Accommodations: Law vs. Ethics

By Kali M. VanLangen, PharmD, BCPS

Student accommodations in pharmacy education is currently a frequent, and somewhat controversial, topic of conversation across the Academy. There are primarily two types of accommodations a student may be eligible to receive – accommodations for learning disabilities (extended time, reduced noise environment, etc.) or physical disabilities (i.e. hearing impairment, extended time due to physical limitations, and many more). Although potentially challenging, it seems reasonable to accommodate physical disabilities but accommodating learning disabilities (in some settings) is more difficult for me to understand. This past summer I attended an AACP Annual Meeting session regarding the topic of accommodations in pharmacy education – searching for answers for accommodating learning disabilities on skills based assessments. Judging from the attendance, I was not the only one interested (and confused) about this topic. I wanted someone to confirm that it was “unreasonable” to accommodate extended time due to a learning disability in assessments that focused on communication and direct patient care skills. After all, students need to be practicing pharmacists some day, right? I left with a new perspective.

Separating Education from Practice
One of the reasons this topic is controversial is that we care about our students’ success in the workplace and we want to make sure we are producing a “practice-ready” pharmacist as required by Standards 2016.1 Many of us worry that if we allow accommodations on skills based assessments, then we aren’t ensuring our students will be practice-ready. However, one of the most important things I learned during the session is that when we think about accommodations in the classroom or on skills based assessments, we need to separate the concepts of education and practice. The Americans with Disabilities Act 2008 and Section 504 of the 1973 Rehabilitation Act prohibit discrimination against people with disabilities and require that students with disabilities have the same opportunity to achieve the learning outcomes as students without a disability.2 These laws don’t address the success of the individual once they leave the education system. And for many of us, that is a difficult concept considering the time and financial commitment professional students agree to upon entering our programs. The laws also talk about “reasonable accommodations” so while it may seem “reasonable” to test students how they will practice, it is not. In this case accommodations are “reasonable” if they do not cause an undue hardship or significantly alter the assessment.2,3 Something that may help put our minds at ease is considering how licensure exams approach accommodations. If the NAPLEX, MPJE and other licensing exams allow for accommodations then shouldn’t we do the same during the PharmD curriculum?

Do Technical Standards Intentionally Exclude Students?
Technical standards are often a part of these discussions. Technical standards are meant to outline the minimum physical and mental attributes a student must possess in order to successfully complete a professional program. A review of technical standards in medical schools discussed lawsuits that have occurred as a result of inflexible technical standards.4 An evaluation of U.S. medical schools demonstrated that 61% of technical standards lacked information on the schools responsibility for providing accommodations and only 27% clearly stated they provided accommodations.5 Has your school made changes to your technical standards to address concerns related to students with accommodations? From a skills based assessment perspective, is it ethical to ensure technical standards are written to exclude students based on their inability to complete a task in what may be an arbitrary amount of time? What standards are you using to determine the “arbitrary” amount of time allotted?

Questions to Discuss
Given this information and with the variety of areas for a pharmacist to practice, can we really say that a student with a physical or mental disability is not capable of becoming a successful pharmacist? While it can be difficult to know that a student may have challenges upon graduation, we should be preparing our students to find ways to overcome those challenges and find a job that best suits their skillset. Research and guidance in this area within pharmacy education is limited but continuing this conversation is critical for the success of our students. What concerns do you have when it comes to providing accommodations? What suggestions do you have for overcoming these concerns?

References

  1. Accreditation Council for Pharmacy Education (ACPE). Accreditation standards and key elements for the professional program in pharmacy leading to the doctor of pharmacy degree (“Standards 2016”). Published February 2015. Available at: https://www.acpe-accredit.org/pdf/Standards2016FINAL.pdf. Accessed February 22, 2019.
  2. Protecting students with disabilities. Office for Civil Rights [Website]. U.S. Department of Education. Available at: https://www2.ed.gov/about/offices/list/ocr/504faq.html. Updated September 25, 2018. Accessed February 9, 2019.
  3. Reasonable accommodations in the workplace. ADA National Network [Website]. Available at: https://adata.org/factsheet/reasonable-accommodations-workplace. Updated February, 2019. Accessed February 9, 2019.
  4. Bagenstos SR. Technical standards and lawsuits involving accommodations for health professions students. AMA J Ethics. 2016 Oct 1;18(10):1010-1016.
  5. Zazvoe P, Case B, Moreland C, et al. U.S. medical schools’ compliance with the Americans with Disabilities Act: findings from a national study. Acad Med. 2016 Jul;91(7):979-86.

imageKali M. VanLangen is an Associate Professor of Pharmacy Practice at Ferris State University College of Pharmacy. Her research interests include APPE readiness and the use of electronic health records in the laboratory setting. In her free time, Kali enjoys spending time outdoors with her husband and two daughters.


Pulses is a scholarly blog supported by Currents in Pharmacy Teaching and Learning

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