Negotiating the Capability Imperative: Enacting Disability Inclusion in Medical Education

Abstract

Medical education is a critical site for disability inclusion. Despite increased attention to diversity, equity, and inclusion, disabled medical students report enduring marginalization that reveals deeply-rooted inequities in medical systems and education. This thesis presents a grounded theory of disability inclusion at four U.S. medical schools. Following a constructivist grounded theory methodology, I iteratively conducted and analyzed 52 semi-structured interviews with 19 disabled medical students and 27 school officials. Relevant medical school policies and observations of physical spaces comprised additional data sources. Theories from the field of disability studies, primarily studies in ableism and crip theory, were engaged to interpret findings. Student and school-official interactions with inclusion were informed by a flawed, dichotomous cultural logic of medical education, the capability imperative. Dominant conceptions of disability as individual inability contrasted with expectations of hyper-ability in medicine. Student and school-official accounts illuminated the capability imperative, which consists of three motifs: selfless superhuman physicians, the “real world” of medicine, and the malleable student. Together, these conditions demanded that students fit existing medical training environments. Competing, alternative conceptualizations of disability supported actions beyond rejection of disability or exclusion, however, the legibility of a student’s experience moderated understandings of disability and associated inclusive actions. I theorize disability inclusion in medical education as a process of negotiating the capability imperative. Students and school officials negotiated barriers to access depending on perceived consequences to seeking or making change. They upheld or worked the capability imperative to meet, or enable students to meet, existing expectations. Some actions resisted the capability imperative, through attempts to resignify capability. These negotiations illustrated an ableist hegemony at work, requiring hyper-able performances but with opportunities for subversion. An accommodations-focused approach to inclusion that individualized disability and access supported this hegemony. As a result, disability inclusion in medical education remains incomplete and requires transformation. In response, I reimagine educational structures that value disabled medical professionals. Fueled by a politics of crip futurity, this transformative vision is grounded by universal design, reconceptualizes notions of capability, and fosters disability epistemology in professional identity formation.