hang a signboard with name of facility&lt;/li&gt;
&lt;li&gt;Provide clear and understandable direction signs near the building&lt;/li&gt;
&lt;li&gt;Provide appropriate width and even surfaces for pedestrian paths&lt;/li&gt;
&lt;li&gt;Ensure tree branches and bushes are not an obstruction or potential hazard&lt;/li&gt;
&lt;li&gt;Provide rest benches&lt;/li&gt;
&lt;/ul&gt;
&lt;/div&gt;
&lt;div class="exhibit-block layout-text"&gt;
&lt;p&gt;&lt;strong&gt;References:&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;Baida, L., &amp;amp; Ivanova, O. (2019).&lt;span&gt; &lt;/span&gt;&lt;i&gt;Universal Design in Healthcare Manual&lt;/i&gt;. (M. Konova, Trans.).&lt;/p&gt;
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