The deaf medical student: Why technical standards need updating

A technical standard is a formal document establishing requirements in several aspects of medical care which all physicians-in-training candidates must possess. Most medical schools require that all candidates meet these requirements in order to receive their doctor of medicine (MD) degree. Some schools require students to sign that document when applying to a program or as a condition to matriculate into medical school.

I took a closer look at different technical standards established by several medical schools in the US. As a deaf medical student, I wanted to look for any discriminatory language in the technical standards document that might exclude individuals who are disabled, but otherwise qualified candidates.

One commonality I noticed in comparing different technical standards, was that the schools require that you possess the ability to hear in order to auscultate, percuss, communicate with your patients or other healthcare professionals. Although, there are some subtle differences in wording in the language used between different schools, almost all seem to have this clause to some extent. Some schools included the Americans with Disability Acts (ADA) clause while others did not.

One good example of incorporating accommodation language into the technical standards comes from the University of Pittsburgh School of Medicine:

Technological compensation can be made for some disabilities in certain of these areas but a candidate should be able to perform in a reasonably independent manner. The use of a trained intermediary means that a candidate’s judgment must be mediated by someone else’s power of selection and observation. Since the treatment of patients is an essential part of the educational program, schools must at all costs act to protect the health and safety of patients.

According to the guidelines for establishing a new medical school set by the Liaison Committee on Medical Education (LCME), in order to get preliminary accreditation, any US or Canadian medical school must: “[sic] define its minimum requirements for admission, and develop criteria for the selection of its students. Technical standards for the admission of handicapped applicants should be delineated.”

While it is great that LCME mandates that this criteria be included, it leaves much to be desired in laying out any truly concrete guidelines towards establishing criteria for admission or rejection of handicapped applicants. It also does not specify in detail how it should be addressing individuals with significant hearing loss.

Existing LCME accredited medical schools that have been around for a long time need to review their technical standards and update them appropriately. Some are outdated or do not include language addressing reasonable accommodations for handicapped students, while still others fail to address the advances in medical technologies which could allow previously barred applicants to participate fully. LCME should bear the responsibility of ensuring that medical schools, which are up for accreditation renewal, revisit their technical standards and update them accordingly. There is a need for a conversation focusing on this issue, one which may go a long ways to help bring LCME and its schools into the 21st century.

Josh Butler is a medical student who blogs at deafmd2be.

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  • Scott

    I find it very interesting that somebody would disagree with these technical standards. I think hearing would be an absolutely essential ability in this particular field, so I mean no disrespect, but I would be very interested in hearing your take on some of the possible issues that may arise – I will only stick to senarios that WILL happen on a regular basis. Keep in mind that these days efficiency is key, and you must be able to operate as part of a team without slowing things down – ie help with efficiency rather than inhibit it.

    - Ascultation, percussion, crepitus, any sound that could be noted even when you may not necessarily be listening for it, etc.
    - Alarm tones
    - A nurse or colleague trying to get your attention who has her hands occupied.
    - A patient trying to get your attention.
    - Communicating with patients, families or other members of your team.

    - Speech impairment that might indicate acute CVA, etc.
    - A fast paced trauma or code-type situation where many things are happening simultaneously and rapid communication between several providers is essential.

    ….I feel like I could keep going here, but if you could even answer these questions I have, maybe I could begin to see where you are coming from.

    • Kristen Adair Wilson

      My hearing husband and I have a daughter who is deaf. I wish we had physicians to turn to who were also deaf. They certainly would have a better understanding of her experiences. As volunteers at our local rescue squad, we are encouraging our daughter to follow the same path. There are stethoscopes with amplification and compatabilities with hearing aids and cochlear implants. I’m sure that if my daughter decides to become an EMT, she will utilize one of these tools. Otherwise, she is perfectly capable of communicating and observing others. Even without amplification, my deaf 7 year old can tell if some has a bad cough. She doesn’t need to hear it to know that it’s there. If nothing else, a deaf physician can certainly be of great use in the Deaf community! I’m sure that many Deaf would love to have a Deaf physician.

  • Docbart

    There are obvious difficulties to surmount, but it should be doable.

    One of my best teachers during my training, Dr. Robert Modlinger, was totally deaf, in the years before cochlear implants. He managed to work around it in various ways. He helped thousands of patients during his career and educated many physicians in training whose patients still benefit from that teaching to this day. His determination to follow his dream and that fact that he was allowed to do so have been a blessing to many, as well as to him.

    Good luck to you.

  • wiseword

    I was once screaming in pain in a dental chair while the dentist (a student) was busy flirting with a hygienist or whatever she was. Turned out he was deaf. But he looked so nice in his white coat.

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