NCD Letter regarding adding disability curriculum requirements into medical education

October 9, 2018

Dr. Veronica M. Catanese
LCME Co-Secretary and Senior Director
Accreditation Services, Liaison Committee on Medical Education
Association of American Medical Colleges
655 K Street, NW, Suite 100
Washington, DC 20001-2399

Dr. Barbara Barzansky
LCME Co-Secretary and Director
Undergraduate Medical Education, Liaison Committee on Medical Education
American Medical Association
330 North Wabash Ave
Chicago, IL 60611

Dear Drs. Catanese and Barzansky,

I write to you on behalf of the National Council on Disability (NCD), an independent federal agency charged with providing advice and recommendations regarding disability policy and law to the President, Congress, and other federal agencies, including the US Department of Education (LCME’s certification granting agency), to request that the LCME formally integrate a requirement for curriculum on developmental disabilities into Element 7.2 of the Functions and Structure of a Medical School, Standards for Accreditation of Medical Education Programs Leading to the MD Degree. Presently, due in part to insufficiencies of the relevant element, patients with certain intellectual and developmental disabilities (I/DD) regularly face unreasonable difficulties in finding clinicians properly trained to treat them; and the health care needs of people with I/DD are largely underserved.

Medical students need content and clinical experiences to support the variety of care needed for all – including the large population of people with I/DD numbering in the millions. Integrating the specific needs of patients with I/DD into Element 7.2 would prompt curriculum development and documentation by medical schools of learning objectives around the needs of this group, while creating better prepared physicians that are able to serve a larger community of patients.

We hereby request the LCME to add language to Element 7.2 that requires medical schools to prepare their medical students to “provide proper care to patients with intellectual and developmental disabilities with specific needs through both clinical and didactic training,” and that “at a minimum, students should be required to demonstrate proper clinical practice skills and a sensitivity to the ancillary needs of this patient population (including respectful nomenclature, supported decision making, knowledge of living arrangements that might impact compliance, communication avenues, and systems of support).” Medical schools should also be required to show the achievement of related learning objectives through the current data collection system.

NCD has been pursuing systems change in the medical profession in a variety of ways. We have been working with the dental community to revise the American Dental Association’s Principles of Ethics and Code of Professional Responsibility to better reflect the rights of people with disabilities in provider patient selection, and to revise the standards of the Commission on Dental Accreditation as a means of making the training of treatment management for people with intellectual and developmental disabilities a part of standard dental training curricula. We have also requested that the Department of Justice establish a clear and unequivocal directive to healthcare providers on the need to provide accessible medical diagnostic equipment to meet their federal nondiscrimination legal mandates for people with disabilities ( https://ncd.gov/publications/2018/letter-us-attorney-general-sessions-accessible-medical); and in our advisory role to Congress, we have assisted in the drafting of legislation that identifies people with intellectual and developmental disabilities as a medically underserved population under the Public Health Service Act, to meet that population’s lacking healthcare services. Our next step is to work with you on improving medical education training. NCD’s staff is available should you request a meeting to engage in further dialogue on this topic, to have NCD assist in the convening of stakeholders from the disability community and representatives of LCME, and to discuss the information and perspectives of NCD on this matter further. Thank you for your time and consideration of this issue. Please contact Amged M. Soliman, NCD Attorney Advisor, at asoliman@ncd.gov or 202-272-2116, as needed. We look forward to further discussion on this important issue.

Sincerely,

Neil Romano
Chairman