Toni Gallo: Welcome to the Academic Medicine Podcast. I'm Toni Gallo. Today, I'm joined by the authors of two articles that look at accessibility and inclusion in medical education. Drs. Theresa Papich and Lisa Meeks are the authors of "Informed Inclusion Model: Medical Student Wheelchair User in an Obstetrics and Gynecology Clerkship." And Dr. Tim Gilbert is the author of "The Inequitable Experiences of Left-Handed Medical Students in Surgical Education."
Both of these articles are available to read for free now on academicmedicine.org as part of the August issue, and the links to those are in the notes for today's episode. In our conversation, we'll get into both of these articles and the authors' recommendations for fostering an inclusive and accessible learning environment, including partnering with learners, addressing the hidden curriculum, attending to faculty development, and thinking about a universal design for learning approach. With that, I'm going to ask everyone to introduce themselves for our listeners. Theresa, could you get us started?
Theresa Papich: My name is Theresa Papich. I'm a first-year internal medicine resident at Thomas Jefferson University. Toni Gallo: Thank you. Lisa? Lisa Meeks: My name is Lisa Meeks, and I'm an associate professor of learning health sciences and family medicine at the University of Michigan. Toni Gallo: Wonderful. Tim? Timothy Gilbert: My name is Tim Gilbert, and I am a general surgery resident at the Wayne State University Detroit Medical Center. Toni Gallo:
Well, thank you all for being on the podcast today. I'm looking forward to our conversation. Theresa, I want to start with you. Could you just give us an overview of your paper and what really led to you and your coauthors writing up this case study? Theresa Papich:
Sure. So this paper describes my experience as a wheelchair user in the obstetrics and gynecology clerkship during my third year of medical school at Case Western. And it describes sort of a before, during, and after of the experience from kind of the planning that went into creating access for me, as well as a reflection on what my experience was like during the clerkship and kind of suggestions for improvement in the future, and also reflections on what went really well for me.
And it offers different perspectives, myself as the student as well as the clerkship leadership and my disability services counselor who was involved in the process. And it also provides some tools that can help other programs apply this accommodations process to their own clerkships, tools including a timeline and a conversation guide that can help other programs implement what we did.
And the motivations for writing this paper were to dispel some myths around students with disabilities, especially wheelchair users, in procedural and surgical specialties, and show that they actually can be very successful in those learning environments, often with fewer accommodations than are assumed, and also to help other programs open doors for students similar to myself. Toni Gallo:
Thanks. And I think we're going to get into more conversation around some of those themes that you just mentioned a little later. But Lisa, I want to turn to you now. You also, in your paper, share recommendations based on this process that you all went through. What were some of the highlights there that you think listeners would be interested in knowing about? Lisa Meeks:
Thanks, Toni. I think for me, thinking about this from a policy and changing practice perspective, the overall takeaway that I hope programs have is that, wow, this was so much easier than they might have imagined, right. As Theresa so elegantly pointed out, this idea of dispelling the myth that an individual that's a wheelchair user is going to result in this arduous time kind of sucking and costly process to include.
And so, for me, I think the biggest takeaway is that this often involves no additional cost. But it does require this thoughtful planning, respectful scenario where the learner is centered in the conversation. And I also hope that people reading this article or listening to the podcast capture a little bit of the enthusiasm that the leaders at the Cleveland Clinic had.
This was through Case Western Reserve University and the Cleveland Clinic Lerner College of Medicine, and the program director at the graduate level and the clerkship director at the undergraduate level were exceptionally enthusiastic. They embraced this opportunity. They really wanted to learn, and I think at the end of the day, everyone in this process had a lot to learn and a lot to share. Toni Gallo:
Well, I'm very grateful that you all wrote up about your experiences and are here talking with us today about them. Tim, why don't we turn to you? Can you tell us a little bit about your study and kind of what inspired you and your team to take it on? Timothy Gilbert:
Yeah, absolutely. The original thought to walk down this path and do this work came from one of the other authors on the paper, Maia Anderson, who is a chief resident at Michigan who's going to go into transplant surgery starting soon, and she operates left-handed, and she was a left-handed student, et cetera.
And even back when she was a medical student, started encountering a lot of the barriers that we ran into, and then progressing into residency basically felt like those things persisted but also changed somewhat as she became more senior.
And then, in conjunction with different faculty, some whom are right-handed, others who are left-handed, basically wanted to fix something within it. And in order to do that, wanted to just characterize a lot of the pain points that were felt across the spectrum of trainees to hopefully better think about the issue, raise awareness of the issue, and then meet out those pain points [inaudible 00:06:10] if possible. Toni Gallo:
You all did a qualitative study and talked to left-handed learners at different points in their training. What were some of the themes or recommendations that came out of their comments that you all explain in your paper? Timothy Gilbert:
Yeah. So we interviewed all sorts of people and took a certain perspective for medical students versus residents, which I think changed, again, as I mentioned, depending on what slice of the pie you look at relative to training level. For medical students, it to me broke apart into three buckets that we articulated the paper through. One being the disorienting advice that faculty and residents would give them, specifically the way that they oftentimes contradicted one another. So day one, you're in an OR, and someone says, "You need to operate with your left hand." And then they go back day two, and they're operating with their left hand, and someone goes, "What? Operate with your right hand." And these things are oftentimes said definitively as dogma rather than opinion or perspective and probably lacked a little bit of the humility from the person giving the advice, which leaves the student kind of in limbo who's right and "Where do I go?"
And the second theme kind of was a little bit cultural in terms of the pressures that someone might say to operate right-handed of which if someone told you, "Operate with your right hand," there's a lot of different reasons why someone could tell you that, which may or may not change how you perceive the validity of that advice.
And then there's a lot of left-handed stigmatization, particularly when you're junior, and you don't really feel like you have any power to wield in that environment. You're kind of a transient on the clerkship as opposed to a permanent fixture. You don't know people as well. You might not be able to ask for things or certainly feel as comfortable asking for things.
And the last piece that we talk about was kind of envision a more positive experience and what would be your wishes to have that come to pass. What are the things that you either wish you had or that you... were you sitting on a board mediating change in this environment, what would you want to see? And in that, there's actually a lot of disagreement because some people take a top-down approach and they want formal education through national bodies, other people want to just kind of raise awareness at the faculty level, other people go in providing different instruments, et cetera, and I think probably to varying degrees all are accurate, which is one of the challenges.
Toni Gallo: Let's talk a little bit about centering learners and partnering with them in thinking about accommodations and inclusion in the learning environment. This was a theme that crossed both papers, and I wonder if you all can talk about what that looked like, maybe in your own experience, how has that come up in your education or practice? Making sure that the learners are really at the center of designing systems that will work. Theresa Papich:
Yeah, I can speak to my experience related to our paper. So the accommodations process for this OB/GYN clerkship, but also for all my medical school experiences, there's different players involved, like the medical school, like that leadership, they're experts obviously in medical education and what's required to train medical students. Any student with a disability, like myself as a wheelchair user, only that student is really the expert in their own strengths or areas of need.
And so part of creating a truly inclusive process and opportunity for the student has to be centered around the autonomy of the student and respecting their own lived experiences and trusting their understanding of themselves, and listening to that when creating these accommodations, and without listening to that perspective, that could lead to a lot of over or under accommodating. Assumptions could be made about what the student can't do that leads to a lot of I would say at best unnecessary allocation of resources but could also lead to exclusion of the student from experiences that they could have really benefited from in their medical training.
For example, something that people often assume is like, "Oh, she'll probably have trouble getting around the hospital in her wheelchair." But my power wheelchair actually moves much more quickly than any walking person would, and so having to cross a large hospital is really not an issue for me. So I wouldn't want to be put on a service to keep me in a certain geographical area if that could change my learning opportunities. So having that open dialogue allows the student to have a better understanding of what will be expected of them, but also make sure that their autonomy and what their needs truly are, make sure those things are listened to.
Lisa Meeks:
Building on what Theresa's saying, I think it's important to note that, at least for disability-related accommodations, the interactive process or kind of centering the learner is the cornerstone of providing effective accommodations. We don't know Theresa's prior experience or how she navigates her world in other ways, so we can take some of those things that she's done already and translate it into the clinical environment. But you can't do this work effectively without centering the learner and having a conversation with the learner. And it's important to have that open communication and that collaboration and ongoing assessment.
What Theresa needed in week one may have changed over time and certainly changes across different types of specialties. But for those with disabilities, this interactive process or centering the learner and getting the learner input is also adhering to the laws that govern disability inclusion. So it's important to note that not only is it important--nothing about us without us and leaning into that principle of centering the learner and letting them be the expert in the space--but it also adheres to the legal framework of the ADA Section 504. So those are really key things that we need to remember when thinking about why it's critical to involve the learner, at least from the disability angle.
Timothy Gilbert:
Yeah, I totally agree with literally everything that was just said. It's kind of interesting because, in medical education, we talk so much about partnering with a patient. Basically, clinical people that are in a hospital that would intersect with someone who's a wheelchair user or theoretically be training a left-handed surgeon or medical student, they kind of subscribe to this philosophy where we recognize that we don't treat the same disease process the same based on the person. I think that applies universally, and I would lump this into that same kind of framework.
I mentioned it before when I spoke earlier about why you need to understand what a person feels and wants and needs foundationally because, fundamentally, they're just different people, and because of that, they want different things. The most specific example I could give for left-handed people and why I think these two studies are highly overlapping would be if someone says you should operate right-handed, sometimes if you really dig down to it, there's this impression that that's because it's easier for the teacher. They know how to teach someone right-handed. And so, that may not be the best thing for the student, but at least it's functional, and it kind of gets them by.
And then the other thing would be someone might say, "It's actually easier for you to learn right-handed because we have a room that's set up for right-handed people. We have instruments that are set up for right-handed people." And then sometimes you have people who are on the complete other side who say, "You need to operate left-handed because left-handed surgeons exist. They're just as safe as far as the literature can elucidate." A lot of people think they're actually better because they can use... they're right-handed a little bit, they can use their left hand very proficiently.
You have all these different perspectives coming down to sometimes say, "This is how I think it should be," but it kind of misses the point. The point is that this fundamentally is a heterogeneous group of learners who should not be treated homogeneously. I'm right-handed. I can't think of a single right-handed person in surgery who decided that they wanted to operate left-handed. But the left-handed people very frequently use their right hand and sometimes exclusively. And so that alone kind of disproves that we're all the same and you should treat this category of people the same.
Toni Gallo: Maybe we can talk a little bit about the faculty development piece here that's come up, whether it's this idea of over- or under-accommodating, or Tim, you mentioned in your description of your study the different advice that faculty are giving to learners, the stigma that's involved here. How did it come up in both of your contexts or maybe how has this kind of come up in your practice as you're thinking about not just the learner but everybody who's around them? Lisa Meeks:
For our article on wheelchair users in OB/GYN, the amazing thing is that when we looked at doing this case study, we looked at the full breadth of what we would need to do to change the narrative and implement it in the practice and training setting. So as we were developing the case study, we were already talking about presentations at national conferences and faculty development. And so that is already underway at the Cleveland Clinic. And Diane Young, the co-lead author of this article, and Stacie Jhaveri are pulling this together.
And we've been kind of going back and forth on what's necessary. We've been able to wrap some anti-ableism around the basic understanding of what might be needed for someone with a mobility disability in the learning environment. But importantly, I think that because they have had this experience and they understand how easy it is to actually implement it, they've kind of caught fire, right.
They want to go out and make sure that every clerkship director and every residency director knows that the things that they're assuming are probably grounded in ableism, and here is how you can actually implement all of these things in the learning and practice setting. So they've already developed this, and this will be available, I believe, through the Cleveland Clinic as a module, so that's very exciting. Theresa Papich:
As a small add-on to what Lisa just said in terms of less formal faculty development, something that I heard was people in preceptors or people in leadership positions, like Craig Nielsen, who's one of the authors on the paper and is kind of the leader of all of the clerkships at the Cleveland Clinic, and him saying before he worked with me, he had his own kind of assumptions or concerns about students with disabilities in medical education and then sort of reflected on what he learned, his own perspectives that he changed kind of after we had the opportunity to work together. And so I think just sort of through those experiences and stories, perspectives can be changed and which could open the door to more students in the future.
Timothy Gilbert:
I think it's important to say we need programs. We need all these things. But I think I was struck with how meaningful the smallest intentional action taken was across a lot of the interviews, which goes both ways. We had someone who was interviewed who was like, "I would flip back and forth with my hands," and then someone just said, "Listen, go right-handed." And that person made a decision to just be right-handed for the rest of their training and the rest of their career, and that's massive. And I guarantee the person who said that to them didn't even think about it by the time they left the building that day. There's an under-appreciation for the impact of these small things, and it cuts both ways, I think also positively.
And so, for me, the big first step is honestly just an elevation of consciousness about the issue, which is why I kind of finished the paper's discussion honestly just talking about a theoretical medical student who is scared walking into the OR because they were left-handed. Because I think if you can see that, you can get really far just to say, "Hey, I see you. I see that this is a problem. I'm a right-handed surgeon who's always dealt with right-handed people. I don't really know exactly how to fix this, but I'm not going to penalize you for the way you exist," and that's so important.
And then there's all these other things relating the department to the medical student to potentially offer sets or have some sort of structured feedback or educational programs for faculty. Theoretically, all of them know how to tie left-handed knots and do all these types of things that a medical student would be doing. So I believe they do already know how to do that, but if not, I think that that would be the next step. Lisa Meeks:
I love what Tim says about consciousness and raising consciousness. We published a paper a few months ago on the need to infuse disability consciousness in medical education, and I think he's so right. Regardless of the marginalized group we're discussing, it's building an awareness that someone is having an experience that's going to be different from yours and that as they navigate two spaces in medical education, they will encounter different types of barriers or different experience that you might have.
Just having that awareness is so helpful to reducing barriers and opening up conversations. I have never been involved in a consult or a case where a medical student was in an environment where the medical school was open to discussion and interested and curious and kind of leaned into the conversation where things didn't go well because I think it is that openness and bringing that humility to the table to say, "I'm not a disability expert. You are an expert in your experiences, but together we can figure it out." And just creating an atmosphere where that conversation can even exist is so important.
Toni Gallo: Something else that, as you all were talking about centering the learners and their experiences, this feels like a larger theme across medical education, not just thinking about inclusion, but whether it's designing assessments or thinking about what's in the curriculum. Lisa, what you just talked about is an openness and a curiosity on the side of the medical school to work out what needs to get done with learners.
And I wonder if there's anything else from your papers or recommendations that you would have for listeners about this kind of broadly, thinking about partnering with learners, being open to different experiences, that there's not this kind of one right way. But anything else that you would share along that? Timothy Gilbert:
These are all people who are fundamentally problem solvers because they've had to solve problems that are related to their issue their whole life. Left-handed people, they experiment constantly when they're kids. They're like, "I actually don't know if I want to throw a ball with my right or left hand or kick with my right or left foot or write with my right or left hand." And so they kind of actually test things when they're really, really young, and they get used to knowing these things, and they flip back and forth based on how they experiment.
And so I think when you get into the OR, having to be told what to do sometimes goes completely against what they would normally do, which is flip back and forth and kind of figure it out. They kind of probably already have a little pathway to hopefully understand where they fall on the spectrum of doing X right-handed or Y left-handed. I think 60 some percent of left-handed people who are in surgery flip back and forth, at least for a couple different things.
The challenge is the hierarchical culture that sometimes views asking for things negatively just by definition, that's kind of a bridge to nowhere because if you actually are interested at all, as Lisa said, if you're curious about this thing, you really have to put that aside because you're going to probably make the wrong recommendation to somebody if you're not actually going first based on what they're asking for.
And the other part is if you're encountering a barrier or struggling with it, I think it's important to refine someone's question because usually, people know that they're encountering a difficulty, and if they ask a question, it may not actually be their need. It may be kind of tangential to the struggle that they're having.
For example, I was working with a medical student honestly a couple of months ago who I noticed was having a hard time cutting dressings. Basically, because I'd worked in this area, I recognized that they were using scissors with their left hand. And because I was aware, I was able to kind of educate them on the way blades come together and that those are not... those are handed instruments that are different. And it was interesting to see. And so I think helping someone refine their question at all might help you better accommodate them, and that can be a collaborative process that I don't think would ever be viewed negatively, which kind of absolves you of needing to always be right. I think, as long as people know you're trying to be right, that's actually great.
Lisa Meeks: It's so funny. Tim and I have never met, and this is our first time, and yet he's saying things that I feel like are teeing me up to talk about what I think is a critical role in medical education, which is the disability resource professional. And so much of the issue with disability inclusion stems from bias, and bias is not understanding, not having that education, and thinking something automatically because that's how we've been socialized to think about disability.
And because of that, as Theresa had pointed out, you might be inappropriately counseled out of a specialty like OB/GYN, or there may be inappropriate accommodations provided for you that feels like you are being treated like a child, right, or you may be excluded from opportunities. And so having someone in that space, leaning into what Tim said about not needing to know everything, allowing the clinician and the teacher to be the expert in their space, but leaning into having a person that has expertise in this that is informed about both the laws and innovative ways to facilitate inclusion, I think that is what schools need to start embracing. We embrace specialty in so many ways, whether that's about assessment or the learning environment or wellness. We have all of these specialists.
We need to understand that if we're going to build a disabled workforce of physicians, it's going to require some level of expertise in medical schools because so many of the things that I think programs worry about could be dismissed or at least answered very, very quickly if there was someone in the institution that had a really good grasp of clinical knowledge and clinical accommodations and to be more innovative and to do that faculty training that we were talking about earlier. So these individuals play a really, really important role in reducing bias, increasing access, and educating our clinical faculty members.
Timothy Gilbert: I was reading the paper beforehand and I hadn't even heard of that disability resource professional until I had seen it mentioned in your guys' article. And it sounds like a potential missing link between needs and wants and actions and outcomes. That sounds great. I mean, so fascinating. Toni Gallo:
Let's keep talking about the hidden curriculum. One of the things that jumped out at me, Tim, in your paper was a lot of the comments essentially were like, "I didn't even know there was an another option. Somebody told me you have to switch and use your right hand, or this is the way it's done." There are those assumptions out there, and I think that creates for students a sense of, "Do I belong here? Is this somewhere that I could be?"
And so I wonder if we can talk a little bit about that and about sort of what does the environment tell students when it comes to "You are welcome here" in terms of inclusion, and this is an accessible space. And maybe all of you can talk about how that came up in your work or what that's looked like for your own education and practice. Theresa Papich:
Yeah, I think I could speak to my personal experiences related to this. I think throughout my journey towards becoming a doctor, I've heard comments or suggestions about maybe what specialty I should go into. I think even once there was a level of acceptance of like, "Oh, she's going to medical school." There have been comments about, "Oh, maybe research would be a good fit." Or like, "Oh, psychiatry or radiology," kind of those less hands-on specialties before anyone had ever seen me interact with a patient or interview a patient, or for all they know, I would be a terrible fit in psych.
So being sure to not let your own bias influence the way students are counseled or directed towards different specialties because really the point of medical school is that you're an undifferentiated learner. So keeping that in mind, no matter what the abilities or demographics of a particular student might be, I think is really important. Lisa Meeks:
To add to that, I think whether it's students with disabilities or students that are struggling with their mental health, which could be both, or students that are left-handed, fear is a pretty big driver of not asking for help, right. So if we want to have students engage in help-seeking, we have to be transparent about the way we're going to navigate the system or what we're going to do.
One of the biggest things that I see currently that's problematic in medical education is that we have this increased discussion about wellness or increased discussion about disability inclusion. And that's wonderful. It's great that we're having all of these conversations, and the party line is seek help, disclose your disability, and you will have everything that you need. We'll fully support you. But I still see this subcontext of, well, we're saying that this is what we want you to do, but only do it if your disability isn't too complicated or only do it if your mental health-related needs are, they're not great. That you need to go to a therapist once a month. There's still a lot of disconnect between what we communicate is important and what we say we encourage and support and what actually happens to learners when they activate that help-seeking.
And that has a pretty powerful feedback loop to the learners that are already in the system. They see this happening, they hear about it happening through their friends, and so then they don't engage, right. And it becomes this everyone's saying wellness is important, and no one's engaging in the wellness resources. And so same for disability. Everyone is saying disability inclusion is important, but people are reticent to disclose their disability.
And we see this, Toni, on the AAMC data collection. We see the difference about 50% between students who will disclose they have a disability anonymously and those that are willing to go to their school and say, "I need this accommodation, or I need this particular mode of support." So I think that unwritten curriculum is a very strong deterrent for students. They don't know exactly how to navigate the environment when they're getting these mixed messages. Timothy Gilbert:
Fear is a very powerful motivator, Lisa, as you said. One of the participants in our study, for example, was a outgoing senior in surgical training who, in their interview, said that no one in their program knew that they were actually a left-handed person. They just figured out right-hand along the way. I mean, that's shocking. I don't even know how you could do that, even by accident, keep it hidden. I think that you eat what's at the buffet, and there's a lot of exclusion by omission. And for students, this starts really early. We're all intelligent, perceptive people, and we pick up on that.
And so if you go to your first suture workshop, they're teaching you how to tie right-handed and suture right-handed. They're not bringing left-handed instruments there. They're not going to have... Maybe they do, maybe there was an amazing opportunity, or there's a free resident or faculty, and they were very intentional, but that's not my expectation or my understanding of kind of what happens. It wasn't what happened at my own institution or otherwise. And so you figured, "I had to tie right-handed. That was the only way it was taught." And then that thing kind of cascades through training a little bit.
And then you run into this interesting way I mentioned how your needs change as you get more senior. And so sometimes you arrive at the time where you're a senior resident, and you're totally proficient, and now you do feel like you have the clout to ask for a left-loaded needle or do whatever you got to do, but at that point, you've rounded out your training, learning how to do it right hand. Why would you go back? You'd have to relearn things. You're kind of needing to advocate for it when you have the least power and understanding. And by the time you have that power and understanding, you sometimes don't need it anymore because you figured it out.
Lisa Meeks:
So many parallels to disability there, Tim. Well, first of all, I'm a lefty, and I learned to suture right-handed. As you might imagine, I'm quite a bit older than both of you and Theresa. But what's so interesting is that as I listened to you talk, I remember, I think it was first or second grade, you get your scissors, and there are no left-handed scissors, right. So you have to figure it out. And if you say anything, I know it sounds silly, but that's a memory that's kind of... that's pretty solid for me was that I had to figure it out very early on.
And so I always played sports right-handed. I learned all of my clinical skills right-handed. But the parallel to disability is that being left-handed, as children, you are taught what's acceptable and what you can and cannot do. And that may actually really impact the trajectory for someone. In your case, Tim, and relative to your paper, it may keep someone from going into surgery. And in Theresa's case and in medicine broadly, I think those are the types of things that keep people from going into medicine at all, to be told, "This is not something that you'll be able to do."
So we need to really think about not only how do we change medical education, but by changing medical education and having more diverse individuals, especially relative to disability, and at the intersection of disability and other identities, we send a message to society that changes the societal narrative, right. It's all circular. So, right now, society doesn't understand that you can be a physician with a disability, and that breeds the idea in young children that they can't be physicians or nurses or anything else. We need to break that cycle. I think that's really important.
Toni Gallo: So how might we do that? What recommendations do you all have for helping people to understand, like really thinking about inclusion and who belongs, who can be here. What might be some first steps that we can all take in that space? Timothy Gilbert:
I think the first step is recognizing that it's the thing. Probably the most important sentence in my paper, and I'd be interested to see if Theresa and Lisa agree, is that the majority of this is misunderstanding and not malice because it's a group of people that don't... they don't live that life. And so they don't know exactly what's wanted. I think what's important is figuring out what is needed and then just building from there.
And I think if you wage that war kind of personally, it could be the smallest thing. And if you at least recognize it's a problem, and you can say, "I did this small thing in my own life." And if you extrapolate that across the whole industry, that would be my first recommendation. And then other people who... people like myself can make kind of the higher-minded articulation for things down the road. But again, if people aren't on your side, you can't make them have these changes. Lisa Meeks:
I think for me, at a 20,000-foot level, it's pretty simple and leans into several of things that have been brought up by both Tim and Theresa today, which is you have to combat bias and ableism. And how do you do that? You do it through education. This case study, I imagine, will be making the rounds at different medical schools, and people will say, "Oh gosh, I thought it would be much more difficult." And people will probably pick up the phone or email Diane or email Theresa and ask further questions. So it's combating this idea that it's not possible and leaning into all of the possibilities.
If we assumed that somebody with a wheelchair user couldn't do a surgical subspecialty, we'd be losing out on a lot of amazing individuals, amazing physicians. The case study is one way of sharing a story. But podcasts like this and podcasts like the Docs with Disabilities Podcast are an incredibly powerful way to change hearts and minds. And I think to change the narrative to decrease bias, we just have to keep infusing the kind of headlines and the stories with individuals with disabilities and how it was done. To me, that is the most powerful way to change, not only change the experience for learners but change the narrative more broadly.
Theresa Papich: Yeah, I think to echo Lisa's point about the importance of sharing stories, I know when I was exploring if medical school was an option for me, I was desperate for stories of success of students with a similar disability who had pursued medicine. And so I think those stories are really valuable for aspiring students.
And then I know my medical school was also, once they had admitted me, were also doing their own research and searching of, "How can we do this and what will this look like for Theresa?" So I think those stories are really valuable, both as sort of inspiration but also as exemplars for how to implement the process for other learners.
Toni Gallo: So I want to give you each a chance then if you have any final thoughts for listeners or anything that you want to mention that we haven't gotten to today. Theresa Papich:
I think my final reflection would be the importance of humility and openness to challenging assumptions, I would say, on both sides, both for medical school faculty but also for the student. I know I really appreciated when faculty had a perspective of humility and openness to learning from the student myself, and also less of a perspective of fear, but more of excitement and optimism. I think that is really important because, in a lot of situations, more can be done, and there's more solutions than you think there are.
But then also from my perspective, I think it's been a valuable tool too. I need to advocate for myself and recognize what I sort of deserve as a student and as a physician now, but also recognize that most people do have good intentions and just don't know what they don't know and want the best for you as a learner. And so instead of having a really kind of defensive position, trying to be more open to a conversation and recognize that both parties can probably get where they want to go.
Timothy Gilbert: I have two things. One, if people weren't convinced that left-handed trainees have unique challenges that are not affected by culture and the way the hierarchies pressure those below them, I would say go even to the animal world, where people can study the handedness of bears and other animals. And it's almost 50/50, interestingly, across the animal kingdom. And yet, in modern America and around the world, it's 90% to 10%, and that's been pretty consistent for a while.
And there is an effect impressing upon the left-handed people to adopt right-handedness at a very young age that progresses through life. I would say the second thing is in a health care environment and in public health and in all sorts of things, we do PDSA cycles, we do QI, we do QA work, and one of the main goals of that is to achieve better, not perfect and to consistently iterate.
And I think when you look at this challenge of disability, and you look at the challenge of fixing left-handedness, for example, it can seem very overwhelming and multifaceted, and you can kind of get lost and bogged down in all the nuance, which I think is true and exists. But the thing you should go into it with is an interest, as we talked about, and a curiosity, as we talked about. But ultimately, we should just start doing something as opposed to kind of relegating the complexity to the reason why we're not making an effort.
And I'd mentioned some of the small things that you could do, but for left-handed students, why can't you just put a needle driver that's ratcheted for lefties and one pair of scissors that's able to cut sutures for lefties in each kit? We go to a lot of operations, and there's a bunch of tools, and usually, most aren't used. So I don't really buy that there isn't room in the inn to do that, and if that helps some people, but not all, I think that's still a success, and we can at least say we've done something and go from there.
Lisa Meeks:
Toni, I think we need to remember in our continued efforts to support disability inclusion in med ed that we need resources and collective support. So Theresa encourages everyone to approach this process with humility and openness, reminding us really that achieving a yes and a win-win is very possible, and especially so when we include the learner in the conversation. And then Tim highlighted that we can't allow the nuance of these scenarios and fear to drive us into a place of stagnation. That progress and taking a step forward is essential.
So when I look at their feedback, I would add that while this may seem overwhelming, numerous resources are available. You are not alone. Many of these resources have been developed by the AAMC, and I know, at least for us, our group is dedicated to providing education and support for schools that are committed to enhancing access.
So you can find resources on our website. Many of these are in partnership with the AAMC. But essentially, when I get a question, oftentimes I know this is a question that's very novel and may be scary for schools. But in most cases, I can point them to something that's been codified or written up in the literature or a resource that will be helpful. So know that you're not alone. There are lots of resources to assist. Toni Gallo:
I want to thank you all again for being on the podcast today. What a great conversation. For our listeners, check out the two articles that we talked about today and some others on accessibility and inclusion in the August issue. That's available now on academicmedicine.org. Make sure you check back next month too, because we'll have another episode on disability inclusion. I'll be talking to the authors of a recently published study that explored disabled students' perspectives on disability inclusion in medical education. That'll be out in September.
Lisa mentioned some other resources that are available. Those include the Docs with Disabilities website and podcast, as well as a recent episode of the AAMC's Beyond the White Coat Podcast. Links to all of these resources and a few others are in the notes for today's episode. So please check those out.
Remember that from Academic Medicine's website, you can access the latest articles in our archive dating back to 1926, as well as additional content like free eBooks and other article collections. Subscribe to Academic Medicine through the subscription services link under the journal info tab or visit shop.lww.com and enter Academic Medicine in the search bar. Be sure to follow us and interact with the journal staff on X, formerly Twitter, at @AcadMedJournal and on LinkedIn at Academic Medicine Journal. Subscribe to this podcast anywhere podcasts are available. Be sure to leave us a rating and a review when you do, let us know how we're doing. Thanks so much for listening.