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Student Disabilities at the Geisel School of Medicine—Policies and Procedures

Each year the Geisel School of Medicine at Dartmouth admits a class of gifted men and women, and sometimes there are people with disabilities among that group. We know from experience that having a disability does not necessarily preclude a person from becoming a wonderful physician. Today there are quite a few practicing physicians who have been successful at the Geisel School of Medicine with physical, learning, or psychological disabilities; and we are proud of that fact. We believe it reflects our commitment to enhancing the field of medicine through diverse representation, and their commitment to overcoming some very real obstacles.

Of course not every applicant*, with or without a disability, is considered qualified for the Dartmouth program. To better understand our definition of "qualified", prospective students are encouraged to read the Geisel School Essential Standards for Matriculation, Promotion, and Graduation on this website. And anyone with a disability will probably want to pay special attention to the "Standards for Capacity" section. This document helps to explain the capacities and competencies we expect, of both our applicants and students, at the various stages of the educational process. We cannot guarantee any student success at the Geisel School, but there is NOTHING we want more than for all our students to succeed.

*Applicants are not required to notify the Geisel School of a disability during the application process. However, those applicants who need accommodation for the Medical School interview itself should contact Admissions as early as possible.

Rights and Responsibilities

All students with disabilities should be familiar with the detailed policies and procedures described throughout this document. Some of the most fundamental information, however, is highlighted in the section below.

Qualified students with disabilities have a right to:

• Full consideration in the admission and promotion processes.
• Reasonable accommodation, when appropriate to insure equal access to the Geisel School curriculum, programs, and activities.
• Respect for privacy in the dissemination of disability information.
• Support from the Office for Learning Services.
• Non-discrimination by Geisel School faculty and staff.
• An appeal process if necessary.

Qualified students with disabilities have a responsibility to:

• Meet all Geisel School Essential Standards for Matriculation, Promotion, and Graduation—as appropriate at each stage of medical education—with or without reasonable accommodation.
• Declare a disability, or suspected disability, in writing (if seeking accommodation).
• Provide professional documentation that meets posted Geisel School criteria.
• Work with the Geisel School Office for Learning Services to request, implement, update, and/or modify any accommodations.
• Request any accommodation in a timely manner—from Learning Services, testing coordinators, clerkship coordinators, faculty, and designated others who may be directly involved in providing accommodation.
• Comply with Geisel School policies and procedures regarding students with disabilities, as well as all other policies that apply to Geisel School medical students.

Making Contact

Services for students with disabilities at the Geisel School are coordinated by the Office for Learning Services. Kalindi Trietley is the primary contact for all student disability issues at the Geisel School. Please feel free to get in touch with her if you are 1) a person with a disability who is considering the Geisel School of Medicine, 2) a current medical student with a disability or suspected disability, or 3) a concerned faculty/staff member. Ms. Trietley is happy to clarify issues and answer questions; and she is committed to respecting the privacy of those with disabilities.

Any Geisel School student who believes he or she has experienced discrimination on the basis of disability is also urged to contact Ms. Trietley. Students may wish to contact the Office for Institutional Diversity and Equity in Blunt Hall, as well. The phone number is (603) 646-3197.

Basic Information for Students with Disabilities

1. The Americans with Disabilities Act (ADA) as amended, building on Section 504 of the Rehabilitation Act of 1973, mandates that no qualified person with a disability shall, solely on the basis of disability, be excluded from participation in, be denied the benefits of, or otherwise be subjected to discrimination under any program or activity which receives or benefits from federal financial assistance. According to federal regulations, otherwise qualified students with documented disabilities are entitled to equal treatment and access at institutions of higher education.

2. The Medical School curriculum, as established by the faculty, represents a core curriculum essential to all physicians. Therefore, the Geisel School of Medicine at Dartmouth expects that each student admitted will be capable of completing the full curriculum of required courses and electives under the established School policies. The faculty believes that the Geisel School has a responsibility both to students and to society; and to help us adequately fulfill those responsibilities, we have created the Essential Standards for Matriculation, Promotion, and Graduation. All students and applicants must be capable of meeting those standards, with or without reasonable accommodation, at each stage of their medical education; and they are asked to sign a statement to that effect before matriculation. Learning Services can help applicants better understand those Standards.
3. Some accommodations can certainly be made for individuals with disabilities, but all students must be able to perform in a reasonably independent manner. No disability can be accommodated at the Geisel School with an auxiliary aid or intermediary that provides a selective function, cognitive support, or medical knowledge. Aids and intermediaries also may not act as a substitute in performing essential skills, or supplement clinical and ethical judgment. That is to say, accommodations cannot eliminate essential program elements.

Committee on Students with Disabilities

The Geisel School of Medicine at Dartmouth Committee on Students with Disabilities (CSD) represents a broad faculty constituency and includes individuals with experience in various disability issues. The Committee membership may include the following: the Director of Dartmouth Counseling, Geisel School Director of Learning Services, a representative from pre-clinical faculty, a representative from clinical faculty, a facilities administrator, a Dean's office representative, the undergraduate Director of Accessibility Services, and legal counsel. Meetings of this committee are considered confidential.

The CSD reviews all requests for accommodation submitted by the Director of Learning Services. It helps to determine 1) whether or not a student should be recognized as "disabled", 2) whether or not a student seems otherwise qualified for medical school, based on Geisel School Standards for Capacity, 3) whether or not a student is entitled to accommodation, based on documentation, and 4) what specific accommodations, if any, would be most reasonable. This committee also aids the Learning Services Director in foreseeing challenges that may arise for particular students in future portions of the curriculum.

At times the CSD may assist in resolving disability issues that cannot be resolved through the Geisel School Learning Services Director alone, and it approves substantial policy revisions related to disability issues. In order to maximize confidentiality, only the Learning Services Director and members of the CSD have access to students' diagnostic information.

Accommodations for Students with Documented Disabilities

Section 504, the ADA, and the ADAAA require the School to consider reasonable accommodation for qualified students, when necessary to provide equal access to learning. "Reasonable" must be individually determined after a student requests accommodation.

Qualifying

To qualify for accommodation, a student must identify him/ herself to the Geisel School Director of Learning Services, declare the disability or suspected disability in writing, and request accommodation. It is also the student's responsibility to obtain a thorough written evaluation from an appropriate professional, documenting the presence, extent, and ramifications of the disability. In addition, the documentation should explain what specific types of accommodation the evaluator believes might be most helpful in offsetting the effects of the disability to an acceptable extent (in a medical school environment, if possible). Our goal at the Geisel School is to provide equal opportunity without undermining the integrity of any course, clerkship, or program.

The student must obtain this evaluation at his/her own expense and arrange to have the evaluation form and all supporting documentation forwarded to the Geisel School Learning Services Director. If an evaluation has already been conducted in the past, the Director will determine if it is recent enough. An evaluation performed more than three years earlier may not be acceptable, and there are instances in which an evaluation must have been completed within a few months or even weeks. The Learning Services Director can provide evaluation guidelines and forms before the student meets with an evaluator, or the student may refer to the documentation guidelines online. All documentation must conform to these guidelines.

CSD Review

After receiving acceptable documentation, the Director discusses the findings and recommendations with the student, and a potential accommodation plan is created.* It should be noted that not all accommodations suggested by an evaluator are necessarily feasible or even useful in a medical school environment. A student's needs and preferences are also taken into careful consideration, as are the Geisel School Standards and Competencies, when determining what might be reasonable.

The Director then presents the information she's gathered to the Committee on Students with Disabilities. The CSD reviews certain elements of the documentation, as well as information gathered through the personal interview with Ms. Trietley, and it considers the student's requests. If appropriate, it approves a plan for accommodating the student.

Accommodation plans may need adjustments and modifications throughout a student's medical education. In the case of minor or foreseen changes, the Director of Learning Services will make those alterations and report to the Committee at its next meeting. If more substantial changes are requested, a subcommittee may be convened.

If either the Director of Learning Services or the CSD finds that the documentation provided by the student does not meet its established standards, additional information will be requested from the evaluator. If further evaluation is required, it remains the student's responsibility to arrange for that evaluation, at his or her expense. If the CSD disagrees with the findings of an evaluation that conforms with Geisel School guidelines, a second evaluation may still be requested, but at the School's expense.

*The Director may approve temporary accommodations, at her discretion, until the CSD is able to meet and consider a student's requests.

Implementation

When a disability has been recognized, and a specific accommodation plan is approved by the CSD, the Learning Services Director meets with the student again to help enact the plan (or to extend/modify any temporary plan already in place). At that time, she gives the student a signed form outlining the approved accommodations. The student may share a copy of this form with testing coordinators, individual course and/or clerkship directors, or other staff who have relevant responsibilities. Sharing this information is typically at the discretion of the student, and is his or her responsibility in order to arrange for accommodations. There may, however, be occasions on which the Director of Learning Services speaks directly with faculty or other administrators, on a need-to-know basis, about a student's functional limitations (see section on Confidentiality).

A student is not entitled to accommodation in any course, clerkship, or activity if the form is not presented before specific accommodations are needed. Faculty and staff provide approved accommodations to all students who have shown their signed forms, provided the forms are presented in a timely fashion. (Presenting the form as early as possible is recommended, and individual courses or clerkships may have deadlines.) If a student's accommodation plan includes assistive devices, intermediaries, or extensive supplemental aid, significant additional time may be required to make arrangements; and the Director of Learning Services may help to make those arrangements directly.

Appeals

Any student wishing to appeal an accommodation decision made by the CSD should first appeal to the CSD itself. The student should explain in a letter why he or she believes the prior decision was unfair or inadequate, and should include any available corroborating information with the letter. The Director of Learning Services will accept the letter and schedule a meeting of the CSD, or a subcommittee, as soon as possible - usually within two or three weeks. A subcommittee is typically composed of 3-5 members, including the Director of Learning Services and the faculty chair of the Committee. The student should be prepared to meet with either committee to answer questions. During the appeal interval, any temporary accommodations will remain in place, or new temporary accommodations may be negotiated.

If a student disagrees with the CSD's decision after an appeal has been presented, that student may make a final appeal to the Dean of the Medical School. Once again, the student should submit a letter (and corroborating information) describing the situation and indicating why the CSD's decision does not appear to be fair or adequate. The Dean may wish to meet with the student to discuss the issues. The Dean may also consult with other professionals for information and perspective. The Dean's decision is final and is normally conveyed within three weeks of receiving the appeal letter.

If a faculty member disagrees with a decision made by the CSD, he or she should first talk with the Director of Learning Services for clarification of the issues. The next step would be writing a letter to the CSD, outlining any objections to the prior decision. If the faculty member is not satisfied with the subsequent decision by the CSD, he or she may make a final appeal to the Dean of the Medical School. He or she should write a letter to the Dean describing the situation and indicating why the committee's decision seems unreasonable.

Confidentiality

Disability information is considered private. Faculty and staff, with the exception of those on the CSD, do not have the right to access students' diagnostic information, although students may share that information with faculty and administrative offices if they choose. Ordinarily, faculty members and other relevant staff are only notified about approved accommodations that are deemed necessary to provide an equal opportunity for students.

There are times, however, when certain faculty members and/or administrators may have a legitimate educational need to know about a student's functional limitations, as well. In such cases, the Director of Learning Services may speak directly with those individuals to ensure appropriate planning. This kind of direct communication by the Director usually happens if the CSD has decided that certain members of the Geisel School community have an educational need to know about a student's limitations, or if an issue arises that may involve the safety and well being of patients, students, or staff. Students are also encouraged to speak with faculty as openly as possible to facilitate better understanding and support.

Faculty and/or staff to whom accommodation forms are presented may copy these forms for their records, but they should take care to keep the information private. The accommodation information conveyed on the forms should be communicated only to other faculty and/or staff who have an educational need to know (for instance, those who are involved in providing the accommodations, or those who are responsible for the educational environment). If a faculty member or a student has any questions about specific accommodations, he/she may contact the Geisel School Director of Learning Services. All documentation and official correspondence concerning a student's disability are kept in a separate file in the Office for Learning Services.

Clinical faculty (e.g. clerkship directors) who have occasion to write student evaluations at the end of clerkships must be careful not to breach the confidentiality afforded students with disabilities. Written evaluations, which may be excerpted in the Dean's Letter or seen by others outside the Geisel School community, should not mention disabilities, or accommodations for disabilities, in any way. Once a student has been approved for specific accommodations by CSD, and has subsequently received those accommodations, that student should be held to the same essential performance standards as all other students. Therefore, clinical faculty should focus strictly on the student's performance in all these evaluations. With regard to letters of reference solicited by students, faculty members may mention a disability IF the student gives prior permission for them to do so.

The Geisel School of Medicine at Dartmouth does not notify potential residency programs or other employers about student disabilities without specific permission from the student. Since students with disabilities, once accommodated, are held to the same standards as other students, the Geisel School does not make notation of any kind on the transcript or in the official Dean's letter (MSPE).

Emergency Evacuation

Those students with concerns about evacuating in the case of an emergency should contact Learning Services to develop a personal plan for safety. This also pertains to students who have not needed to request accommodations for their impairments or disabilities, but who believe a fire or other emergency might necessitate special assistance. Dartmouth's comprehensive emergency plan is located here.

Disability Policy Summary

• The Geisel School of Medicine does not discriminate against students with disabilities.
• Students with disabilities have both rights and responsibilities.
• In order to progress through the Geisel School and graduate, all students must be able to meet the Essential Standards for Matriculation, Promotion, and Graduation including the Standards for Capacity, with or without reasonable accommodation.
• Specific accommodations for a disability are explored on an individual basis once a student makes that request and provides acceptable documentation.
• Requests for accommodation must be made through the Geisel School Office for Learning Services.
• The CSD gives official approval regarding disability status and accommodation.
• The particular needs of each student, as well as the essential components of each course and clerkship, are taken into careful consideration when determining accommodations.
• Whereas the Geisel School may not always be able to meet every accommodation preference a student expresses, it does its best to arrive at solutions that work well for students.
• Disability information is considered private, and is shared only with those who have an educational need to know within the Geisel School system.
• The Director of Learning Services is available throughout a student's course of study to coordinate accommodations, answer questions, help with learning and performance strategies, resolve problems, and provide supportive counseling. She also acts as a liaison to faculty, providing information and helping them understand disability issues more thoroughly.

At the Geisel School of Medicine, our sincere intention is to provide equal and excellent educational opportunities to all of our highly qualified students, including those with disabilities.

Faculty Consultation

Learning and disability issues can sometimes be hard to understand. The policies and procedures outlined in the previous section should answer most questions faculty may have. However, any Geisel School faculty member or administrator is welcome to talk directly with Ms. Trietley about questions or concerns.

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