“Pipeline programs” to ensure adequate educational preparation
Pipeline programs to prepare DHoH students for health professions education should be modeled after current programs that target other underrepresented groups. In addition to academic preparation, improving students’ access to DHoH mentors and changing expectations regarding what a DHoH individual can achieve are essential components for creating a pathway to health professions careers for DHoH individuals.
Outcomes over process
Medical education, including schools’ “technical standards,” should be more outcomes-oriented than process-oriented. For example, a physician should be expected to be able to diagnose pneumonia (an outcome), but this does not necessitate the ability to hear the lung sounds associated with pneumonia (a process). Alternate processes to achieve the outcome might include conducting a thorough history and physical exam using tactile fremitus, amplified stethoscopes, and appropriate imaging diagnostics. Teachers and learners will need to work together to determine appropriate processes to achieve educational outcomes and will likely need to include DHoH physicians as mentors and advisors. An outcomes-oriented approach to assessment in medical education will help faculty more effectively teach all students and residents with diverse learning styles.
Collaboration for efficient use of resources
Sharing or pooling accommodation resources in centers of excellence would enable more efficient and higher quality training. We should identify, encourage and provide financial support to those medical schools and training programs with experience and expertise in educating and training DHoH students, residents, and physicians. Consolidating these efforts might improve efficiency and contain costs of accommodations. For example, the costs of interpreter services for a lecture are the same whether there is one deaf student or more than one. Working with multiple DHoH students simultaneously, training centers of excellence can use resources more efficiently, identify best practices quickly, and share what they learn with other schools, programs, and health care facilities. Additionally, individual DHoH students may benefit from having other DHoH students in the program.
Increased funding to address accommodation costs
Difficulty obtaining funding for certain accommodations (e.g. interpreters) and assistive devices (e.g. FM systems) poses a significant roadblock to the inclusion of DHoH applicants for positions in training and practice. The legal requirements to support these accommodation requests are perceived as punitive by many medical schools that do elect to accept DHoH applicants. Institutions engaged in medical education and health care should actively pursue funding to address the additional costs associated with working with DHoH learners and clinicians. A more equitable or broader distribution of the accommodation costs would mitigate the financial burdens that certain institutions undergo as a result of these accommodations.
The right accommodation for the situation
The population of DHoH individuals in medicine is heterogeneous in many ways, including variation in hearing acuity, communication styles and preferences, and accommodations used4
. It is critical that admissions committees, faculty, and administrators do not make assumptions about which accommodations are needed for an individual DHoH student or physician. Working directly with the DHoH person is the best way to determine how a particular accommodation works in a given setting (e.g., lecture hall, small group, surgical suite). Students and programs frequently need assistance to locate and test the available accommodations (List 1). There are limited data on assistive devices and their use in medical education and health care, and technology continues to change rapidly, creating opportunities for new and improved devices and accommodations. To be successful, programs must allow for the time needed to test, select and become proficient with a device. Moreland and colleagues reported that DHoH respondents spent on average 1.3 hours per week to arrange for accommodations.4
Accessible educational materials and programs
Efforts to create and advocate for accessible educational materials and programs should include the informal curriculum (e.g., study groups, mentoring) and the formal curriculum, such as continuing education programs, real-time captions and/or sign language interpreter services for lectures, web-based materials, and captions for videos (List 1). Captioning ultimately benefits everyone, allowing the video to be indexed and searched by a keyword used in the video.
Interprofessional infrastructure to support work with DHoH individuals
We need to build collaborative multidisciplinary health care teams that include DHoH physicians. Doing so requires other health-related professions to increase the number of students and graduates who are deaf or hearing and ASL fluent. Expanding interpreter training programs will help to accomplish this goal as well.
Research that includes DHoH people
Research and evaluation in medical education and health care services delivery should specifically study processes that include DHoH people. This will provide objective feedback on outcomes including documenting the career trajectories of DHoH students and residents.