Creating Inclusive and Accessible Residency Training programs: Lessons Learned from Establishing a Deaf and American Sign Language Inclusive Model for Residency Training

Abstract

<h3>Purpose</h3> There is a growing need for a more diverse physician workforce to address gender, racial, and ethnic disparities in medicine. Investigations into vulnerable populations, including African, Native, Hispanic, and rural Americans all have overwhelmingly shown that these groups have diminished access and increased barriers to receiving radiation treatment. Increasing diversity among physicians can help address health care disparities in underserved populations. Accessible and inclusive residency training programs are needed to promote recruitment and retention of underrepresented physician groups. However, limited attention has been given to the potential benefits of training physicians with differences other than gender, race, or ethnicity. Americans with a disability represent about 27% of the population, whereas 1%-3% of physician trainees report having a disability. In 2017, our program matched a Deaf resident who preferentially utilized American Sign Language (ASL) to communicate. However, to date, there had been no published strategies on how to create an ASL inclusive residency training program for Deaf trainees. Herein, we report the development of a Deaf and ASL-inclusive residency program to serve as a model, which can be tailored to meet the needs of other underrepresented physician trainees in radiation oncology. <h3>Methods</h3> In preparation, department leadership engaged key stakeholders and leaders within the university's health system and among the department faculty, residents, and staff as well as the incoming resident, which led to the development and implementation of an inclusive ASL training model for the program. <h3>Results</h3> In this process, 5 important principles and steps were identified. First, the trainee should be directly engaged and involved as a primary and key collaborator as to any cultural, linguistic, or physical needs and preferences. Second, key stakeholders within the institution, including hospital and department leadership, should be engaged early, and involved in implementing and creating strategies. Third, with the trainee's input, efforts should be initiated to utilize resources internal and external to the institution, including institutional ADA officers, disability services, and training consultants. Fourth, cultural and communication expectations should be discussed with faculty and staff with the goal of creating an inclusive training culture for all participants. Finally, workspace accommodations that remove any physical barriers should be addressed based on the trainee's input. <h3>Discussion</h3> Through collaborative efforts, a Deaf and ASL-signing resident was successfully integrated into the residency program. The 5 principles of our model allow for efficient implementation of a similar framework at other institutions seeking to employ similar inclusivity initiatives.