Characterising ableism to promote inclusivity within clinical teaching

Abstract

Ableism largely occupies silent spaces in health professions education (HPE). By this, we mean that discussions of its manifestations and how we can act as a collective to challenge its impact are infrequent and often remain unheard. The silence around naming and characterising ableism hinders progress towards inclusive HPE environments.

Ableism is the production, and reproduction, of social/cultural/economic/political beliefs, practices and norms that devalue and oppress those perceived not to meet these norms.¹ This includes discrimination against disabled people. Ableism negatively impacts health and is implicated in systemic barriers to employment and education.¹

Within HPE, scholars are increasingly recognising the importance of naming, and ‘learning ableism’, by identifying the hidden norms that shape practice.² However, as strategies to ‘unlearn’ ableism are not yet well established, it can be challenging for clinical teachers to know where to start in recognising and addressing ableism in practice. The purpose of this article is to summarise high-quality, contemporary scholarship on ableism to promote inclusive practice.

Shaw et al. (2023)³: An in-depth study regarding the experiences of autistic medical students within the United Kingdom. The study reports Autistic students face challenges relating to encountering stereotypes, sensory processing and norms relating to socialisation. Significantly, the study advocates for increased understanding and support from medical schools, emphasising the importance of combating ableism.

Hogan et al. (2019)⁴: Explores the perspectives of disabled communities regarding improving HPE. Emphasises the need for training to be more inclusive and responsive to disabled people's needs, advocating for the integration of disabled people's lived experiences within curriculum to challenge ableist attitudes and practices.

Jain et al. (2023)⁵: This paper highlights the importance of incorporating a JEDI lens within educational research, with a focus on doing so to understand and challenge ableism. It discusses the complexities of engaging with JEDI issues in research, highlighting how neglecting these can lead to exclusionary practices. The paper encourages readers to actively engage with diverse perspectives and challenge ableism to facilitate inclusive practice.

Singh et al. (2022)⁶: The authors advocate for a paradigm shift towards embracing disability inclusion. The paper critically examines HPE and how it often portrays and treats disabled people as problematic. An alternative approach is proposed, where disabled trainees are seen and treated as integral to diverse educational communities. To challenge the systemic barriers and ableist attitudes disabled trainees face, the authors propose a quality improvement approach to build inclusive, equitable systems.

These articles collectively emphasise the necessity of a paradigm shift within HPE. We need to move from viewing disability as a problem to be solved to recognising disability as part of a diverse spectrum of human experiences. Across this spectrum, all should be afforded equitable access and opportunities.

A paradigm shift requires high-quality, empirical evidence.⁷ Critically appraising our articles reveals strengths and areas where further development is required. All articles advocate strongly for enhancing inclusivity. Two (Shaw and Hogan) are empirical, whilst two (Jain and Singh) are perspectives—we selected these intentionally for balance, though wider literature skews towards perspectives, and there is a pressing need for further empirical evidence. Available empirical articles are rigorous, though active consideration of transferability would be beneficial in enhancing impact.

Whilst this is far from a comprehensive review, the articles also signpost areas for development. These include exploring disabled learners' experiences of support,³ strategies for incorporating lived experience,⁴ the impact of power on educational outcomes⁵ and evaluating the implementation of quality improvement principles.⁶

In considering these articles on disability within HPE, we see an emerging understanding of ableism within our field and, through this understanding, begin to appreciate necessary changes to practice. Though all articles contain practical messages for teachers, they also signpost the importance of activism to challenge ableist systems. By collectively examining these diverse articles, we can begin to ‘learn’² ableism, so that we may effectively dismantle it within educational environments.

Megan E.L. Brown: Conceptualization; writing—original draft; writing—review and editing; methodology; formal analysis. Gabrielle M. Finn: Conceptualization; writing—original draft; writing—review and editing; methodology; formal analysis.

The authors have no conflict of interest to disclose.

The authors have no ethical statement to declare.