We thank the authors for their positive comments regarding our Invited Commentary and the recent Association of American Medical Colleges/University of California, San Francisco School of Medicine report. We agree that coercing learners and physicians to use services is contrary to the Americans with Disabilities Act (ADA) and that, where services are developed, they must adhere to the law. As such, the claim that our recommendations will lead to coercion does not accurately reflect our position. The authors similarly conflate corporate wellness programs with the provision of confidential mental health services and accommodations for learners.
There are students, residents, and physicians who are not currently using accommodations afforded them under the ADA and Section 504 because they do not believe them to be available or applicable to their situations.1 As such, we propose that formal processes be in place and clearly communicated to educate them about the availability of accommodations. This requires that staff with ADA and clinical accommodation expertise be available to respond to requests.2 As noted in our Invited Commentary, we also contend that these structural components are most effective when accompanied by a cultural shift that actively supports overall well-being for all learners.3
Therefore, we encourage medical schools to refer students experiencing symptoms of poor mental health or acute crises to qualified individuals for assessment. The purpose of such referrals must be to identify mechanisms of support, which may include appropriate and reasonable accommodations.4 We also encourage schools to recognize that persons with mental health diagnoses can be well-qualified learners who contribute to the advancement of medicine and improvements to patient care.5
Lisa M. Meeks, PhD, MA
Assistant professor, University of Michigan Medical School, Ann Arbor, Michigan; firstname.lastname@example.org.
Neera R. Jain, MS, CRC
Doctoral candidate, Faculty of Education and Social Work, University of Auckland, Auckland, New Zealand.
Kurt Herzer, MD, PhD, MSc
Director, Health, Oscar Health, New York, New York.
1. Meeks LM, Jain NR. Accessibility, Inclusion, and Action in Medical Education: Lived Experiences of Learners and Physicians With Disabilities. March 13, 2018.Washington, DC: Association of American Medical Colleges.
2. Meeks LM, Jain NR. The Guide to Assisting Students With Disabilities: Equal Access in Health Science and Professional Education. 2015.New York, NY: Springer Publishing.
3. Meeks LM, Herzer K, Jain NR. Removing barriers and facilitating access: Increasing the number of physicians with disabilities. Acad Med. 2018;93:540543.
4. Murray J, Papadakis M, Meeks LM. Continuing the conversation: Supporting students with psychological disabilities in medical school [webinar]. Association of American Medical Colleges webinar series on working with students with disabilities. March 10, 2016.
5. Gupta R. I solemnly share. JAMA. 2018;319:549550. doi:10.1001/jama.2017.22135