Creative Approaches to the Inclusion of Medical Students With Disabilities

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/156200/2/aet210425.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156200/1/aet210425_am.pd

IL-22 Production Is Regulated by IL-23 During Listeria monocytogenes Infection but Is Not Required for Bacterial Clearance or Tissue Protection

Listeria monocytogenes (LM) is a gram-positive bacterium that is a common contaminant of processed meats and dairy products. In humans, ingestion of LM can result in intracellular infection of the spleen and liver, which can ultimately lead to septicemia, meningitis, and spontaneous abortion. Interleukin (IL)-23 is a cytokine that regulates innate and adaptive immune responses by inducing the production of IL-17A, IL-17F, and IL-22. We have recently demonstrated that the IL-23/IL-17 axis is required for optimal recruitment of neutrophils to the liver, but not the spleen, during LM infection. Furthermore, these cytokines are required for the clearance of LM during systemic infection. In other infectious models, IL-22 induces the secretion of anti-microbial peptides and protects tissues from damage by preventing apoptosis. However, the role of IL-22 has not been thoroughly investigated during LM infection. In the present study, we show that LM induces the production of IL-22 in vivo. Interestingly, IL-23 is required for the production of IL-22 during primary, but not secondary, LM infection. Our findings suggest that IL-22 is not required for clearance of LM during primary or secondary infection, using both systemic and mucosal models of infection. IL-22 is also not required for the protection of LM infected spleens and livers from organ damage. Collectively, these data indicate that IL-22 produced during LM infection must play a role other than clearance of LM or protection of tissues from pathogen- or immune-mediated damage

Institutional Accountability for Students With Disabilities: A Call for Liaison Committee on Medical Education Action

Medical educators and leaders have called for greater diversity among the physician workforce, including those with disabilities. However, many students with disabilities are precluded from entering and completing medical training due to historically restrictive technical standards and poor internal practices to protect student privacy. This limits the possibilities for growing this part of the workforce and making progress toward the ultimate goal of having a physician workforce that better represents the patients it serves. To achieve diversity among the physician workforce, medical education must create environments that allow students with disabilities to apply to, flourish in, and feel well supported in medical school. Recent additions to Accreditation Council for Graduate Medical Education requirements have helped to catalyze work in the area of disability inclusion by incorporating disability-focused mandates into graduate medical education accreditation standards. However, similar mandates for undergraduate medical education have not yet materialized. In this article, the authors call for the Liaison Committee on Medical Education (LCME) to elevate disability as a valued part of medical school diversity in its accreditation standards and to include protections for disabled students. The authors propose that the LCME can take 5 actions to promote institutional accountability toward students with disabilities: (1) define disability as diversity, (2) mandate disability support, (3) protect from conflicts of interest, (4) protect privacy, and (5) verify schools\u27 technical standards comply with the Americans with Disabilities Act. By adopting these recommendations, the LCME would send the powerful message that students with disabilities bring welcome expertise and value to the medical community

A decade of decline: Grant funding for researchers with disabilities 2008 to 2018.

Recent data highlights an imbalance in research grant success among groups underrepresented within the biomedical workforce, including racial/ethnic minorities and women. However, there is no data on grant success for researchers with disabilities. For these analyses, aggregate data on self-reported disability status for National Institute on Health (NIH) research grant applicants and awardees was obtained from 2008 to 2018, including disability category: mobility/orthopedic, hearing, visual disabilities, and other disabilities. The percentage of applications and awards, as well as grant success rates (% of applicants receiving awards), by Principal Investigators (PIs) disability status were calculated. Data was desegregated, and logistic models determined trend of applicants reporting disability over time. The percentage of NIH grant applicants with PIs reporting a disability significantly declined from 1.9% in 2008, to 1.2% in 2018 (p<0.001). Data on grant awardees was similar, 1.9% of awards in 2008, declining to 1.2% in 2018 (p<0.001) had PIs reporting a disability. Across all years, the percentage of applications and awards with PIs reporting visual disabilities was lower than the percentage reporting mobility/orthopedic, or hearing disabilities (16.5%, 34.2%, and 37.8% in 2008, respectively). Overall grant success rates differed by disability status (27.2% for those reporting disability vs 29.7% in those reporting no disability, p<0.001). The lowest overall grant success rate was among PIs reporting unknown disability status or who withheld this status (18.6%). These results underscore the underrepresentation of researchers with disabilities among grant applicants and awardees, and indicate lower grant success rates among PIs reporting disabilities

Deaf and Hard of Hearing Learners in Emergency Medicine

Approximately 23% of Americans over age 12 have some level of hearing loss.1 Emergency departments can reduce healthcare barriers for deaf and hard-of-hearing (DHoH) patients through improved patient-physician communication. DHoH students, once they become physicians, may provide one mechanism for reducing existing healthcare disparities and communication barriers for DHoH patients, and may be more adept with patients facing other communication barriers. A renewed interest in disability access and a commitment to social justice has increased efforts toward the inclusion of individuals with disabilities in medical education and training. Despite this increased interest and a growing number of DHoH students entering medical education, DHoH students continue to be dissuaded from specialty careers such as emergency medicine (EM) over concerns regarding effective communication and ability. Given the academic medicine communities’ commitment to diversity, a recounting of the successful inclusion of DHoH students in EM can benefit medical education and practice.In this account, the authors reflect on the successful experiences of a visiting DHoH medical student in an academic EM rotation at a Level I trauma hospital that serves a diverse population, and they identify the potential challenges for DHoH students in an EM setting, offer solutions including reasonable accommodations, and provide commentary on the legal requirements for providing full and equal access for DHoH students. We secured permission from the student to share the contents of this article prior to publication. 

Deaf and Hard-of-Hearing Learners in Emergency Medicine

Approximately 23% of Americans over age 12 have some level of hearing loss. 1 Emergency departments can reduce healthcare barriers for deaf and hard-of-hearing (DHoH) patients through improved patient-physician communication. DHoH students, once they become physicians, may provide one mechanism for reducing existing healthcare disparities and communication barriers for DHoH patients, and may be more adept with patients facing other communication barriers. A renewed interest in disability access and a commitment to social justice has increased efforts toward the inclusion of individuals with disabilities in medical education and training. Despite this increased interest and a growing number of DHoH students entering medical education, DHoH students continue to be dissuaded from specialty careers such as emergency medicine (EM) over concerns regarding effective communication and ability. Given the academic medicine communities’ commitment to diversity, a recounting of the successful inclusion of DHoH students in EM can benefit medical education and practice. In this account, the authors reflect on the successful experiences of a visiting DHoH medical student in an academic EM rotation at a Level I trauma hospital that serves a diverse population, and they identify the potential challenges for DHoH students in an EM setting, offer solutions including reasonable accommodations, and provide commentary on the legal requirements for providing full and equal access for DHoH students. We secured permission from the student to share the contents of this article prior to publication

Burnout Among Physicians With Disabilities

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