Medical school graduate Eshani Kishore never received any formal education in how to treat patients with disabilities, considered one of the largest minority groups in the nation.

“If we were more broadly prepared through formal disability education to interact with these patients, then the patients would almost certainly experience better health outcomes,” said Kishore, who is graduating from Paul L. Foster School of Medicine in El Paso, Texas.

More than 1 in 4 adults in the country, about 29%, have some type of disability, which the Centers for Disease Control and Prevention (CDC) define as a condition of the body or mind that limits their interactions and makes it more difficult to perform certain activities.

The same ratio of adults with disabilities, 1 in 4, do not have a regular healthcare clinician, and 1 in 6 did not have a routine checkup in the past year, according to the CDC. As a result of such barriers, people with disabilities are more likely to have poorer overall health with an increased risk for preventable health conditions, the CDC reported.

Depending on the source Medscape Medical News consulted, medical schools are either providing appropriate disability care education or not providing enough in the best way to improve the health of people with disabilities.

Enough Disability Education

Joshua Marquez, who recently graduated from The University of New Mexico School of Medicine in Albuquerque, New Mexico, considers the training he received in a single half-day session on disability care 2 years ago a helpful introduction to the subject.

“I was satisfied with what I learned because the rest is within actual practice,” said Marquez, who will begin his neurosurgery residency at the school. “Having a lot of didactic lectures would not be the most useful.”

The goal of the training session involved required reading that “emphasized the structural factors that lead to healthcare inequities for disabled patients,” he said. “We also covered inclusive communication strategies for patients with intellectual and developmental disabilities [IDD], which I found the most practical in terms of learning for clinical practice.”

Not Enough Disability Education

The latest in a series of studies by Northwestern Medicine found that medical students haven’t been taught adequately to care for people with disabilities because there’s a lack of standardized disability education in medical schools.

Students may have learned about disability in individual lectures, seminars, or electives led by peers or faculty who personally experience disability or were interested in the subject, as per the study published earlier this year in Journal of General Internal Medicine .

Some of those same students and faculty teaching others about caring for people with disabilities are leading efforts to convince medical education leaders to add more disability training to the curricula. But change has been slow, the study concluded.

“Without improvements to disability-related curricular content, physicians will remain ill-equipped to care for the nation’s largest minority group,” the research concluded.

The Association of American Medical Colleges (AAMC) acknowledges that medical education on disability care is not standardized “but is intentionally designed, delivered, and governed by the local faculty to support the needs of their local community,” said Lisa Howley, senior director of AAMC’s Transforming Medical Education.

She cited AAMC’s most recent report showing that the vast majority (95%) of medical schools surveyed include disability as a required curriculum and 73% as required curriculum and elective courses. Only 2% of schools, a total of three, indicated the topic wasn’t covered, and 87% participated in the 2022-2023 survey.

However, the lead author of the Northwestern Medicine study isn’t convinced medical schools are providing enough disability education.

“How they teach about disability is what matters,” said Carol Haywood, assistant professor of medical social sciences at Northwestern University Feinberg School of Medicine, Chicago. “Programs saying that they have required disability curriculum doesn’t change that students feel underprepared to care for people with disabilities and that faculty feel unsupported to teach about disability.”

She believes having a medical workforce trained to treat people with disabilities will be increasingly important to keep up with a growing population of aging Americans, especially those who have disabilities. “It’s problematic that doctors are not prepared to care for a higher proportion of people with disabilities,” said Haywood.

Looking At Disabilities Through a New Lens

For many decades, disabilities have been referred to as conditions to be prevented, treated, or cured, the American Medical Association (AMA) stated in an educational primer on disabilities, part of its 2024-2025 strategic plan to advance health equity.

Terms such as “normal” and “abnormal” are still common in International Statistical Classification of Diseases and Related Health Problems diagnostic codes and medical assessments required for people to access services, benefits, or accommodations, the primer stated.

Medical students usually learn about disabilities as a problem or weakness to diagnose, treat, and eliminate as if they are an illness or disease, Haywood said. If a disability is considered bad by the patient, family, or society, students may also harbor negative bias against the person with the disability, she explained.

Why Physicians Feel Unprepared

The findings of the Northwestern Medicine study resulted from focus groups with faculty and students from medical schools across the country between September 2021 and February 2022. The research team, which included clinicians and professors from Northwestern, Brown University, and Harvard Medical School, chose study participants based on their knowledge of disability-related training and involvement in efforts to advance disability-related medical education.

Participants represented a range of clinical interests and specialties, genders, faculty rank, and, in the case of students, varied points of training. It wasn’t criteria for enrollment, but participants either had a disability or were supportive of people with disabilities through personal experiences with family or friends.

Another study published a year later in the same journal revealed doctors’ strategies for discharging patients with disabilities from their practices with such comments as “I am not the doctor for you.”

Haywood said, “We wanted to understand why physicians were unprepared to care for this population.”

A similar study published last year in the AMA Journal of Ethics also discusses the lack of disability training in medical education, the biases of healthcare professionals against people with disabilities, and how it contributes to inequitable care.

It states that, “Future clinicians must recognize disability as an aspect of diversity, express respect for disabled patients, and demonstrate flexibility about how to care for disabled patients’ needs. These skills are currently undervalued in medical training.”

The study urges healthcare educators to better prepare the future medical workforce, such as adopting the core disability competencies for healthcare education proposed in 2019 by the Alliance for Disability in Health Care Education. The core competencies provide broad disability standards for healthcare education.

In addition, the AMA has a health policy on medical care for people with disabilities, last updated in 2022, which calls for medical schools and graduate medical education programs to train doctors to properly care for patients with disabilities and improve their health. The policy also seeks legislation to increase funding to train doctors in such care and raise insurance and government reimbursements to accurately reflect the cost of that care.

The National Inclusive Curriculum for Health Education offers grants to medical schools and student scholarships to expand curriculum in IDD and encourage clinical away rotations in IDD.

Haywood believes expansion of disability education should be tied to accreditation. “Even faculty that try to build it into the curricula are told it’s not a priority to meet accreditation. They receive pushback from medical schools who say the curriculum is already too full. There’s no external motivation to make sure there is disability training.”

The Liaison Committee on Medical Education (LCME), which accredits medical education programs, said it does not prescribe specific curricular topics. It expects the faculty of its accredited schools to make those decisions, according to LCME co-secretary Ronnie Catanese.

Disability training also is hampered by the lack of faculty able to teach it, Haywood said. “They can’t teach what they don’t know so there are gaps in knowledge and skills within clinical practice and in academic settings.”

Howley cited the AAMC’s ongoing efforts to improve “how we educate physicians and other healthcare professionals to care for those persons with disabilities.” AAMC was a founding member of a coalition formed in 2021 to build national strategies for better preparing clinicians to care for people with disabilities.

The organization representing medical schools also supported the planning of a recent summit by the Accreditation Council for Graduate Medical Education on disability-inclusive resident education that will help “how we educate physicians, especially medical students, and residents in caring for persons with disabilities.”

Continuing Education

Though she is graduating med school, Kishore believes medical students would benefit from a formal class during the preclinical years to prepare them to care for patients with disabilities. She is starting her internal medicine residency at Baylor University Medical Center in Dallas.

Marquez believes medical trainees would benefit from more direct engagement with patients who have disabilities, and disability care that’s integrated into lessons throughout their training, reinforced through practical experiences in a variety of medical settings.

“Disability care is something we engage with throughout our entire careers. Whether or not it’s explicitly labeled as ‘disability training,’ it’s inherently ingrained in how we practice and learn as physicians since we all encounter patients with disabilities,” said Marquez.

Haywood agreed that disability training shouldn’t be limited to one class, panel discussion, or workshop but should be taught throughout medical training.

In recent years, she said she’s become optimistic about educational leaders prioritizing disability training in medical school. Still, such education has traditionally been included in diversity, equity, and inclusion efforts, threatened lately by federal budget cuts, so it remains to be seen if disability training will gain the attention she believes it deserves.