Dyslexia Initiative in Medicine

Overcoming Barriers, Enhancing Medical Practice

Raising awareness about dyslexia is crucial in the medical field to ensure that individuals with dyslexia receive appropriate support and accommodations.

Affiliations and Services:

MARINEMD LLC is an exclusive, innovative think tank with a diverse range of capabilities dedicated to solving important issues and improving lives through strategic research and practical solutions. They are a veteran-owned and operated enterprise and proudly affiliated with the Dyslexia Initiative in Medicine (DIIMED) enhancing our ability to provide specialized support and advocacy for dyslexic medical students. This affiliation reinforces our commitment to creating inclusive educational environments and advancing research and technology to benefit the wider community.

Dyslexia Awareness

Definition: Dyslexia is a heterogeneous group of disorders that deficit language processing characterized by problems with accurate or fluent word recognition, poor decoding, and poor spelling abilities. People with dyslexia can have poor working memory, speed of processing, and delayed rapid retrieval of information from long term memory. The combination of dyslexia phenotypes: phonological awareness, and mental processing speed is termed “double deficit dyslexia” which is the most severe form of dyslexia.

Section 1: Prevalence statistics Dyslexia affects approximately 5 to 10% of the population worldwide. It is the most common learning disability, with prevalence rates varying depending on diagnostic criteria and population studied. In the United states it is estimated that about one in five individuals have dyslexia to some degree.

Section 2: Risk and Prognostic Factors

Prematurity or very low birth weight increases the risk for dyslexia, as does prenatal exposure to nicotine.
Family history of reading difficulties (dyslexia) and parental literacy skills predict literacy problems in offspring.
Heritability for both reading ability and reading disability in alphabetic and non-alphabetic languages (e.g., Japanese, Chinese) is high (0.6).
Increased risk of suicidal ideation and suicide attempts in children adolescents, and adults.
Inattentive behavior in preschool years is predictive of later difficulties in reading and mathematics and non-response to effective academic interventions, but not necessarily dyslexia
Early delay or disorders in speech or language, or impaired cognitive processing predicts later dyslexia.
ADHD increases your chances chances of having dyslexia
ADHD is predictive of worse mental health outcome than dyslexia without ADHD.
Dyslexia is more common in males than in females(ratios range from about 2:1 to 3:1) and cannot be attributed to factors such as ascertainment bias, or measurement variation, language, race, or socioeconomic status.

Section 3: An uneven profile of abilities

An uneven profile of abilities is common, such as above average abilities in drawing, design, and other visual spatial abilities, but slow, effortful, and inaccurate reading and poor reading comprehension and written comprehension. Individuals with dyslexia may even exhibit poor performance on psychological tests of cognitive processing but many of the processing deficits in individuals with dyslexia are also found in other neurodevelopmental disorders (e.g. Attention deficit hyperactivity disorder, autistic spectrum disorder, communication disorders, developmental coordination disorder).

Section 4: Functional consequences

Dyslexia can have negative functional consequences across the lifespan, including lower academic attainment, higher rates of high school dropout, lower rates of post-secondary education, high levels of psychological distress and poorer overall mental health, higher rates of unemployment, and under-employment, and lower incomes. School dropout and Co-occurring depression symptoms increase the risk for poor mental health outcomes, whereas high levels of social and emotional support predict better mental health outcomes.

Section 5: Phonological deficit theory for a primary sensory processing deficit

Howard Levinson was a renown neuropsychiatrist who dedicated his life to treating dyslexia and comorbid ADHD. He hypothesized that dyslexia was primarily a deficit in the auditory, cerebellar and/or vestibular system which can impact various cognitive processes, including language processing, leading to difficulties in reading, writing, and related skills. The theory recognizes dyslexia as a primary sensory processing deficit, not a primary cerebral cortex deficit. Implying that changes that occur in the cerebral cortex must be secondary to a primary vestibular, cerebellar and/or auditory deficit. Dr. Levinson's hypothesis mechanistically supports the phonological deficit theory which uses generalized behavioral components to characterize dyslexic phenotypes. The Phonological theory gives specialists the ability to screen for dyslexia. The diagnosis is made when there is incongruence between achievement and intelligence, and importantly patterns of strengths and weaknesses.

Section 6: Dyslexic strengths can benefit medical practice

Visual thinking: excel in visual thinking and spatial reasoning. This ability can be beneficial in fields such as radiology, where interpreting complex images and identifying subtle abnormalities are essential skills.

Holistic thinking: tend to have a holistic approach to problem solving, considering multiple perspectives and connections. In medicine, this can lead to more comprehensive assessment of patients and considerations of various factors that impact their health and well-being.

Innovative communication: may develop innovative communications strategies to overcome challenges with reading and writing. In medical practice, effective communication is essential for building rapport with patients, collaborating with colleagues, and conveying complex medical information.

Section 7: How does dyslexia enhance medical practice?

Enhanced problem-solving skills: dyslexic individuals often develop strong problem-solving skills as they navigate challenges related to reading and language. These skills can be invaluable in diagnosing complex medical cases and developing innovative treatment and plans.

Empathy: many dyslexic individuals have experienced the frustration of struggling with traditional learning methods. This firsthand experience can foster empathy and understanding when working with patients who face their own challenges, whether related to health conditions or communication barriers.

Creativity: dyslexia is often associated with enhanced creativity and out-of-the-box thinking. Medical professionals with dyslexia may bring fresh perspective to patient care, leading to more innovative approaches to diagnosis, treatment, and research.

Attention to detail: while dyslexia can involve difficulties with reading and processing written information, individuals often compensate by developing keen observational skills and attention to detail. This attention to detail can be crucial in medical practice, particularly in tasks such as performing physical exams, interpreting diagnostic tests, and monitoring patient progress.

Resilience: many dyslexic individuals face significant challenges in their education and careers, yet they often develop resilience and perseverance in overcoming these obstacles. This resilience can be an asset in the demanding and often stressful environment of health care, helping medical professionals persist in the face of challenges and setbacks.

dyslexia can bring unique strengths and perspectives to medical practice, enriching the profession and improving patient care.

Tailoring training for individual needs: intervention: Systematic, intensive, and individualized instruction, using evidence-based interventions, may promote the use of compensatory strategies.

Benefit: Dyslexics can benefit from adaptations, accommodations, and compensatory strategies.

move away from the notion of one-size-fits-all for medical training.
Recognize that every person learns and trains differently.
Support and tailor training to individual needs to exploit their full potential.
Medical students and doctors should not have to fail exams or commit errors to be considered for dyslexia screening.

Creating an inclusive environment:

Inclusion of dyslexia awareness and accommodation in the medical school admission process
incorporating dyslexia awareness and support in the curriculum evaluation process
fostering a welcoming and supportive environment for dyslexic individuals in medical residencies.
Importance of screening for dyslexia in primary care due to its comorbidities with other conditions and potential impact on health outcomes
Promote the benefits of a diverse and inclusive medical workforce.

Section 8: collaboration and support

the role of preceptors and mentors in supporting dyslexic medical students
building a supportive community among medical students to advocate for inclusivity and accommodations.
Encouraging open dialogue and understanding among peers about dyslexia.

Section 9: administration in the college of medicine

inclusion efforts of administration on raising awareness about dyslexia are key for creating an inclusive and supportive working environment for physicians.
recognition and disclosure of dyslexia in the workplace is essential for creating a supportive and safe working environment in line with the equity legislation.
It's important for both students and doctors to acknowledge their condition without fear of stigmatization, enabling them to receive appropriate help to carry out their professional duties.
Greater awareness and early identification of dyslexia will improve the training experience of doctors and allow them to excel in their chosen career.

Section 10: systemic barriers

in 2016, 2.7% of US MD candidates disclose disabilities, indicating a growing need for accommodations [2].
Graduate medical education programs must understand their legal responsibilities and create inclusive policies.
A 2018 report identified 3 barriers to accessibility: undefined policies, lack of knowledgeable staff, and unawareness of legal requirements [2].

It's crucial to recognize the benefits of disability inclusion.

Section 11: challenges with USMLE accommodations

despite the need for accommodations, a significant number of medical students face obstacles in obtaining them for the USMLE.
Medical students with disabilities accounted for approximately 4.6% of the US allopathic medical student population in 2019 [1].
In the 2018-2019 academic year a survey of 141 schools [1], revealed that out of 276 students from 73 schools who applied for step one accommodations,144 52% were denied. Of those denied, 51% experienced delayed progression in their medical curriculum, and 110 or 76% were forced to take the step one exam without accommodations. Shockingly, among these students, 32% failed the exam.

Section 12: advocating for change

Collaborate with UMEC, LCME, GME, and ACGME to implement policies and practices that support dyslexic individuals in medical training and practice.
advocate for dyslexia, increase awareness, and support by promoting inclusivity and accommodations in medical education and residency programs.

Investing in disability related inclusion has the potential to improve conditions for all medical students and residents.

Section 13: institutional accountability towards students with disabilities:

the role of preceptors and mentors in supporting dyslexic medical students
define disability as diversity, and by recognizing unique perspectives and strengths.
mandate disability support services for equal access to resources.
protect student privacy, ensure accommodations, and technical standards align with the Americans with Disabilities Act (ADA)
ensuring that they do not unfairly disadvantage students with disabilities.

Conclusion:

Physicians with disabilities inform healthcare practices and may reduce disparate population health outcomes.
demonstrate greater empathy for patients and enrich the educational learning environment.
Research indicates that physicians with disability are more likely to provide care for underserved populations.
importance of fostering inclusivity and support throughout medical education and practice.
call to action for educators, administrators, physicians, and medical students to advocate for dyslexia awareness and support.
Dyslexia inclusion extends beyond merely improving representation of underrepresented groups, meeting quotas or academic standards. It's about recognizing and harnessing the full potential of individuals with dyslexia, who are entirely capable of excelling in the medical field. By embracing their unique strengths, we not only enhance the diversity of thought and approach within the medical profession but also improve the overall practice of medicine.

How to get involved in the dyslexia initiative within medical education?

Join disability support committees: Joining these committees allows students/residents to contribute to the development and implementation of support accommodations for dyslexics.

Advocate for inclusive policies: advocating for the provision of accommodations, fostering a supportive learning environment, and promoting diversity and inclusion in admissions and recruitment.

Raise awareness: Organize informational sessions, workshops, or presentations to educate faculty, staff, residents and students about dyslexia and the challenges faced by dyslexic individuals in medical education.

Provide peer support: Sharing personal experiences, strategies for success and resources for support can provide valuable encouragement and guidance to dyslexic students/residents navigating medical education.

Collaborate with disability services: identify and address barriers to inclusion and support for dyslexic students/residents. Advocate for the development of tailored support accommodations and resources to meet the needs of dyslexic learners.

Participate in research: contribute to research studies, participate in data collection or analysis, or support research initiatives aimed at improving support, accommodations and outcomes for dyslexic medical education.

Promote faculty development: advocate for faculty development initiatives focused on supporting dyslexic students. Provide training and support resources for faculty members on recognizing and accommodating diverse learning styles, fostering inclusivity, and support for the academic success of dyslexic learners.

References:

[1] Petersen, Kristina H., et al. "Impact of USMLE Step-1 accommodation denial on US medical schools: A national survey." Plos one 17.4 (2022): e0266685.

[2] Meeks, Lisa M., et al. "Realizing a diverse and inclusive workforce: equal access for residents with disabilities." Journal of graduate medical education 11.5 (2019): 498-503.

[3] Wagner, R. K., Moxley, J., Schatschneider, C., & Zirps, F. A. (2023). A Bayesian probabilistic framework for identification of individuals with dyslexia. Scientific Studies of Reading, 27(1), 67-81.

Nickolas Pasetto a medical student and marine veteran

Founder: Nickolas A. Pasetto

Point of contact:

Nickolas.Pasetto@wsu.edu

Nickolas A. Pasetto is a United States Marine Corps veteran, 1st generation college graduate, and medical student at WSU Elson S. Floyd College of Medicine. Growing up, Nick faced numerous challenges, including an undiagnosed ADHD. These experiences fueled his determination to overcome obstacles in school, work, and the military. Despite these challenges, his drive to help others led him to pursue a career in medicine.

Coming from a lower income background, Nick understands first-hand the barriers that can prevent capable individuals from achieving their dreams, including biased opinions that can hinder success. His journey through the Marine Corps, college, and now medical school has been marked by significant systemic challenges, access to care, evaluation processes, and financial struggles. However, it has also been characterized by hard work and perseverance.

At the end of his fourth year of medical school Nick was formally diagnosed with ADHD after years of being misunderstood. Recognizing the broader implications of his experience, Nick founded the dyslexia initiative in medicine to ensure that others do not face similar obstacles. He aims to eradicate biased perspectives in medicine, advocating for empathetic compassionate physicians who prioritize genuine patient care over outdated and misguided notions of what patient care should be for neurodivergent people. Neurotypical and neurodivergent individuals have different approaches to patient care, reflecting their unique strengths and perspectives.

Nick believes that neurodivergent individuals are underrepresented in medicine and face unique social determinants of health. He argues that having more neurodivergent health care providers would lead to better understanding and care for neurodivergent patients as they share similar experiences and challenges. His initiative strives to promote inclusion and support for those with dyslexia and other learning differences, fostering a more equitable and understanding medical community.

References:

[1b] Godfrey-Harris, M., & Shaw, S. C. K. (2023). The experiences of medical students with ADHD: A phenomenological study. PLoS One, 18(8), e0290513.

Vision

"empowering a diverse and inclusive health care workforce by raising awareness, providing education, and fostering support to recruit and retain medical students, residents, and clinicians with dyslexia. Together, we can strive to improve access to care for underserved populations and create a health care system that is truly inclusive and equitable for all."

Dyslexia Support & Education:

Educational Resources:

Reid, Gavin. Dyslexia: A practitioner's handbook. John Wiley & Sons, 2016.

Eden GF, Moats L. The role of neuroscience in the remediation of students with dyslexia.

Nat Neurosci. 2002.

Shaywitz, Sally E. Overcoming dyslexia: A new and complete science-based program for reading problems at any level. Knopf, 2003.

GME support:

ACGME Equity matters initiative.

Online assessment:

Marker Learning