Accessibility & Inclusion in Teaching Across the Medical Education Continuum

Good afternoon everybody good to see you all okay today's presenters have um a little note for you all while you were in the waiting room if you were in the waiting room uh they posted a little chat message that ask asking you to complete a super quick little brief mometer quiz um Heather just pasted the link right into the chat now so if you go down to the click on the chat icon at the bottom of your screen you'll see a little link to the mentimeter survey just click on that it's just five quick questions um and that will help their presentation today um okay so we can go ahead and get started Isn't it nice when we all have access I had some accessability issues as we were starting as I was trying to log in um but there are folks who always have problems with accessibility um so it's really helpful I think that uh we make our present ations we make our teaching available for um the broadest group of Learners possible particularly if we know um that we have Learners with accessibility needs um so today we have Dr David halin um is one of our presenters he's an instructional designer and trainer um for the center for Innovation and teaching and learning at Redford University corillian and we also have Vianne Greek um who is a director of digital initiatives for medical education over at the Virginia Tech kilan school of medicine and Virginia Tech um so they're going to present today on accessibility and inclusion in teaching across the medical education Continuum again if people have just popped on there is a little Link in the chat so if you go to the bottom of your screen and click on the chat um you'll see a link click on the link and just complete that super brief survey that will help um David and Vianne with their presentation if you don't mind go ahead and take it away folks thank you all for coming here today and and for doing the mentor meter question what we like to get a sense ahead of time on what people's perceptions are as to what some of the barriers are for education for students with disabilities and in this case presentation been Tor for medical students with disabilities and David if you could switch over to the mentimeter screen and we'll we'll see what is popping up as you are completing the one question with five answers but so far we've had two people fill it in so far um so we'll give you a few more minutes to uh to add more information about every minute or so look at that more answers I like about this particular presentation and the mtim meter is as you fill in the answers more things pop up which is great so we'll give it one more refresh and then we'll switch back to the presentation look at that there you go thank you so much um so David and you can keep filling this in throughout the presentation you can keep clicking on it and for right now we just move on and one thing on this um what we wanted to come across was access and I'm glad I saw the word access come up rather large toward the end there because that seems to be the main issue and the main barrier really is ableism um it is society's low expectations of what people are able to do um and then so what this has here is an image representing a line of people going through a door that's labeled non-disabled only and then a wall separating people with disabilities there somebody in a wheelchair cane crutch user and what might be a migraine and intentionally or unintentionally and and I would go with unintentionally most of the time we are creating these barriers just because we don't think a top of Mind as to what folks with disability have to go through and so I wanted to talk a few bit about the the medical education continue with some of the systemic barriers that arrive there they start from the home from very young If the parents don't have the financial or or health insurance needs to take care of some of the disabilities the children have we're going to start off having some issues if the K through 12 situation isn't set up for specialized education um then we're going to have some barriers there access to college physical and digital accessibility access there getting into medical school there's all kinds of barriers there and that carries all the way through graduate medical education and Beyond so let's first talk about what what these systemic barriers could be and Cabrera Al talks about um the dsrp way of defining syst systems issues and they talk about distinction systems relationships and perspectives so the distinction we'll start with that is anything that's different or other than in fact we make them fill in a form that proves to us that they are other than so talk about a cool little system that makes you separate yourselves from others then we have various types of other systems that could impact people with disabilities there's funding systems there's Health Care Systems Technology access prioritization if there's money available for a new initiative where do you put it and often the people with disabilities are are left at the bottom of that list relationships so this is between the systems and also between people it's all about inclusion versus exclusion and belonging versus Outsider so the question to ask here is if you are not being inclusive in your approach who are you excluding from participating who are you treating as an outsider then we have perspectives social beliefs and attitudes and it pops up on LinkedIn and all social media all the time is that there is no greater barrier for people with disabilities than society's low expectations of their competencies and abilities and today's talk is trying to talk about accessibility and inclusion and teaching across the medical education Continuum what we're trying to do is go beyond the blue tag and we're going to do that by broadening what a um what the word disability actually means so our learning objectives are to list and compare three categories of disabilities Define the terms accessibility accommodation diversity and inclusion and then your challenge is to employ two strategies for creating content that reflect your learner unique identities and experience so my portion here will be on accessibility and then David will talk about inclusion so the our goal here with this is to broaden our diff definition of what a disability is as indicated by our title we want to go beyond that blue tag um often when we think about disability we just think about physical disabilities blindness deafness wheelchairs we see those all the time but definition of disability is broader than that uh and Mead Al adds two categories to it it says cognitive disabilities and chronic illness so cognitive disabilities could be dyslexia anxiety ADHD chronic illness could be something like cancer migraines or diabetes and when we look at these three categories we can identify each group as having different challenges the challenge for the physically disabled people is actually getting access to the environment this can be physical access such as curbs and elevators and ramps or it could be digital access such as caption screen readers um things like that the challenge for people with cognitive disabilities is understanding they may be able to get to the learning environment they're going to have some difficulties processing the content and then for chronic illness the main challenge is managing their energy they may need more frequent breaks and they may have some issues with medications and trying to manage those chronic illnesses but what they all have in common is that they all need more time and time is something that's also at a premium for us Educators especially once a class is already rolling uh we have limited time in blocks and rotations to make adjustments and so um we we propose by way of this presentation that we start saving time on the implementation Side by building in accessibility in the plan planning stage for your course so this is the period when you have more time available to be creative and make adjustments if you neglect accessibility and Universal Design for Learning in the planning stage then you'll have to provide accommodations in the implementation stage where time is really at a premium let's take a look at what these words actually mean so accessibility is the practice of creating materials in environment ments so that they are able to be accessed by people with disabilities accomodations are an academic adjustment to the learning environment curriculum or use of auxiliary AIDs that allow students with disabilities to have equivalent access to the education as non-disabled students the key here though is that accommodations generally only benefit effective students Universal Design for Learning involves creating inclusive learning environments that reduce barriers accommodate diverse learner needs and provides all stud students with equal opportunities to succeed and so the key here is if you incorporate udl it'll benefit all students so the next three slides I use primarily for illustration purposes to show you what would happen if you think about accessibility and udl prior to the implementation of your course I've listed 10 Common accommodations for the didactic setting the text is small um so I apologize for that but it gives you a quick um visual representation so this first slide shows the 10 accommodation which include extra time use of stools during the labs periodic breaks for physical and cognitive well-being and the need to provide notes during the L before the lecture the second slide shows what would happen if we made change changes to the course to where we could eliminate possibly up to seven of these 10 accommodations and if we removed time restrictions added stools um built in periodic breaks and provided notes for every lecture then if we address that on the front end we're only left with a few things on the back end so that's a lot more manageable for us on the implementation side and so that's that's our um our call to action for you uh um to to look for ways that you can improve your course and add ways to make it better for all students so that you as a faculty member only have to deal with fewer accommodations as you go so before we continue let's do a bit of a knowledge check Heather has created a poll for us um we have two questions in that poll the first question asks you to pair the categories of disabilities with the challenge that they face it's a matching question so you get a prompt with a drop down to select your options and the second question asks you to pair the definitions and benefits of the accommodations and Universal Design and again that is also a matching sty questions so use the drop down to make those selections okay so we just talked about the dactic setting so beyond the dactic setting this this presentation is about across the medical education Continuum so we'll go through a couple of ideas and tips for reducing barriage in the other settings as well so for lab setting um we may be dealing with some sensitivities to chemicals the need for specialized seating or Furniture um there might be some needs for plan brakes visual aids Etc I'm not going to list all of the different types here they're on the screen and they'll be available on the slide deck after the presentation in the clinical setting we suggest having a pre-rotation visit with the student to ensure they'll be able to access the facility also address any itudinal attitudinal barriers for the people who work at that facility there may be a need to change the order of rotations such as breaking up two intensive rotations with a less intensive one just to be able to conserve that energy and and mental capacity it's also important to note that the office for civil rights um considers a service animal at the same level as it does a wheelchair it's considered a right and not an accommodation they've ruled on this several times according to Meek sadell in the book in the gme side many of the things that apply in the clinical and clerkship side carry through the residency and Beyond so again we have making sure that things are accessible flexible scheduling to allow for replenishing energy for those with chronic illness and cognitive issues we suggest a mentoring programs providing role models and implementing training and awareness plans to address biases for competency and stigma and then making sure that your career advancement criteria are inclusive and they don't include any bias for the continuing medical education side a lot of this has to do with the planners of these programs so it's making sure that professional development opportunities are accessible and that they we include a diverse group of voices um think about the physical accessibility as well for conferences such as elevators ramps visual accessibility such as captions and transcripts for all your ongoing education efforts and I'll share a quick story recently attended in Orlando where um at the previous venue not this one there was a an elevator that had only a touch screen and had no Grail and there was a blind person who couldn't operate the elevator and their solution was that he had to wake up their the neighbor in the next room and have them help him with the elevator um I'm going to say that's not an acceptable way of dealing with this um the other person that told me this story uh she herself was a wheelchair user and they couldn't find the key that would lift her up to the floor that they needed to get her to with the wheelchair so they made her go to the garbage elevator and use that to get to the second floor these are all things that if you're planning a conference uh please make sure that your experience for the users is not that so for the future um venues the accessibility team's always been included on making sure that the venues are accessible so I hope this gives you a sense of things you could be thinking about as you prepare for your learning environment in any of these settings um um Heather I don't know if you're still planning on attaching the resources in the chat but they will be available on the website um as soon as she will post them so there's about 10 pages worth of information about fostering an inclusive environment about accessibility checks things like that and I hope you'll take a look at that and David will be talking about something called plus one and I hope that as you plan your course for the next term or the next block or the next year that you incorporate one or two of these ideas into the future of medical education here at vdcs so I'm in kolan take it away David okay so we're gonna move on to um talking about inclusion and first off thank you for everyone for uh showing up I see some names I recognize so it's good to it's good to see the names um so first off you often hear about Dei which stands for diversity equity and inclusion sadly this has become rather controversial and political but that doesn't discount its importance to education and Vian was discussing accessibility and so you see we can add the A on there for accessibility and we end up with de a and I've started seeing it flipped around and when you do that you have idea which I think is a much nicer um term and encompasses all of those Concepts inclusion diversity Equity accessibility they're all somewhat related but I want to start off by talking about a couple definitions so with diversity that relates to individual differences that you see here in group group social differences that can be engaged to achieve excellence in learning research scholarship and administrative and support services for our Learners and then if we switch over to inclusion inclusion involves the active intentional and ongoing engagement with diversity in people in the curriculum in the co-curriculum and in communities with which individuals might connect and so it's tied to div diversity but it goes further than diversity and I've often heard an analogy a sandwich analogy which I like that says that diversity is having all of the ingredients you need for a sandwich on your counter spread out before you and inclusion is putting all those ingredients together to make a tasty sandwich and so that's what we want to do we want to make sure we're using all of our resources that are available to us now here are some related terms you may be familiar with separation in the top left to me is similar to segregation where a certain group of others is set aside from the main group and next is inclus exclusion which is when you leave certain people out of your little bubble you're not segregating them you're just leaving them out and then we have integ ation well they're in the bubble but you're still leaving them out and finally inclusion where you're making an active effort to include everyone and when you do that you find out that there are no others because you're all together on one team and here's a quote it's a poem that ties into that and it's only four lines he drew a circle that shut me out heretic Rebel a think to flout but love and I had the wit to win we drew a circle that took him in and so going back to that Circle that bubble we want to draw a circle that takes in all of our Learners and includes everyone now here's kind of a a related cartoon that I've seen a lot that ties back to what Vianne was talking about but it also ties to inclusion so in this cartoon we have a set of kids who are waiting to get into school and there's a man shoving the steps and a disabled child he says could you please shovel the ramp and the man says well all these other kids are waiting to use the stairs when I get through shoveling them off I will clear the ramp for you and the child says but if you shovel the ramp we can all get in and so the thing to keep in mind is that being more inclusive doesn't take away from anyone else if you attempt to incorporate more inclusive practice IES into your teaching or your work environment it won't hurt you now the man who's shoveling probably thought he was doing a good thing by offering to shovel the ramp which is to say that most of us don't intentionally want to leave people out we just may not know the best ways to be more inclusive and so I'd like to approach this from the perspective of communication Theory so communication Theory describes how information is passed from one place to another and every communication involves a sender a source who has a message to present and the sender has to encode that message to prepare it for delivery to a recipient and they utilize a Channel or multiple channels to deliver that message and then the receiver receives the message and then has to decode it and you'll notice here we have noise that can interfere at any step along the way and there can be many sources of that noise and they serve as barriers to effective communication and in our case learning they're barriers to learning and you'll notice these these ovals these fields of experience are going to determine how the sender encodes and delivers the message and how the receiver decodes and interprets that message and so the more you take into account your learners unique characteristics their backgrounds experiences preferences all those things the more effective you'll be at being an instructor a preceptor a clinician or a coworker and that means being more inclusive so let's talk a bit about how you can create more inclusive learning environments and here's a definition I like for inclusive design it is design that considers the full range of human diversity with respect to Ability language culture gender age and other forms of human difference so awareness compassion and togetherness form the core values of inclusive design so that means awareness to recognize the diversity in your learners compassion to include the needs of those who are different from us and togetherness in Sharing positive outcomes of the process so prior to your experience and this me means whatever learning experience that you are developing there are some things you can do as you're getting ready so the first thing is to try to understand your learner characteristics their backgrounds the prior knowledge and experiences and their potential needs and you can conduct A needs assessment to do this and there are a lot of different ways to do that but certainly for medical students um we can we have a good set of demographic data already on on the students who are coming in and by assessing the requirements of your learners you can design learning materials that meet the needs of diverse Learners and so when you're creating activities for your learners here's a few things that you can do to be more inclusive first off you can make your expectations clear so don't leave room for ambiguity in what you're asking your learners to do the clearer you are the more likely everyone will understand what you're asking for and then B based on who your learners are look for potential misunderstandings the next thing is to have clear deadlines what is expected and when is it expected if we're talking about traditional course assignments you might want to perhaps even reassess your deadlines because deadlines that are too strict can be inclusive and Vianne talked about time a little bit earlier and you don't always know what's going on in people's lives so a little Grace shown at the right time can make a big difference in people's lives and so looking at your deadlines can be one way to do that and different cultures look at deadlines differently than we do so um you have to keep that in mind another thing is to build in multiple opportunities for you to provide your learners with feedback and I call these mile posts or check-ins and it shows the Learners that you care and gives you an opportunity to see how doing other things include sending frequently frequent reminders um announcements and again remember by doing these things you're not hurting anyone none of your learners are being excluded by making efforts to include everyone another thing you can do while you're creating activities is you want to make sure to create diverse learning materials that incorporate multiple perspectives examples and case studies obviously we want to do that I was recently reviewing a set of culturally diverse case studies and I was amazed at the at the Variety that they had included one involved the young undocumented teenager another one had an elderly Asian woman another one had a young woman from Mexico who was working as a laborer one was an elderly Iranian immigrant one was a young Afghani woman and you can include cases that feature LGBT Q people and the issues they face young people elderly families a wide variety because data from the US Census shows that less than half of the nation's children aged 15 and under are single race non-hispanic and white and so not only are you being more inclusive towards your learners but you're helping them prepare for the population that they will be working with because diseases don't discriminate your learners will have to interact with all different types of people and this image is from the patient diversity campaigns very very good site just as important is that by ensuring that Learners cultures and identities are reflected in the learning environment you're helping them develop a deeper understanding of the content this connection between their own experiences and the educational material enhances the significance of their learner and increases their engagement and it's also called culturally responsive teaching so other things you can do are to create activities that provide Learners with options for how they complete them um this could be for example uh having them decide on the topics they want to use for an activity or giving them multiple ways to meet the requirements of the activity this could could be say a literature review on a controversial topic that they are interested in or perhaps a health assessment assignment on an underserved population of their choice or perhaps they can choose topics or cases related to an identity of theirs and also you can leave room for creativity which can allow them to um you know bring out some of their background and their interests now vanan touched on this idea of plus one thinking and this is a comp a component of Universal Design for Learning which is an educational framework that attempts to reduce barriers to learning and maximize accessibility for the widest range of Learners and it says for every interaction that you create offer another way for Learners to get the same information and here's some examples here another example might be and I think I saw this earlier if students don't seem to take notes well in class you can provide your notes ahead of time say on the on the learning management system this could be a particularly of interest to say International students who may have a difficult time taking notes because they have to process a second language before they can write the information down and so it takes them longer to to write notes sometimes so that's just another idea so during your learning experience you can provide opportunities for Learners to share something about themselves to include a part of their identity into what they're doing and by doing this you you can then learn more about their lived experiences you might learn about their family you might learn about their struggles growing up you might learn about their interests do they have pets I know several people here have cats already um are they a Swifty you might learn the grandma loves heavy metal music and to me that's much more interesting than just having a line of unknown formless people passing through your experience in some of my courses I have activities that encourage Learners to be creative or share something personal about themselves what brought them to the point they're at for example an essay that asks why are you here studying a healthc care field what brought you here the answers can be very interesting and sometimes quite moving and by doing so you start to see them as complex human beings and again this can subsequently influence the design of future activities and I always tell everyone that you should always approach your learning experiences with the idea that it is in constant revision every learner question should be saved because every learner question reflects the backgrounds experiences and diversity of your learners so when I get an email from a learner that says can you explain this more or I don't understand this or any kind of question I immediate you make a note of that for next time I say okay I received maybe a couple questions related to this maybe I should rethink um how I how I ex you know explain things and how I ask for um the assignments to be completed some Learners may be reluctant to ask questions or point out discrepancies in learning materials and this could be due to anxiety or cultural differences in some cultures Learners are not encouraged to speak up or ask questions of instructors so it's important to keep that in mind it's also important to make sure that you use current examples and references and make them relevant to your learners and to be careful of jokes and cultural references and that doesn't mean you can't be humorous but you have to be um culturally sensitive and be aware that your learners may not always get your jokes so when I taught courses at Virginia Tech a while back I had a large number of foreign students in our program and they were from all over all over the world and I realized at some point that my exceedingly clever pop culture references were resulting in blank stat for my um Learners because I was talking about the Brady Bunch to people from countries who had never even heard of that but as I learned more about my students I was able to incorporate things that they understood better so for example I had a lot of Asian students so when the Lunar New Year came around I was able to um talk about it and wish them a happy Lunar New Year for my Chinese students I learned to say shinin during the Lunar New Year and another example is just a couple weeks ago I made a reference to a Seinfeld episode and this is with the medical students I made a reference to a sein Fed episode regarding standardized patients and the students had the same blank look that my students had when I talked about the Brady Bunch um because they heard of Seinfeld but they hadn't actually seen it and so as you get older you have to update your your comedy material although it was a funny episode and it was relevant to what we were talking about so the other thing you want to do is foster a welcoming supportive and safe space where all Learners feel accepted and valued and one good way to do that is to facilitate peer work so if you create activities that require participation from everyone and you encourage your learners to interact with each other they're going to learn more about each other and you're also including everyone so you have to design the activities to make sure everyone's included even the student who used to sit in the back of the room and never said anything looked at their paper and didn't look up you have to try to get them involved and getting people with diverse backgrounds to work together is the best way to foster a respect for differences and to make sure everyone's included and it's and it's even better if you can get them to share something about themselves so for example ask them about a book they read recently share the history of or meaning behind their name uh a couple weeks ago I had to go to a retreat out at Smith Mountain Lake and they we played people Bingo where you have the Bingo cars and you have to run around find somebody that that meets all of the things on your car to to get bingo go things like that also during your learning experience provide promote respectful communication encourage diverse perspectives um and promote inclusive language if possible you want to provide multiple means of assessment some students may not perform well on certain types of assessment um authentic assessment is preferred certainly when you're doing clinical types of activities you're you're you're you're doing more authentic assessment but ideally authentic assessment attempts to provide the same conditions students will encounter in the real world so the closer you can get to that the better and then some a couple of notes for online courses to to make students feel more included make sure you're present in the course frequently instructor presence is the most important best practice for an online course and you also have to look for ways to build community to get again get the the Learners interacting and then consider technology barriers barriers that your learners may have that's also another critical point the digital divide does exist between those who are able to take advantage of technology and those who are not and digital exclusion happens when people are not able to access the benefits of technology and being digitally excluded whether because it's a lack of Internet access a lack of digital literacy or other barriers marginalizes people and so certain groups of Learners are more likely to face barriers to digital inclusion and that includes people living in poverty um older adults people with disabilities non-native English speakers or those living in remote or rural areas when we uh when we went through the pandemic we had a lot of difficulty with some students you know being able to get access to all the online materials we were putting out there and some students would actually drive to the the building the hospital and sit in the parking lot so they could take advantage of our Wi-Fi so keep that in mind and then I want to talk about again communication just mentioned Troublesome non-inclusive language when possible you want to try to use inclusive language and behaviors and there are so many examples but I've included a few here um Brown Bag lunch freshman we have a lot of words that that have man at the end of them um and as a society we're I think we're slowly trying to move away from that um things like Blacklist and white glove the colors black and white have long carried um opposite connotations with black representing evil and and disgrace and The Black List is is what you don't you want to put things on there that you don't want and white connota decency and Purity other things include terms like illegal alien Native American type terms circle the wagons and the last one's powow well I've been using that word for my whole life but I just recently read something that may me stop and think about it um that said it could potentially be insensitive to Native Americans because the powow was a was kind of a sacred ceremony that they undertook and so I've had to rethink that but I'm okay with that it's just I didn't know it I just always said hey let's have a pow and talk about this you know this project we're working on so you can't be expected to know everything and then a couple more things Troublesome behaviors ignoring pronouns and preferred names that's obviously um more recent development and I listed standup meetings here because um years ago I worked at a a small company and they like to do kind of fad type things and so one of the fads at the time was you bring people in for a department meeting you have everybody stand up for the meeting male and it was supposed to be a a a 10-minute meeting well at the time I had a bulging disc in my back and so okay we stood up for 10 minutes but their their 10-minute standup meeting lasted over an hour and so this goes back to what Vianne was talking about you don't always know who has the disability not everybody's in a wheelchair and so I stood there and after about 10 or 15 minutes the pain started and by the end of the the meaning I couldn't I couldn't walk anymore because of that so just building that awareness I think is is is the critical thing and I want to Circle back at communication Theory to remind you that being inclusive is all about being able to effectively get your message across to your learners and you do that by being aware of how you encode your message and the channels you use to deliver Del that message so you're using multiple channels giving Learners an opportunity to receive your message in different ways that benefits them and you also do that by respecting the backgrounds knowledge experiences preferences interests and other characteristics of your learners that field of experience that you see there which represents their lived experiences and you also do that by being aware of potential noise those barriers that can interfere with learning which include technology barriers language barriers cultural barriers disabilities and by your commitment to being more inclusive so you have to commit to doing these things to learning more to being the guy that's shoveling the snow and realizing oh you know what I can do better because I can shovel the ramp and that's going to help everybody at once and not single out one person and so I'm asking you for commitment to being more inclusive and I end with this another quote from pearl S buck who is a famous author who had some very interesting lived experiences that she wrote about and she says exclusion is always dangerous inclusion is the only safety if we are to have a peaceful world and so with that I'll stop thank you all so much um for this Illuminating conversation um if anybody else has any questions um I'm sure you can contact Vianne or um David to ask additional questions or engage in further discussion hope you all have a wonderful rest of the day.