The capability imperative: Theorizing ableism in medical education

Area of Science:

• Medical Education
• Disability Studies
• Sociology of Professions

Background:

• Medical education programs aim for justice, equity, and inclusion to diversify the medical field and improve patient care.
• Disability is a recently recognized diversity category, yet disabled learners encounter substantial obstacles in medical schools.

Purpose of the Study:

• To develop the concept of the "capability imperative" in medical education.
• To analyze how this imperative impacts disabled students and institutional practices at U.S. medical schools.
• To examine the role of ableism and compulsory hyper-able-bodiedness in medical training.

Main Methods:

• Constructivist grounded theory study.
• Analysis of technical standards policies at four U.S. medical schools.
• Interviews with 19 disabled students and 27 school officials (faculty and administrators).

Main Results:

• The "capability imperative" was identified through three motifs: the selfless superhuman, the "real world" of medicine, and the malleable student.
• This imperative defines physician characteristics, justifies institutional structures, and shapes learner expectations.
• The imperative functions as a manifestation of ableism, promoting compulsory hyper-able-bodiedness and mindedness, which contradicts inclusive objectives.

Conclusions:

• The "capability imperative" in medical education reinforces ableist norms and marginalizes disabled individuals.
• Challenging the cultural logic of compulsory able-bodiedness is crucial for achieving justice and inclusion in the medical profession.
• Re-evaluating the definition of a physician and for whom this vision serves is essential to dismantle ongoing marginalization.