“The Forgotten Minority”: Perpetuation of Ableism in Medical Education

Background: Accounting for approximately 1 in 4 community-dwelling adults in the United States (US), people with disabilities (PWD) experience significant disparities in health care quality, access, and outcomes. At the same time, US physicians have reported feeling unprepared to care for PWD and have revealed significant negative bias about this population. Objective: To understand how physicians are trained to care for PWD in US medical schools. Design: Qualitative, critical theory paradigm. Participants: US medical school faculty (n = 8) and students (n = 9) were purposively sampled for knowledge of disability-related training based on known engagement in activities to advance disability-related medical education. Inclusion was limited to English language proficiency. Interventions: n/a. Approach: Data were collected through focus groups, hosted virtually with separate groups for faculty and medical students between September 2021 and February 2022. Each meeting was recorded, transcribed, and de-identified. Deductive and inductive coding schemes were applied by multiple coders until reaching thematic saturation. Key Results: Prominent themes revealed critical shortfalls in medical education, including (1) disability being omitted from standard curricula; (2) disability being framed as a problem within individuals; (3) pervasive discrimination against PWD in medicine; and (4) over-reliance on ad hoc faculty and student-led efforts to cultivate curricular change. Data also revealed multifactorial barriers to including disability training as part of US medical education, such as avoidance of personal and institutional responsibility, and permeations of ableism across social and training contexts. Conclusions: Medical education may perpetuate negative bias about disability through a hidden curriculum. Insufficient support from institutional and licensing authorities has stymied efforts to expand and improve disability-related training such that disability is not included in existing curricula focused on mitigating health care disparities — despite known vulnerabilities for PWD. Without improvements to disability-related curricular content, physicians will remain ill-equipped to care for the nation’s largest minority group.