by George Lamare Haines, PharmD, PGY1 Community Pharmacy Resident, The University of Mississippi School of Pharmacy
There is only one way to look at things until someone shows us how to look at them with different eyes.
—Pablo Picasso
At times it is hard to see problems that face others. Often, when a problem doesn’t affect a person, they don’t perceive it as a problem or that it exists because they don’t have to deal with it. This is certainly true when it comes to people with disabilities. There are many things that an able-bodied person takes for granted and never even considers. When it comes to students in college, title II of the Americans with Disabilities Act (ADA) protects people with disabilities from discrimination by universities, community colleges, and vocational schools.1 Most of us are at least somewhat familiar with accommodations for students with disabilities in the classroom setting, but it is far less common to see these considerations in experiential learning environments.
Every educator tries their best to determine the most appropriate teaching methods for the largest number of students. For most programs, there are special accommodations made for students with learning disabilities in the classroom, like providing extra time during testing or having someone read the exam questions aloud. When students with disabilities enter professional programs, they will be required to participate in experiential education that places them in environments similar to those that they will work in after completion of their program. These “non-academic” settings, which are not under the control of the university or college/school, can be challenging for students with disabilities.
When the University of Colorado School of Medicine was faced with this, they took steps to ensure that their students were set up for success. To illustrate, the school made special accommodations for a third-year medical (M3) student who uses a wheelchair. The student was scheduled to start an Operative/Perioperative clerkship. Before the start of the student’s M3 year, the student met with the medical school dean to discuss requirements, barriers, and reasonable accommodations for the clerkship. The dean then met with preceptors for the clerkship to inform them of the student’s disabilities and to develop a plan for an optimal experience, which included selecting clerkships that would allow for maximal physical access and participation. By putting in this extra effort, the student was able to fully participate in all required clerkships and went on to complete the degree with honors.2
Due to the student’s proactive behavior, there was effective communication and reasonable accommodations made so that they could complete their clerkship. Early communication is the key here. As with most issues, if they are addressed as early as possible, the issue can be addressed before it causes real problems. Often administrators have to do the groundwork to ensure that learners with disabilities are able to complete the requirements of an experience. These steps are important for both physical and learning disabilities. Students with learning disabilities are often hesitant to report these since there is often stigma and shame. Or they may not understand the impact of their disability and the potential benefits of sharing the information with their preceptors.3
Preceptors and faculty in experiential education administration can determine reasonable accommodations for students if they are given adequate time, resources, and knowledge of the disability.4 There are five basic principles that should guide institutions to ensure that reasonable accommodations are provided. The accommodations should be based on a reliable diagnosis; they must mitigate factors of the disability that affect student competencies; it should be tailored to each experiential site; they must ensure collaboration and communication occurs between the students, staff, preceptors, and administration; and most importantly, it must uphold privacy. If the accommodation takes away from any of these, it can not be considered reasonable.4 Often, accommodations for a student with a learning disability can be made by minor adjustments to the environments, policies, and procedures. Students with physical disabilities may require significant adjustments in the environment. By having proactive policies and procedures in place, preparing preceptors for what to expect, and monitoring student learning outcomes, students with disabilities have the best chance for success during experiential education.4
A recent commentary published in the American Journal of Pharmaceutical Education provides a stepwise approach to addressing these needs.5 The first step is to create a system for students to submit a request when entering the experiential program. Once the student has submitted the request, the program is then responsible for exploring accommodation options and sites that either already meet the requirments of the accommodation or that can reasonably accommodate the request. The next step would be applying and fully implementing these accommodations. This will look different for different locations and will depend on the needs of the student. For example, a student who does not have sufficient strength may be accommodated by shortening the length of the rotation day but extending the total number of days in order to meet the required number of experiential hours. Another example would be to avoid rapid-fire questioning for a student that struggles with processing information.4 A practice walkthrough by both the student and preceptor may also be useful before the start of the rotation to allow the student to familiarize themselves with the environment and what to expect when they start the experience. The final, and possibly most important, step is to monitor the effectiveness of the accommodation. Continued communication between the preceptor, student, and experiential program director is essential to quickly address oversights and ensuring the accommodation is effective.5
When we start looking at these required experiences from the student with a disability perspective, we see problems that we didn’t know were there. It takes students with courage to tell you what their needs are. Open, honest communication seems to be the key to addressing the needs of students with disabilities, especially in experiential education.
References:
- Americans with Disabilities Act of 1990; 42, USC §§ 12101 et seq.
- Malloy-Post R, Jones TS, Montero P, et al. Perioperative Clerkship Design for Students With Physical Disabilities: A Model for Implementation. Journal of Surgical Education. 2022; 79(2): 290-94.
- Vos S, Kooyman C, Feudo D, et al. When Experiential Education Intersects with Learning Disabilities. Am J Pharm Educ 2019; 83(8): Article 7468.
- Vos S, Sandler L, Chavez R, et al. Help! Accommodating learners with disabilities during practice-based activities. J Am Coll Clin Pharm; 2021; 4(6): 730-37.
- Kieser M, Feudo D, Legg J, et al. Accommodating Pharmacy Students with Physical Disabilities During the Experiential Learning Curricula. Am J Pharm Educ 2022; 86(1): Article 8426.
