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The Practice Application by Burt and colleagues
1
provides compelling approaches to increase diversity and inclusion in dietetics. However, the strategies are largely focused on racial, ethnic, and socioeconomic diversity, whereas the Academy’s revised diversity definition2
and Diversity Strategic Plan3
are more encompassing. Specifically, we are concerned about the absence of strategies to include people with disabilities. Strategies to enhance diversity and inclusion of people with disabilities in medical education and biomedical research have been proposed4
, - Meeks L.M.
- Jain N.R.
Accessibility, Inclusion, and Action in Medical Education Lived Experiences of Learners and Physicians With Disabilities.
https://sds.ucsf.edu/sites/sds.ucsf.edu/files/aamc-ucsf-disability-special-report-accessible.pdf
Date: 2018
Date accessed: June 3, 2019
5
and can serve as a model for nutrition and dietetics.As faculty at the Rochester Institute of Technology, we routinely teach and mentor students cross-enrolled in the National Technical Institute for the Deaf, one of Rochester Institute of Technology’s nine colleges with the specific mission of providing deaf and hard-of-hearing students with state-of-the-art technical and professional education programs. This has heightened our awareness of discrimination faced by individuals with disabilities, specifically in entering the workforce. However, our experience working with students with disabilities is not unique; national data indicate that 11% of undergraduate students
6
and 25% of US adults aged 18 to 64 years report having a disability.7
The Americans with Disabilities Act (ADA),
8
together with the Rehabilitation Act of 1973,ADA.gov homepage. https://www.ada.gov/. Accessed May 20, 2019.
9
prohibit discrimination against people with disabilities as workers, students, visitors, and patrons of all public accommodations (including private hospitals and universities). A key feature is the requirement to provide reasonable accommodations to enable people with disabilities an equal opportunity at success as people without disabilities. Defining a “reasonable accommodation” can be challenging,10
but recent legal decisions trend toward upholding accommodations in the education of health professionals.The U.S. Equal Employment Opportunity Commission
Questions and Answers about Health Care Workers and the Americans with Disabilities Act.
Questions and Answers about Health Care Workers and the Americans with Disabilities Act.
https://www.eeoc.gov/facts/health_care_workers.html
Date accessed: May 21, 2019
11
Furthermore, the financial resources of the institution, not individual departments or units, must be used when assessing whether an accommodation poses an “undue burden.”5
, 12
Supervised Practice Program directors and work supervisors must coordinate with their human resources or disability services office to identify appropriate accommodations, ensure compliance, and provide true inclusiveness in our profession.Nondiscrimination on the Basis of Disability in Public Accommodations and Commercial Facilities. 36 CFR.
https://www.ada.gov/regs2010/titleIII_2010/titleIII_2010_regulations.htm
Date: 2010
Date accessed: June 3, 2019
Another institutional barrier to inclusion of individuals with disabilities are technical standards (ie, required physical, cognitive, or behavioral abilities) used to assess applicants that emphasize motor and sensory skills rather than cognitive skills.
13
Some medical schools’ technical standards have been called “ableist” through exclusion of persons who cannot see, hear, or use their hands.14
An alternative is writing inclusive language in technical standards, such as allowance for “accommodation through the use of a trained intermediary or other communication aides.”13
By explicitly writing that accommodations are permissible, people with disabilities will not be screened out by nonessential job functions. Dietetic Supervised Practice Programs with technical standards should review these standards for ADA compliance before litigation forces the issue.14
Furthermore, a powerful signal from the Accreditation Council on Education in Nutrition and Dietetics (ACEND) toward true diversity and inclusion would be for ACEND accreditation to require documentation of technical standard compliance with ADA, as has been suggested for medical schools.15
Currently, ACEND and the Commission of Dietetic Registry do not collect information on the degree and type of disabilities among students or credentialed practitioners. Collecting this information would help to better understand representation in the profession and to support reasonable accommodations.As university faculty, we do not claim to have all the answers to accessibility. We simply share a desire to ensure that students and practitioners with disabilities are afforded an equal opportunity to thrive in the profession. We call on the Academy and ACEND to work with disability experts and practitioners with disabilities to develop guidance for educators, preceptors, and supervisors to ensure our profession is indeed inclusive for people with disabilities.
References
- Strategies and recommendations to increase diversity in dietetics.J Acad Nutr Diet. 2019; 119: 733-738
- To support all: diversity and inclusion.J Acad Nutr Diet. 2019; 119: 543
- Diversity Strategic Plan: Objectives and Strategies 2015-2020.
- Accessibility, Inclusion, and Action in Medical Education Lived Experiences of Learners and Physicians With Disabilities.https://sds.ucsf.edu/sites/sds.ucsf.edu/files/aamc-ucsf-disability-special-report-accessible.pdfDate: 2018Date accessed: June 3, 2019
- Disability inclusion: moving beyond mission statements.N Engl J Med. 2019; 380: 2089-2091
- The NCES Fast Facts Tool provides quick answers to many education questions (National Center for Education Statistics).(Accessed May 17, 2019)
- Prevalence of disabilities and health care access by disability status and type among adults—United States, 2016.MMWR Morb Mortal Wkly Rep. 2018; 67: 882-887
ADA.gov homepage. https://www.ada.gov/. Accessed May 20, 2019.
Rehabilitation Act. USC; 1973:794(a).
- Questions and Answers about Health Care Workers and the Americans with Disabilities Act.https://www.eeoc.gov/facts/health_care_workers.htmlDate accessed: May 21, 2019
- Technical standards and lawsuits involving accommodations for health professions students.AMA J Ethic. 2016; 18: 1010-1016
- Nondiscrimination on the Basis of Disability in Public Accommodations and Commercial Facilities. 36 CFR.https://www.ada.gov/regs2010/titleIII_2010/titleIII_2010_regulations.htmDate: 2010Date accessed: June 3, 2019
- Technical standards and deaf and hard of hearing medical school applicants and students: interrogating sensory capacity and practice capacity.AMA J Ethic. 2016; 18: 1050-1059
- Patients to peers: barriers and opportunities for doctors with disabilities.Nev Law J. 2013; 13: 645-667
- U.S. medical schools’ compliance with the Americans With Disabilities Act.Acad Med. 2016; 91: 979-986
Article info
Publication history
Published online: September 24, 2019
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT There is no funding or financial support for this work.
Identification
Copyright
© 2019 by the Academy of Nutrition and Dietetics.
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- Strategies and Recommendations to Increase Diversity in DieteticsJournal of the Academy of Nutrition and DieteticsVol. 119Issue 5
- PreviewAs the population in the United States becomes more diverse, health professions in the country require a diverse workforce to ensure proper and more personalized care for patients.1 Currently, whites account for more than 80% of the health professional workforce, whereas minorities are underrepresented in the field.
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- Authors’ ResponseJournal of the Academy of Nutrition and DieteticsVol. 119Issue 10
- PreviewWe would like to thank the authors for illuminating the importance of diversity across demographic categories. We agree that the inclusion of persons with disabilities—and that of all religions, gender identities, sexual orientations, ages, and other marginalized groups—is critically important. We omitted other demographic groups from our article because different research is needed to contextualize each and propose evidence-based solutions.
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