Episode 48: Dr. Allison Kessler

In this episode we are joined by Dr. Allison Kessler. Allison Kessler, MD, MSc, is the Section Chief of Renée Crown Center for Spinal Cord Innovation. She is board-certified in Physical Medicine & Rehabilitation (PM&R) and Spinal Cord Injury (SCI) Medicine. Dr. Kessler is the Associate Director of Shirley Ryan AbilityLab's SCI Medicine Fellowship. She holds appointments at Northwestern University Feinberg School of Medicine as Assistant Professor in the Department of PM&R and Teamwork and Leadership Curricular Thread Leader.

Transcript

Allison Kessler, MD

Transcript 

 

Lisa Meeks:

Doctors with disabilities exist in small but measurable numbers. How did they navigate their journey? What were the challenges? What are the benefits to patients and to their peers? What can we learn from their experiences? My name is Lisa Meeks, and we are thrilled to bring you the Docs With Disabilities podcast. Join me as I interview Docs, Nurses, Psychologists, OT’s, PT’s, Pharmacists, Dentists, and the list goes on. I’ll also be interviewing the researchers and policymakers that ensure medicine remains an equal opportunity profession.

Sofia Schlozman:

Welcome back to the Docs with Disabilities podcast. In this episode, we are joined by Dr. Allison Kessler, a spinal cord injury and Physical Medicine and Rehabilitation physician practicing in Chicago, Illinois. Dr. Meeks and Dr. Kessler first met several years ago, when they worked together on the AAMC's 2018 report on Accessibility, Inclusion, and Equity in Medical Education. 

 

This publication, which we will link to in the episode notes, shares the lived experiences of learners and physicians with disabilities and highlights the importance of including disability in diversity and inclusion efforts in medical education.

 

In this episode, Dr. Kessler and Dr. Meeks reconnect to discuss accessibility in medical school, how to improve care for disabled mothers, and the importance of providing and receiving mentorship. We begin with an introduction from Dr. Kessler.

Allison Kessler:

Hi, I'm Allison Kessler. I'm the section chief of spinal cord injury at the Shirley Ryan Ability Lab. And I'm also an assistant professor of physical medicine and rehabilitation at Northwestern Feinberg School of Medicine. Thanks so much for having me today.

Lisa Meeks:

Allison, you know that I'm a huge fan. We met when we were conducting the lived experience project with the AAMC and I just loved interviewing you. I loved your story. I loved your perspective. I would be lying if I didn't say I loved a little of the cheekiness too. And we just got along so well. I'm thrilled to be able to circle back and just chat with you and talk about what you've been doing in this space. So I'm so excited and I'm so grateful for you making the time. 

 

And because I know your story from that AAMC project, there are a couple things that I would really love to get in this podcast. But I'm gonna ask you to talk in general about your experiences of being a wheelchair user as you were entering medical education. If you can just talk to the listener about what that experience was like, and why you decided to apply to Northwestern and, how you even came to the conclusion, given all of the ableist messages that are in our society, that you couldn’t be a physician. 

 

Allison Kessler:

Yeah. You know, it's really funny, obviously you brought up the lived experiences. And it's so interesting to even just think back on my own journey over the past five years. Cause I think it was about five or six years ago that we did that. Right? And I have to tell you that the further that I get along in my clinical practice and my academic practice as a teacher and really thinking about all of these things, it's really interesting to understand my own evolution and to be able to think back and, oh my gosh, all the mistakes that I made. And so being able to kind of share some of those both positive and negative, you know, if I could do it again, I'm sure I would've done things so much better, but that's always what happens, right? Hindsight is that 2020. 

 

So thinking back into my own journey, I came from a family of physicians and after my own injury, I knew that I really wanted to go to medical school to be able to help care for other people in, in whatever way. And I wasn't sure when I first went to medical school, what I wanted to do, but I did know that I wanted to be in a place that I thought understood taking care of people with disabilities.

 

I had done my own inpatient rehabilitation at Rehab Institute of Chicago, which is now Shirley Ryan AbilityLab where I work. And they are affiliated with Northwestern medical school. So I was really committed and wanted to go to Northwestern medical school because I felt that because they were affiliated with RIC now, Shirley Ryan, that they would perhaps really understand what it means to have a student with a disability. What I can say is that I did not know what technical standards were at the time, but I just knew that I would be able to do it. I just needed to find a way to get someone to believe in me. 

 

I went to a women in medicine conference recently and there was an amazing female neurosurgeon that gave a talk. And she talked about how, when she was a resident that she tried to fly under the radar and not let anybody know she was a woman because neurosurgery is very male dominated and being a woman was somehow perceived as not a good thing or a weakness or something like that. And so she was very happy when anybody didn't realize “that she was a woman”. Now, obviously her perspectives on that have changed completely now that she's a woman out in practice and has really reflected on, you know, it shouldn't be this negative, bad thing to be a woman, right? She celebrates being a woman now, but she didn't when she was in residency. And that really resonated with me because I realized that I did the same thing in medical school. I tried (laugh) with every fiber of my being to fly under the radar. 

 

Now, obviously, you know, I have a very visible disability. I'm a wheelchair user. I can't hide that, but I can draw as little attention to it as possible, right? And that was the tactic that I took. I thought that if I just downplayed it and was like, “nope, don't need accommodations. I'll be fine. Let's just, you know, roll with it literally and figuratively,” that would be my way to do it. Now again, in retrospect, I shouldn't have had to do that, and I probably would've done things a lot better earlier in my career had I been able to both celebrate and express that, but I didn't necessarily feel that  people were receptive to that at the time. 

Lisa Meeks:

Did you feel like you had to be a better student, like you had to perform better? Was that part of this whole like flying under the radar?

Allison Kessler: 

Oh, of course I had to be better. I had to not mess up. I had to not draw attention to it. You feel like this burden, or sometimes you feel like they don't want you there, especially in settings, like in an OR, places like that. And so I tried to sort of shrink my presence and, and not be that problem. 

 

When I talked to the, the powers that be for accommodations and things like that, they really wanted to help me, but they didn't know how, they didn't have the language or the skills to really  be able to provide for me what I think I needed. What I mean by that is like, they were a hundred percent willing to do things for me, but they would only do the things I asked for. And the problem was, I didn't really know what to ask for, right? When you enter medical school, you don't really know what medical school takes. You don't understand how all the rotations work, you don't understand a lot of things, you're learning as you go. And so it's really hard to ask for accommodations if you don't really know what's going on. 

Lisa Meeks:

I think that DRP's that do not have specialization in medical education are one of the biggest barriers actually. And like you said, there's no intention there to do any kind of harm, but you can't possibly facilitate access if you don't understand what you're facilitating access to.

Allison Kessler: 

And that was the problem I showed up the first day and they said, well, what accommodations do you want? And I was like, I don't know, what do I need? 

 

Lisa Meeks: Exactly

 

Allison Kessler: I mean, the only thing that I knew concretely, and this actually came from Susie Kim, who is amazing. Susie Kim is a wheelchair user that I met, and she is a physician and she gave me some tips and tricks specifically for the OR. She kind of said, you know, your surgical rotation is gonna be one of the biggest barriers. I used this standing chair. It really helped me be able to be involved in the OR and be a part of the case, and so that was one of the accommodations that I asked for, cause that was the one I knew I was supposed to ask for. Again, to my medical school's credit, they were great. They actually purchased the chair. which I think is fantastic. 

They were interested in helping me. They just didn't know what I needed, but I didn't know what I needed. And so that was the hard part. And because I didn't know what I needed and I felt like asking for things, would make them not like me or, you know, sort of, because they didn't have the language to make me feel supported. I felt like asking was not okay. And so I really didn't ask for things until it really came to a head and, and I really needed them, which again, if I could go back, I would do it a lot sooner.

Lisa Meeks:

We have so many learners and probably people that are listening to this podcast right now are kind of crowdsourcing information. For a while there was almost this underground network of wheelchair users who had spreadsheets of what other people had done in other clerkships. And part of it wound up in, and one of our books, because one of the authors was a student who was crowdsourcing this information. It has not been information that is well known and so you really kind of have to be connected to this network, or you had to have been a super outgoing person who was willing to email a ton of people and do the research and scour the web for stories of physicians that were wheelchair users. 

Allison Kessler: 

Nobody was talking about these things. When I went to med school, it wasn't a conversation. And so what I love now, as in the past couple of years, people are starting to acknowledge the problem. And that really is the first step, right? We can't fix something unless somebody acknowledges that there's a problem.  People are talking about bias right now. People are starting to talk about ableism. People are starting to open the conversation and the dialogue up. And what I love about that is that's now creating the space where people are getting funding, to be able to do these things that I think will really be able to help support our students down the line. And I love that the conversation is out there.

 

Obviously we're not there yet, right? We have to take the conversation and move it into practice, but that's the first step. And so that's really been a big change even in my, career thus far is to really see something that was very underground, very hidden, very much not acknowledged is now starting to be acknowledged. And we haven't quite figured out how to fix it all yet, but, but we're on the way, right?  One of the biggest things that I remember and we talked about this in the lived experiences was that there were so many just background ableist things that were occurring during my medical school career. And I didn't have the ability to get people to understand why it was a problem.

 

Even things like the, you know, the first week the team bonding experience was a high ropes course. Well, you know, obviously I'm not gonna be able to participate in that team bonding experience for our class, the student council set one of the graduation venues as a non-wheelchair accessible venue. These are the things that, again, there's this language out there now that people have. And those events don't take place at Northwestern anymore. 

 

There’s been this understanding and this acknowledgement that to be able to better support our students, that we need to recognize ableism in medicine and make those changes. And what I love in my career is that I'm seeing that happening. Again, my disability is visible, but not everybody's is. And so we have to do better as a community to think more inclusively when we design things, someone shouldn't have to come and ask you for the accommodation. You should think about designing things universally to be open for all of your students who may not have disclosed to the greater, population, whatever their accommodations might be. And if we think more inclusively about how we design curricula and even just social activities and team group things that I think we would better support all of our students, and again, the conversation's out there now, and that's starting to happen. And I'm incredibly excited about that.

Lisa Meeks:

I am literally grinning ear to ear because that was exactly the part of our interview that I wanted to talk about.  I need you to know that your stories to me during that project, I went back and wrote an article about accessible orientation.  Even if you have an office, even if you think you're doing everything right, ableism infuses everything, and you're not thinking about it. It's not like you're trying to exclude people, but you're not gonna know, similar to what you said, if somebody has a disability. So somebody with a chronic health disability going on, you know, five mile hikes, you have to be more thoughtful 

People need to be thinking, how do I create a celebration space that is accessible? Or how do I make sure that what I am creating is going to be accessible to everyone. And it's such an important point. 

 

But Allison, if you hadn't talked to me in 2016 or whatever, you know, way back date we had actually moved this forward, you and everyone else who participated in that AAMC project and agreed to be interviewed, and who gave us such rich stories and rich information, and the AAMC, of course, who published it and let us have a lot of, creative license on how we presented the information, I think without those partnerships and without people like you sharing their story, we wouldn't be where we are.

 

And I certainly respect everyone's decisions about whether to disclose and not disclose. But for those that have shared their stories, it has been remarkably impactful. We get emails about the podcast on a weekly basis from learners that say, you know, that really resonated with me, that got me over a hump just hearing  that that was possible in medical school, I got to play this for my administrator. So these stories help kind of tear down the assumptions that people with disabilities cannot be physicians.

Sofia Schlozman:

In the next section, Dr. Meeks and Dr. Kessler discuss the value of mentorship for students and physicians with disabilities. Listen or read along as Dr. Kessler shares the role models that impacted her training experience and describes her ongoing mentorship efforts.

 

Lisa Meeks:

And that leads me right into my next question for you, which you sort of spoke to already, which was, did you have a role model, and was it important, and how important was it to know that somebody else had done it?

Allison Kessler: 

Yeah. Shoutout to Susie Kim. I think that like I told you, people didn't know how to help me and not through malice, not through any kind of mal intent, but they didn't know how to help me. And so I really needed someone to be able to turn to and say, I'm going to do this, but how do I make it the best that it can be? How do I do the best that I can, and what can I do to make this work? And so having had her do it before me and be able to say, yes, it's doable, and here are some tips and tricks. That is just invaluable because otherwise, you feel like you're sort of reinventing the wheel, or just out there on your own, laugh trying to figure it out.

 

So I think being able to have those people and have those role models is part of what I'm trying to do to pay it forward. That's what Susie did for me, and I try to do that for other people. It's really funny that you talk about the lived experiences and just sort of thanking those of us who shared our stories with you. I think, do you remember at the time I wasn't so comfortable being outwardly vocal, right? I was, I, I was willing to share my story with you, but that was anonymous at the time.

Lisa Meeks:

And, and for the audience, I did ask permission before we started (laugh). But it was absolutely anonymous. 

Allison Kessler: 

I had never shared the story because I felt, you know, that people didn't wanna hear it. And that goes back to the original me trying to sort of fly under that radar. I didn't feel that people wanted to hear it, that I didn't, I couldn't share that, that I was somehow, not helping by sharing that story. And I think after discussing with you was the first time I had ever taken those thoughts and feelings and actually translated them into spoken word. And I think once you say something out loud, it makes it different. It makes it real. And I really feel that part being part of that experience helped me be able to look outward and say, what can I do? I did it so let's help other people do it.

 

 I only had one role model that I could find she was fantastic, but wouldn't it be great to be able to see more people and to your point, crowdsource from a lot of different people, how, how we all kind of made things through and did things. And so, I am trying to take my own experiences, and my own cognitive faculties as a clinician, who's looking at the research, looking at the literature, looking at the data, and be able to translate that into how do we help other learners? How do we combat ableism and biases for our future physicians for all physicians? And how can I use my own lived life experience to translate that into both my clinical and my teaching career. And so I've really taken that thought process of I'm trying to hide it to now, I wanna celebrate it, now. I want to be open about these things. And that's part of why I said yes to doing this podcast is I want other people to feel empowered to have these discussions openly, because that's the only way that we're gonna be able to help other people move their careers forward and be able to do the things that they wanna do.

Lisa Meeks:

I love everything about that.  We have all these projects coming up and one of them is actually literally called women with disabilities in medicine. It's a mentoring group and I need to find mentors and I, have all of this stuff and I just I'm like, okay, let's finish the podcast and then can we talk for another three hours? Cause there's so much.

Allison Kessler: 

Remember that I wanted to do a mentoring group when I was a medical student. I tried to get that off the ground. And what we found is this goes back to people didn't want to disclose.

 

Lisa Meeks: Yup

 

Allison Kessler: They didn't want to talk about their disabilities openly

 

Lisa Meeks: Nope

 

Allison Kessler: And we couldn't find enough mentors. We couldn't find enough people that were willing to openly disclose their disabilities. And I have to tell you that was way more true when we're talking about invisible disabilities. And trying to find those kinds of mentors was just really difficult because it has to be something that self-selected, and it has to be something that people are willing to self-identify. And as I said, at the time that I, I wanted to make that happen, this conversation wasn't out there. But to your point, the dialogue is starting. And so now is the time to do it. So yes, I'm so on board with helping (laugh). Yay.

Lisa Meeks:

I'm so excited. Our time together was really rewarding for me as well. And like I said, it almost immediately translated into some resources for people to say, look, you need to be thinking about all of these different areas that have barriers 

MUSIC

 

You're obviously in practice, and so it's an awesome opportunity for the listeners to kind of have one story that's continuous about going into medical education and then going into residency and then going into practice. And so with that being said, you know, one of the things I'm curious about was how that experience that you had in medical school, how it was different for the match. In what ways was it worse? In what ways was it better?

Allison Kessler: 

I think I knew a lot more about what I wanted and I knew a lot more about how to find a community, and I think I was more able to be honest with myself, that I needed to pick a place where I felt supported for me to be able to be the best physician that I could be and really succeed. So, when I went into the match, I had a lot better idea of what it takes to succeed in medicine. That translated into how do I find a community that I think will be able to meet those needs and not just meet them, but really support and champion me. 

 

That is how I picked and I matched it, my first choice, and I have stayed on here and this past year I took over as the spinal cord injury medical director for our inpatient, we call them section chiefs, but it's our inpatient medical director for the spinal cord injury unit. And so that has just been so exciting for me to be able to take that journey full circle from being a patient here, to trying to get into med school, to deciding to go into PM&R and spinal cord injury. And now I get to help shape our clinical practice. And it's just been an amazing journey. And I'm so excited in my new role because I just started. So I have a lot of things that I wanna get done over the next, you know, long time. 

 

But part of looking for residencies, I've never actually shared this story with anybody. One of the places that I interviewed, I think it was a clinical psychologist that was doing the interview and he asked me, how was I so successful in my rehab? And I was like, what do you mean by that? And he is like, well, we have so many patients, who've had spinal cord injuries and they don't do well, but you obviously did very well here, you are applying for our residency. So how did you do it? And he didn't wanna talk about where I was and what I wanted from my career and what I wanted to do moving forward. All he wanted to talk about was my inpatient sort of time. And at that point that had been a long time ago, right. I was an incredibly different person, and I had aspirations and desires and things that I was excited for in my medical career. And he just didn't wanna know any of that. And I found it really disheartening that he was focusing so much on just like, well you were disabled, but you didn't “suffer.” And he didn't wanna talk about the empowering aspects of what I wanted to do. And that really turned me off. That was one of the places I was considering ranking number one or number two. And it dropped well down in my ranking because I, I didn't feel that he understood where I was coming from and what I wanted to do. As I said, I, I think I just was so much better going into the match for residency on asking people, how are you gonna support me? What can I do here? I felt that I had a better understanding of myself and, and what it meant to feel supported and it helped me pick, I think, a lot better community for me.

Sofia Schlozman:

The conversation now shifts to discuss the barriers faced by disabled mothers. Listen or read along as Dr. Kessler shares her experiences with pregnancy and motherhood, and her efforts to improve access to quality women's healthcare for women with physical disabilities who want to be parents.

Lisa Meeks:

Allison, you’re a mom. I wanna talk to you right now about your experience becoming a mom. And, you know, oftentimes when I'm out doing trainings or I'm doing a talk, I'm sharing one, how many disabled people there are, right, in the world two, the disparate health outcomes that exist within the disability community and the disparate access to healthcare. The example that I use almost exclusively at this point is the example of women that are wheelchair users, or that have physical disabilities and their access to women's medicine and their experience with childbirth and getting counseled on pregnancy. What was that experience like for you? I'm sure you already know the literature and you are a physician. And so you're in this weird space of having this amazing amount of knowledge about medicine. And then of course having a mother that's an OBGYN, what was that experience like for you?

Allison Kessler: 

This is one of those same examples of, you know, I've read the literature and I'm so disheartened by it, and I've seen it firsthand with my own patients. So many people and women with disabilities being told they can't get pregnant, they shouldn't get pregnant. It would be, you know, unconscionable that they would want to be a parent or have children. And so I've seen this firsthand as a clinician. I've read the literature and, and I, I have to say that this is one of those times where having also lived it. This is now something that I want to really focus my career on moving forward. I want to be able to help improve access for women's health and particularly wanting to have children or be a parent, because you don't have to carry a child to be a parent, but I want to help enable clinicians moving forward to be able to have that conversation with women with disabilities.

 

Again, obviously, my clinical focus is predominantly women with spinal cord injury or spinal bifida. But I think a lot of the topics and discussions that we're having around this are really more widely applicable to women of all abilities. You know, as you said, I came from a place of privilege. I have two children. I knew that carrying them physically would be difficult and that there would be some challenges related to, you know, my spinal cord injury during the pregnancy. But I also know, what pregnancy isn't hard, (laugh) right? Pregnancy itself is hard. And to your point, I came from a place of privilege where I figured between my own expertise as a spinal cord injury physician and my mother's expertise as an OBGYN and picking an OBGYN that I felt I could talk to about my knowledge and concerns that together our community would be able to help me go through pregnancy successfully.

 

That doesn't mean that it came without challenges. And I think my own experience really opened my eye as to, you know, it was hard enough for me and I had all of this access. How in the world do we expect some of our patients to be able to do this? One example is most OBGYN offices don't have a wheelchair scale. Well, you know, monitoring weight is one of the most important things that we do during pregnancy for all women. Right, and my OBGYN office didn't have a scale either. And so I work at Shirley Ryan ability lab. I have a bunch of scales, so I was weighing myself. But again, that's the luxury I had because I'm a physician, what do my patients do, right? And so it was really hard and I, and I had to direct a lot of my own care. And I have to tell you as a physician, I don't want to direct my own care, right? I want someone else to tell me what to do. And I want someone else to, you know, be the expert, cause I'm not an OBGYN. I'm not an expert in OBGYN, but I am an expert in spinal cord injury and I do know myself in my own body. And I did find that I had to be very vocal and very well informed to help steer things, to make sure that I have the best outcomes possible. So I do wanna take my own experience and my own knowledge and understanding. And my own understanding of the literature and what's out there.

And I want to, in my practice, in the future, be able to drive that forward and really help with understanding and perspective and counseling and all of the things that it takes to help women with disabilities, be able to be parents in whatever way they want to be or choose not to be. And I'm okay with that too. But I think people should be choosing not to be a parent for the right reason. Not because someone else tells them that they shouldn't. Being a parent is hard. I have a one and a half year old and a five year old. So again, it's not for everybody, but I want that decision to be thoughtful. And I want that decision to be because the person wants that. Not because someone tells them that's what they have to do.

Sofia Schlozman:

Although efforts to improve accessibility and inclusion in medical education have increased over time, additional improvements are certainly needed. In the next section, Dr. Meeks asks Dr. Kessler to reflect on the areas where she perceives ongoing shortcomings to disability inclusion.

Lisa Meeks:

In the last four to five years, I think we've improved the climate definitely for students with disabilities, but it is, it is situational, right? What are areas where we have room to grow?

Allison Kessler: 

Oh man. I mean, if you look nationally, as, you know, we just still have a long way to go. The numbers are still minuscule in terms of how many people are even accepted to medical school. Even some of the lectures that I've been to where people are talking about the technical standards and how we should apply to medical school. I mean, some medical schools still have on their website "We're sorry, disabled people aren't really welcome here because they don't meet our technical standards". And we believe that being a physician takes all of these physical attributes. And so that is a hard pill to swallow because I know so many wonderful people and physicians who are great at their jobs. And no, they don't meet those stringent technical standards, but it doesn't mean that they aren't fantastic physicians. And it doesn't mean that their voices aren't important when we're talking about increasing awareness in medicine in general. There was the 2021 paper that came out talking about physician perceptions of working with patients with disabilities, right. Less than half of the physician surveyed and how many people were in that survey, 750, something like that. Less than half of the physician surveyed said they welcomed people with disabilities into their practices. Yeah. I mean, that's, that's scary.

Lisa Meeks:

That's Lisa's Iezzoni's paper in Health Affairs. We laugh because she says, I can't believe people answered honestly, either. Right. (laugh) There's this, I mean, one of the biases, one of the limitations of papers is social desirability and how you respond to something in a way that makes you look good. 

Allison Kessler: 

They didn't even blink. They're like, yeah, of course. I don't want patients with disabilities in my practice. I was like, okay, interesting. All right. And that's, and, and, and that's where, you know, why I think it matters is because you have to have these voices to speak up to say, that's not okay. We need to do better, you know, even here working at Shirley Ryan, what I see in the Chicago land area is a lot of patients with disabilities get shunted here because, you know, the physicians that they're working with in acute care or other hospital settings are like, I don't know, you have a disability go to Shirley Ryan. Well, I'm a physiatrist. I'm a rehab doctor. I'm very good at what I do, but my scope of practice is limited to rehab. I'm not an internist, I'm not a cardiologist. I'm not any of these things, and we have to be able to care for patients with disabilities in all settings. And I think that there has to be the awareness of what it takes to be able to work with those patients, to be able to provide that good care. Again, I'm one of those people that I start small and I try to work big. So I started small with, we were noticing that a lot of our patients with disabilities were having a really hard time accessing women's health and OBGYN care. So the OBGYN department at Northwestern is actually gutting their floor and building new clinic space. And I invited myself over and I did a tour with their clinic manager and I said, let's talk about accessibility. You guys are building a brand new space. Can we make sure that this space is gonna be truly inclusive for all of our patients? 

 

And I have to tell you, I invited myself, but they were so welcoming. And they were very happy to hear my suggestions. They were really open to absolutely. How can we make the system better and design now to kind of open it up?  I've also started giving more lectures. I started with Northwestern. Leslie Rydberg is also a physician here at Shirley Ryan ability lab. And she's very active also in Northwestern medical school curriculum. And we started looking at well, what type of curricula already exists in, in Feinberg and how can we help supplement? And so the past couple years, I have started giving lectures on bias in medicine and really calling it out, naming it and saying, this is real. And, and again, like I talked about the first step to making a change is that people have to acknowledge that there's a problem. And I have had such great responses to these lectures that I have to tell you, students have emailed me and come up to me afterward and been like, wow, I really didn't know it was that much of a problem. And they were like, I get it now that you've said it, now that you've named it, I see that. And from my little one time lecture to Feinberg, I've been invited to other medical schools now.

 

I did a couple national lectures on this as well for some of the national organizations for like their summer externship and medical student programs, similar lectures to our physician assistant program. So again, it's been really exciting to have people be willing to have that conversation and to add it to the curriculas, I'm sure, you know, medical curricula are always tight for time and space. And it's often hard to insert new curricula because they're always trying to kind of pare things down. So again, are we there? No, but are people willing to have the conversation, and is that the first step? Absolutely. 

Lisa Meeks:

We need an integrated curricula that, that works from an anti-ableism framework because to teach people competencies is one thing and that's helpful, right? That's a tool in your toolbox. But if in your brain, as you're interacting with this person, you still are bringing all of your ableist ideas to the conversation. Then you're not doing the best that you can with that patient. So

 

Allison Kessler:  

I love what you just said, integrated. It's so much that the disability curricula this other, it's this separate, right? It is, but why a huge percentage of our population, 25% of our population has some sort of disability, right? We are going to see these patients in your clinic. It can't be this separate discussion. I would love to see when students go and do their standardized exams, you know, the, like the OSCEs and things like that in their cardiology unit have a patient in a wheelchair, have a patient with a language or aphasia or some sort of communication deficit. 

 

These are real life things that are gonna come up in a cardiology clinic in a GI clinic. Why are we doing it just as this quote, separate, this is the disability unit. And that that's important too. So don't get me wrong. You know, I think it is important to have language and teach students how to use appropriate language, how to discuss these things with patients. So I'm not saying that we don't need that curriculum, but I would love to see it integrated into all of the units. Why is it this other, why is it this separate thing? It's not it people with disabilities get sick too. So  why is that not being integrated?

Lisa Meeks:

A pregnant woman that's a wheelchair user. That's the OSCE we need.

Allison Kessler: 

That is my fantasy OSCE right there. (laugh)

Lisa Meeks:

Because we need her to present with symptoms that have nothing to do with her pregnancy and nothing to do with their disability and let people sit in that really uncomfortable space.

Allison Kessler: 

It's always like, oh, well it's your disability or your chronic illness. And I'm like, well, but it isn't always, so.

Sofia Schlozman:

As usual, we end this podcast with Dr. Kessler's words of wisdom for faculty members seeking to improve accessibility at their institution, and for disabled students who are pursuing or planning to pursue medical careers.

Lisa Meeks:

I want to give you so much space for the last question, because I know when we opened this conversation, you said, you've been thinking so much about, you know, your experience and what you would've done differently and, and all of that and wanting to give that back to the listeners and there are lots of them. 

 

People with disabilities are here and the numbers are growing, and I love it and we're celebrating it. And as people enter the pathway, right, we want them to have some advice. And so we thought, how can we capture the stories and experiences and knowledge and provide really this mentoring that doesn't exist formally in this space? How can we provide it through the podcast? And so with this last question, which is, what advice would you have for a faculty member, an administrator, a person with a disability that is in this space or coming into this space? What, what would you say to them? What are the things that you learned?

Allison Kessler: 

I think what I would like to say is acknowledge your own bias. We all have them. I'm not immune to it either. Right? Acknowledge your own bias that you have, think about it, check it at the door and then go and approach the student or the trainee or the learner, and have that open and honest discussion. We can all do better. I've made mistakes even on the faculty side. Right. But I need to be able to acknowledge and own those mistakes to do better for the next person and the next time. 

 

I'm an interviewer for residency and we do this sort of self-gut check before you go into any interview. And it's this, this gut check of saying, you know, check your own biases at the door.

 

And, and we are given this little handout to remind ourselves to acknowledge that those things exist and then try to move past them and ask the questions that are important for what it is that you're doing. And that's what I would say as educators, not to make assumptions because often those assumptions are wrong. And to go in with an open mind and just show that you're supportive by asking the question and inviting the discussion, you are allowing the trainee to tell you how they're feeling or what it is that they really need half the time, what the educator thinks the person needs and what they actually need are completely separate. But if you don't give the trainee that space, then you know, they may not wanna ask for it. 

 

Lisa Meeks:

Absolutely. First of all, I love the anti-biased training. We're doing that at Michigan, too in the admissions committee. I think everybody should be doing that. 

Allison Kessler: 

You have to, you have to name it, but you have to name it for yourself to be able to move past it. And that's what bias training's all about, right?  Is, is really acknowledging it to yourself so that you can think about things in a different way. And I think ableism is so, so pervasive and it's relatively new that it's being talked about. Mm-hmm (affirmative) that, you know, even certain words and things that people use colloquially and signage that we use for disabled access. Right? All of those things are so pervasive in our society and in our culture and they've been deemed, okay, this is mainstream, this is “normal”. Right. And so it's not just in medicine we're fighting against, we're fighting against American culture as a whole and that's hard. And so as you're, saying we need to have trainings available to name it, call it out and give people concrete suggestions.

 

People are nervous. So I think giving people tools on how to talk with a person with a disability or how to, uh, you know, ask questions about what you can do to be supportive of them without being pejorative or somehow degrading to them, right? It can come off as very paternalistic and degrading if you ask them what help they need in the wrong way and so again, having the language and the sensitivity and the training to understand what is the right approach, I think is essential.

Lisa Meeks:

What about for someone who wants to go to medical school, but has all of these societal messages, and even as you mentioned earlier, the technical standards that explicitly say  you are not coming here, what advice would you have for those students?

Allison Kessler: 

This is something that I've struggled with. Early in my career when I was still a student some people reached out to me and there's one person I know that applied to medical school and didn't get in the first time. And when I talked with that person, I asked them, did you look at the technical standards? Did you look at the school? Did you look at their track record of working with persons with disabilities? And they said, well, no, I'm an excellent candidate, I should be able to go where I want. And I said, you should, but that isn't the reality. And you didn't get in because these schools still have this horrible stigma and these biases towards people with disabilities and they're excluding you, even though you are a fantastic candidate and any school should be so lucky to have you.

 

So the second time this person applied, I helped them look at schools and read the technical standards. And I gave them language to ask during their interviews about how to feel supported and accommodated. And this person did get in the second time around and did great. Now I struggle with that though, right?  I helped that person get in because I said, “well, here's how to go look for the people that do want you”, but that's so unfair. They shouldn't have to. It is so upsetting to me that I had to say, you need to go find a school that does have a good technical standard because that person really should have been able to go to any school. As I said, they're a fantastic candidate. So I struggle with how to counsel people because, on the one hand, there's the aspiration that I want for our society and for medical schools in general. And then there's the reality of where the world is right now and it's really hard to be a mentor and to walk that line, right?

 

What I would say for any listener out there that's thinking about whether or not they should go to medical school or can they go to medical school? My answer is if you have the passion and the drive and you wanna do it, we can find a way to make it work. You need to find people who can help you or champion you, or just give you some advice. And from there it can be done. It doesn't mean it isn't gonna be hard. It doesn't mean that there aren't going to be barriers along the way, but I promise there are people out there that want to help you strip down those barriers. So come find us and we will help you do what it is that you wanna do. It may not be easy, but I would encourage you all to do it. If that's truly what's in your heart and what your passion is.

Lisa Meeks:

I second that, and we often have people who say, when I went to residency or I went into medical school, you know, the Dean of admissions said, “I don't know how we're gonna do it, but we're gonna figure it out.” You know, people that just had the attitude of "we'll figure it out". It's not insurmountable. And certainly, we have enough data on enough learners at this point that nobody should be recreating the wheel for something like figuring out how to sterilize a wheelchair user's wheelchair when they go into surgery. Like that should not be a question that is keeping someone from admitting a learner. I think that's the big takeaway is getting people to recognize their own ableist ideas and how that influences their decision-making.

Allison Kessler: 

And as you said, there are enough people that have done it now that people don't have to reinvent the wheel. I think that was one of the daunting things for me, the information wasn't out there and readily available. And so I did feel like I was reinventing the wheel. And that is the bigger message out here is that this stuff does exist. And so reach out to people and we can help you find it because you shouldn't have to reinvent the wheel. And I do often find, as you said, Lisa, that many medical school faculty are so willing to help. They just don't know how. And so if you bring the tools to them, Hey, here's this literature on how to do this. Great. Right? That gives them those tools to say, awesome. I can, I can take this and I can run with it.  So yes, it takes a little bit of work and I wish it weren't so. But the other answer is that data and that information is out there now and so people should be empowered to use what people have done before and be able to move forward in their careers.

Lisa Meeks:

Absolutely. 

 

Allison Kessler: 

Thanks so much for having me today. You know, every time I do one of these discussions with you, I feel like I learn so much more about myself and what I wanna do. So I hope that for anybody listening, you know, if you are interested in medicine and you have questions, please feel free to reach out to me. I would love to be there for you all. And just Lisa, thank you so much for giving me the opportunity to do this. It was really great.

 

Lisa Meeks:

Alison that's so generous of you. Our time together, way back when was so impactful for me. I remember everything about it. And so to hear that it was impactful to you as well. Makes me so happy because you really influenced kind of where I went with this work. I love getting to know people and, and becoming friends with them. And it's just been a, a great experience for me. 

Sofia Schlozman:

To our guest, Dr. Kessler, we are so grateful for your generosity in sharing your story and wisdom with our audience and for your ongoing efforts to make medical education and healthcare more welcoming and supportive to individuals with disabilities.

 

To our audience, thank you so much for joining us for this episode. If you are interested in being a mentor or mentee through Dr. Kessler's new Women with Disabilities in Medicine Mentorship program, we encourage you to reach out to Dr. Kessler at WWDinMedicine@gmail.com. We also encourage you to check out the AAMC's report on Accessibility, Inclusion, and Action in Medical Education, if you have not done so already. We hope you enjoyed this episode, and we hope you join us next time.

Sofia Schlozman:

This podcast is a production of the DocsWithDisabilities Initiative and is supported, in part, by the University of Michigan Medical Schools Department of Family Medicine M-Disability Initiative, the Stanford Medicine Alliance for Disability Inclusion and Equity and the Ford Foundation. The opinions on this podcast do not necessarily reflect those of the hosts, their respective institutions, or the funders. This podcast is released under Creative Commons Attribution Non-Commercial, Non-Derivative License. This episode was produced by Sofia Schlozman and Lisa Meeks, with support from our audio editor Jacob Feeman.