Available online 26 May 2023, 101483

Author links open overlay panel, , , , , AbstractBackground

People with disabilities face significant health disparities. Studies show that healthcare professionals harbor negative attitudes towards disability, compromising the quality of care. These attitudes, in unwritten, unofficial, and even unintended ways can be passed from providers to learners in the medical education setting.

Objective

Using a Critical Disability Studies (CDS) paradigm, the authors uncovered the disability-related hidden curriculum within Case-Based Learning (CBL) and proposed guidelines for promoting a disability-conscious medical education that resists ableism.

Methods

The study team conducted a qualitative analysis of all CBL cases from the pre-clerkship curriculum (n=53) at [Blinded for review]. The authors employed a directed content analysis approach to develop a codebook based on case examination, literature review, and CDS concepts. Two researchers coded all cases and assessed intercoder reliability. The results informed the development of an explanatory model.

Results

Only four of 53 cases overtly mentioned disability, none of which defined disability according to CDS. Coding did not identify content challenging stereotypical views of disability. Additionally, two cases included content fueling negative attitudes of disability.

Conclusion

By inadequately addressing disability from a CDS perspective, harmful assumptions of disability may go unchallenged, driving a hidden curriculum within CBL. This phenomenon leaves medical students ill-prepared to care for people with disabilities and creates physicians ill-equipped to teach the next generation. Since many health professions utilize CBL to educate students, these cases provide an untapped opportunity to resist ableism and better prepare students to address the negative attitudes driving health disparities experienced by people with disabilities.

Section snippetsFunding/Support

None

IRB Approval

Not applicable. The study was exempt from IRB approval based on our institution’s guidelines. No human subjects participated in our research study.

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of Thomas Jefferson University.

Previous Presentations:

Oral Presentation at Northeast Group on Educational Affairs (NEGEA) Annual Conference of the AAMC; Virtual Conference, May 2022.

Oral Presentation at Learn, Serve, Lead, Association of American Medical Colleges; Nashville, TN. November 2022. (Published abstract: Ankam, Nethra S. MD; Seymour, Rory; Scher, Carly; Truong,

Context

Despite a recent curricular revision [Blinded for review], concerns were raised by students and faculty regarding disability representation in the pre-clerkship phase of the curriculum. Following the Consolidated Criteria for Reporting Qualitative Research guidelines, we designed a qualitative study to analyze the CBL written cases in the pre-clerkship phase of the [Blinded for review] curriculum.30 Our study employed a Critical Disability Studies (CDS) lens that drew on concepts from

Data set

We coded a total of 53 cases. The distribution of code usage across the cases is depicted in Supplemental Digital Appendix 2. Of note, we used the Disability code only four times across all cases (see Supplemental Digital Appendix 2).

Thematic categories

We identified several codes pertaining to the patient experience inside and outside the healthcare system (Table 1). We then sought to understand key factors that contribute to or resist ableism. So, we grouped the remaining codes into three thematic categories

Discussion

Disability is inadequately addressed in CBL at [Blinded for review]. Only four cases overtly discuss disability, and none of the cases acknowledge disability as a social or cultural identity from a CDS perspective. This is evidenced by the following gestalt codes applying to all cases: Missing – Definition of Disability from Critical Disability Theory, Missing – Feminist Disability Studies. Additionally, two cases include content promoting disability stigma without providing a means for

Conclusion

Our qualitative study uncovered the disability-related hidden curriculum in CBL. By inadequately addressing disability from a CDS perspective, students are not equipped to recognize and challenge ableism. Thus, harmful assumptions of disability may go unchallenged in class discussion. Unfortunately, this phenomenon leaves medical students ill-prepared to care for people with disabilities and creates physicians ill-equipped to teach the next generation. By developing a guide to address this

Conflicts of Interest

The authors report that there are no conflicts of interest to declare.

Acknowledgement

The authors wish to thank Cari Picciano for their help and expertise in trauma-informed care.

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