What Makes a Good Health Science Professional?
Guest Lecturers Discuss the Implications of Entrance and Graduation Requirements for Health Medical Students

The Myth of the Undifferentiated Graduate in Medical School

"Medical education aims to give the student a comprehensive concept of man and his diseases and to inculcate those habits of mind which will enable him to enter without handicap any one of the fields of medical practice..." (Trans American Surgeons Association 1950; 68:523-554).

The concept of an "undifferentiated graduate," a graduate who can go into any specialty has historically eliminated many otherwise qualified persons with disabilities from entering health science professions. With the passage of such laws like the Americans with Disabilities Act of 1990, health sciences programs have had to reexamine what this means. Should an intelligent and capable individual with a visual disability who aspires to be a psychiatrist be eliminated because he or she cannot successfully complete a 4-week surgical rotation? Is the average graduate without a disability really capable of entering any field when considering personal strengths, weaknesses and preferences? These issues are being discussed in a lecture series called "Diverse America in the 21st Century: Implications for Health Sciences Education Programs," cosponsored by Oregon Health and Sciences University=s Office of Diversity and Multicultural Affairs and the Health Sciences Students with Disabilities: Faculty Education Project. In March, Dr. Michael Reichgott, Associate Dean for Students and Clinical Education at Albert Einstein School of Medicine and Dr. Sui Zee, attending pathologist at Jacobi Medical Center and North Central Bronx Hospital delivered a lecture entitled, "Medical Students with Disabilities: Implications for Medical Education Programs." Dr. Zee is a former student at Albert Einstein Medical School and uses a wheelchair.

Drs. Reichgott and Zee spoke about the myth of the "undifferentiated graduate" in medical education. They argued that medical school does impart most of the skills that students will need to practice medicine. These "technical skills" are learned during a student's residency in the specialty she or he selects. Drs. Reichgott and Zee suggested that medical school provide students the opportunity to assess which medical field is suited to their strengths and interests. However, the technical standards of most medical schools, which are derived from the "undifferentiated graduate" myth, does not permit many students with disabilities to be admitted and the opportunity to assess the specialty which best suits their abilities and strength. "Why should individuals with disabilities be the only ones obligated to the ideal of the "undifferentiated graduate?" asked Reichgott.

Reichgott has developed a list of desired health professionals' abilities that does not focus on procedures, but includes the other important qualities of a good health professional. This paradigm shift in the model for the development of technical standards places a greater emphasis on such critical skills as communication and compassion for ALL medical students and does not automatically exclude individuals with disabilities from entering and succeeding in medical school solely because they experience a disability.

Desired Health Professionals' Abilities

Skill
_ Communications
_ Data Development
_ Analysis
_ Procedures

Knowledge
_ Science
_ Clinical Practice
_ Community
_ Quality

Altruism
_ Compassion
_ Empathy
_ Honesty
_ Duty/advocacy

 

Nursing Needs to Recruit a Diverse Workforce During Shortage

In the May Diversity Lecture, Candace Moore, R.N., M.S.N and Stacey Carroll, R.N., M.S.N., discussed technical standards and essential functions, and their implications for the nursing profession and for students with disabilities. Carroll, who is Deaf and has had cochlear implants, is a nurse practitioner, a doctoral student in the nursing program at Boston College, and on the Board of the Association of Medical Professionals with Hearing Losses (AMPHL). Moore is a faculty member in the nursing program at Elgin Community College. Both Carroll and Moore have a depth of work experience in clinical settings.

In her lecture, "Nurses with Hearing Loss: Creative Inclusion," Carroll discussed how individuals with hearing impairments can be excellent candidates for the diverse profession of nursing. Especially due to the current nursing shortage, it is especially important to be inclusive by using creative ways to include those with disabilities such as hearing impairments. Carroll discussed several concerns that usually come up when considering nurses with hearing impairments and creative solutions that have allowed her and others to be successful nurses. For example, some people question whether nurses with hearing impairments would know when there is a code situation. Carroll amusingly assured listeners that when 20 people start running in one direction, the hearing impaired nurse is well aware that there is a code. Other solutions she gave were to use a pager, to have the hearing impaired nurse monitor the rest of the floor during codes, or set up a practiced communication system prior to codes occurring. She also discussed the use of adaptive equipment such as amplified stethescopes and see-through surgical masks. Carroll also emphasized the added value that nurses with hearing impairments may possess. She says nurses with hearing impairments are often more attentive to patients, and may have special skills such as sign language or lip reading (a benefit when caring for some ventilator dependent patients.)

Moore argues that the essential functions of many state boards of nursing are unfairly focused on physical abilities because they are easier to observe, though may not be as essential as other, harder to observe skills. For example, it is easier to measure whether a person can lift 25 pounds than it is to measure whether a person can respect differences in their patients. Also, most state boards allow for less than 100% accuracy when testing cognitive knowledge, but require a demonstration of 100% of the physical requirements. This puts more weight on physical ability than what is arguably more important, cognitive skill and interpersonal skills.

Moore believes that nursing as a profession is at a disadvantage if individuals with disabilities continue to be excluded based on the fact that they may accomplish procedures differently. She believes that Apeople who accomplish differently see the world differently, ask the world different questions, and answer these questions differently. This is always an advantage.