Dr. Lina Mehta is a seasoned admission professional, associate Dean for admissions at Case Western Reserve School of Medicine and a Professor of radiology at University Hospitals Cleveland Medical Center. Dr. Mehta has been a vocal advocate for equal access in medical school admissions and has given talks and written articles on the topic of accessible admissions. She is the lead author on a chapter in a forthcoming book entitled, “Creating a Program Within a Culture of Inclusion.” In our talk, Dr. Mehta discussed her experiences with disability, the changes she has implemented at CWRU and how she thinks the AAMC report on disability will impact admissions broadly.
Lina Mehta, MD, Associate Dean, Department of Admissions and Professor of Radiology Case Western Reserve University School of Medicine
Episode 11, Transcript
DocsWithDisabilities Podcast #11
Dr. Lina Mehta
Introduction: 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 I am thrilled to bring you the Docs with Disabilities podcast.
Join me as I interview Docs, Nurses, Psychologists, OTs, PTs, Pharmacists, Dentists, and the list goes on. I’ll also be interviewing researchers and policy makers that ensure medicine remains an equal opportunity profession.
Welcome to the Docs with Disabilities podcast. I’m Dr. Joseph Murray, your guest narrator. I am an associate professor of clinical psychiatry at Weill Cornell Medical College.
Today on the Docs with Disabilities podcast, we have the pleasure of chatting with Dr. Lina Mehta. She is the Associate Dean for admissions at Case Western Reserve School of Medicine and a professor of radiology at University Hospitals Cleveland Medical Center. Dr. Mehta has been a vocal advocate for equal access in medical school admissions and has given talks and written articles on the topic of accessible admissions. She is also the lead author on a chapter in a forthcoming book entitled, “Creating a Program Within a Culture of Inclusion.”
We asked Dr. Mehta about her views on the role of admissions in ensuring equal access in medical education and her experience with disability.
At the admissions level, we talk about ensuring we admit a diverse class and then if we're doing things right, at least this is why I say our students are going to learn as much or more from each other than they do from us as educators and disability has to be included in that conversation.
We had a student who underwent an injury after he was accepted to medical school, hadn't yet matriculated and wound up becoming a wheelchair user early in my admissions career. And it was the first time that I'd really been confronted with a situation of somebody who may not potentially look like all of the other matriculants into medical school. And it was a really interesting and formative process to go through and continue on, of course, to honor his acceptance.
I think it's a very positive thing to see physicians practicing who have a disability or see students matriculate into medical school with a disability. It will change how we define disability. But from my perspective as an admissions professional, there's a reality that in admissions, we sort of dictate what the face and function of medicine is going to look like. By virtue of who we bring in, that's in some ways going to dictate what the outcome measurements are going to be.
So from my perspective, it's critical that we bring in a group of learners and future practitioners who will mirror the patient populations that they're going to be taking care of. I know even practitioners who try to keep the most open mind sometimes make assumptions about the patients and their functionality without really having a lot of evidence at their fingertips. So I think having physicians and students with disabilities into the process will make us think more thoughtfully about the challenges that our patients face. It'll help us to really understand that we shouldn't pre-judge and then I think it'll remove that uniqueness. At some point, I think disability and physicians with disabilities need to move into the general pool and not be pulled out differently than their cohorts who don't have a disability.
We asked Dr. Mehta to tell us about her passion for the topic, how she became involved with disability work and how she is working to address disability inclusion at Case Western Reserve School of Medicine.
The turning point for me was about three years ago when Dr. Meeks came to speak at Case Western about her work with the coalition and about access. She came and gave an hour lecture and I went right back to my office and I rewrote the way we do a lot of things based on what she was talking about. We had been doing, I think, a good job, but I realized and hearing from Lisa that we could do an even better job and we could make our process so accessible to students. We could come up with ways so that they wouldn't be prejudged before they even showed up, that they wouldn't be prejudged through the admissions process, that we could make this a really accessible process for everybody. It's been really, I think, a remarkable thing for these small changes that we implemented into our process in ensuring comfort of our applicants as they apply, as they interview and then as they matriculate.
Some of the things that we did was we actually address disability. I think that's something that no one really talks about. We acknowledge it on our website. We welcome students with disabilities. Our technical standards, meaning sort of the laundry list of what students need to be able to accomplish in order to graduate successfully from our medical school, is listed there for all of our applicants to see. We acknowledge that some students may need accommodations in order to meet some of these technical standards. Just removing that barrier of silence, I think has really gone a long way in helping our applicants to understand that we're welcoming and to understand that this isn't a scary, terrible thing. We're here to help students get into medical school and to get through it successfully and we're willing to work with them collaboratively.
We've also worked to train our admissions interviewers. The reality is, a lot of people are uncomfortable with what they don't know. And when an interviewer is faced with a student with a physical disability, they can really feel off kilter. They don't want to offend the applicant, but they want to be able to get the information. They don't know how to navigate this in a way that is fair and inclusive. So we've trained our interviewers in methods of interview techniques to be able to elicit the information that they need without infringing on somebody's rights or privacy. That's gone a long way in helping to make the process much more accessible on both sides. And it's also gone a long way in helping our admissions team, my admissions committee, my interview team, and starting to think about disability in a very different way.
Students with disabilities have been so used to hearing, “No, you can't do that,” their whole lives. They've developed incredible resilience and grit to be able to have gotten where they are. So to even see on our website that we acknowledge that we will welcome you if you meet the other criteria for admission I think is they're potentially finally hearing a yes. And I think that's really powerful. For students without a disability to see that kind of language, the more that students are sort of immersed in these different worlds that they may not have lived in before, but will see as practicing physicians, the more it becomes destigmatized and the more it becomes normal for them and the fewer prejudgments that they make.
We asked Dr. Mehta how she thinks other medical schools are reacting and responding to the increasing number of students disclosing disability and the recent focus on disability inclusion in medical school.
It's maybe something that they feared before and they couldn't really understand how a future physician could have a disability. And it's also normalized in their minds. They start to realize they could do this. We've had this conversation, and they've lived their whole lives with this disability, so why would they stop living their life now as they move forward just because they're going to get into medical school? They may have a different way of doing things. They may have been more creative in the approach to how they've gotten through certain milestones in their life, but they're going to continue on.
There probably is a fear factor on admitting students to medical school, whether it's conscious or unconscious. You know, let's face it, there are far more applicants to medical school than we're able to admit. And so there's maybe some subjective leaning towards the student who doesn't have a disability. But I also think that a large part of it is that maybe students are more comfortable reporting a disability than they were in the past, now that we're having this conversation. You know, we look at certain disease states, and we say the incidence is rising. Are people really developing this cancer more readily? Or are we actually diagnosing it earlier? So I think it's probably a combination of maybe there's a reality that we aren't as inclusive and welcoming as we should have been.
I think when the public thinks about physicians, they think about the superhero mentality that a physician, you know, runs into a room and you know, saves the day. I think that patients and physicians alike don't think about physicians as being real people. We don't have lives, we don't have disabilities, we don't have these things. We have to come in and be perfect out of the get-go. And I think that conversation is slowly changing. I think that's more true for medicine than any of the other graduate programs out there. There's an expectation of perfection that never existed and can't exist. And as we become more humanized and we start to understand that physicians are people, then I think that we're going to start to see an increase here in A, the number of students that we accept and matriculate. But B, I think students will become much more comfortable in reporting and asking for accommodations as they move forward.
Students will feel safer coming out with their disabilities because now there's a national recognition that this is a thing. It's important and it deserves its own attention.
The AAMC report pointed out the inequities in access to accommodation and qualified disability personnel across the country. We asked Dr. Mehta for her observation about the current practices for disability inclusion and what this means for the student with a disability looking for a good fit.
The question of how easy it is to get accommodations is a difficult one to address globally. It varies from school to school. There are some schools that are very open and understand what these mean, and they have a specialized person in place who can navigate the interplay between what the student needs and their ability to meet the expectations of the medical school. So there are some schools that are very welcoming and open. UCSF certainly is one. I like to think that my institution is one as well, but then it comes down to what type of accommodations are we talking about. Certainly there are ones that are very easy and very common. A student who has a learning disability or a learning difference, who needs extended time and has a long history of this starting from kindergarten on. Those are very common. We see those a lot in a very large cohort of our students.
Much less frequent is a student who has a significant physical disability. But certain schools may not have the tools that they need or the experience with providing that for their students. So it's really uneven and that's where I think this disability report is going to go a long way in helping schools to understand what is best practice. Where's the blueprint that we can follow? Every school wants to do the right thing but may just not have been able to access the information that they need in order to put this forward.
I come from an institution that is open and creative and has always embraced diversity in its various forms and maybe didn't understand that disability was a form of diversity but was very open to integrating it once we had that conversation. It really required a lot of conscious thought and a lot of readdressing of what's our mission statement? What is our responsibility to our students? What's our responsibility to medicine and who do we want to be?
So it was actually really, I think, a good thing. It made us sit down and readdress who we are and who we want to be and what we want to deliver. I think it's good to sit down every now and then and navel-gaze and sort of recalibrate. And this was actually a good thing for us to do.
Dr. Mehta talked about the “superhero mentality,” that a physician runs into a room and saves the day. This is a common fallacy in medicine, and the superhero image can be quite damaging, especially to the inclusion of students with disabilities. We asked Dr. Mehta how her perspective of a great physician has changed over the years and how a physician with a disability might actually be the superhero to their patients.
I think that the concept of the most able physician is a fallacy. Are you talking about the six foot four guy who used to be a linebacker and has an imposing physical presence? I've been a practicing physician since 1999. I've been in admissions for 14 years, and my perspective has really grown. And to me, the most able physician is the one who can connect the best with their patient, who can empathize from whence they're coming, who can empathize with the issues that they faced and who can think creatively out of the box to help them come up with some solutions to some of the challenges that they face. And certainly a patient with disability faces much greater challenges than we can imagine.
The literature definitely shows that patients with disabilities have worse outcomes on many levels. When a patient with a disability presents to a certain practitioner who's never thought about disability or engaged with disability or worked with anyone who has a disability, they may make an assumption. Certainly patients with certain disabilities are asked less frequently to have a pap smear. They're asked less frequently about, you know, what their sexual activity is like. All things that are still very important. It's critical for patients that we’re having these dialogues at the medical school level and at the educational level and at the practice level.
So the definition of what an able physician has historically been needs to change precipitously. We need to ensure that what an able physician is, is somebody who, again, thinks creatively, who can come up with solutions to questions that we may not even have asked yet, who can provide additional insight and information into something that seems black and white to one but is actually fully nuanced to another. So we need to take that away from talking about physical capabilities and really taking it down to the bare essence of who we are as physicians. We are here to heal. We're here to provide care to our patients. We're here to look at our patients with as broad of a lens as we need to, to ensure that their needs are being met. And that to me is the most able physician.
Thank you for joining us today, and thank you to Dr. Mehta for sharing her perspectives on disability inclusion. Be sure to subscribe to our podcast and tune in next time!
This podcast is a production of the University of Michigan Medical School, Department of Family Medicine, MDisability initiative. The opinions expressed in this podcast do not necessarily reflect those of the University of Michigan Medical School. It is released under a creative commons, attribution noncommercial, nonderivative license. This podcast was produced by Lisa Meeks and Kate Panzer.
*This podcast was created using excerpts from the actual interview and is representative of the entire conversation. Interviewees are given the transcript prior to airing. Some edits may reflect grammatical and syntax adjustments for transcription purposes only.