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Leading Practices and Future Directions for Technical Standards in Medical Education

Kezar, Laura B., MD; Kirschner, Kristi L., MD; Clinchot, Daniel M., MD; Laird-Metke, Elisa, JD; Zazove, Philip, MD; Curry, Raymond H., MD

doi: 10.1097/ACM.0000000000002517

The medical profession first addressed the need for technical standards (TS), defining the nonacademic requirements deemed essential for participation in an educational program, in guidelines published by the Association of American Medical Colleges in 1979. Despite many changes in the practice of medicine and legal, cultural, and technological advances that afford greater opportunities for people with disabilities, the profession’s approach to TS largely has not changed over the ensuing four decades. Although physicians with disabilities bring unique perspectives to medicine and contribute to a diverse physician workforce of culturally competent practitioners, they remain underrepresented in the profession.

As part of an initiative sponsored by the Association of Academic Physiatrists, the authors describe the need for an updated TS framework, outlining interval changes in the legal and regulatory climate, medical practice, and medical education since the initial TS guidelines were put forth. They conclude by offering eight recommendations and two functional approaches to TS that are consistent with now-prevalent competency-based medical education constructs.

The profession’s commitment to diversity and inclusion should extend explicitly to people with disabilities, and this stance should be clearly communicated through medical schools’ TS and procedures for requesting accommodations. To this end, schools should consider the principles of universal design to create policies and assessments that work for all learners, to the greatest extent possible, without the need for after-the-fact accommodations. A thoughtful and concerted effort along these lines is long overdue in medical education.

L.B. Kezar is professor, Departments of Physical Medicine & Rehabilitation and Medical Education, University of Alabama School of Medicine, Birmingham, Alabama.

K.L. Kirschner is clinical professor, Department of Medical Education, University of Illinois College of Medicine, adjunct professor of disability and human development, College of Applied Health Sciences, University of Illinois at Chicago, and attending physician, Schwab Rehabilitation Hospital, Chicago, Illinois.

D.M. Clinchot is vice dean for education, associate vice president for health sciences, professor of physical medicine and rehabilitation, Ohio State University College of Medicine, Columbus, Ohio.

E. Laird-Metke is director, Disability Resource Center, Samuel Merritt University, Oakland, California.

P. Zazove is George A. Dean, M.D. Chair and professor, Department of Family Medicine, University of Michigan Medical Center, Ann Arbor, Michigan.

R.H. Curry is senior associate dean for educational affairs, University of Illinois College of Medicine, and professor of medicine and medical education, University of Illinois at Chicago, Chicago, Illinois.

Funding/Support: None reported.

Other disclosures: This article represents the conclusions of the Task Force on Technical Standards for Medical Students established by the Association of Academic Physiatrists and was reviewed and approved by the Board of Trustees of the Association of Academic Physiatrists.

Ethical approval: Reported as not applicable.

Supplemental digital content for this article is available at

Correspondence should be addressed to Laura B. Kezar, Spain Rehabilitation Center, 1717 6th Ave. South, Birmingham, AL 35294-0019; telephone: (205) 934-2785; e-mail:

© 2019 by the Association of American Medical Colleges