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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