Charting Deaf Territory

How UVa Is Managing To Accommodate a Deaf Medical Student

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Braille poem overlaps Roy Nachum painting of a girl with her mouth wide open and hands on her head in disbelief
A photo of artwork, Someday, by Roy Nachum

Preface (December 2013)

Utter disbelief. That’s the initial reaction some people have when they hear that a Deaf student is attending the medical school program at the University of Virginia. The underlying sentiment is – How is that possible?

Call me jaded, but after nine years of serving people with disabilities, I’m not very surprised by what the human spirit desires and can achieve. I know of Braille-reading students who have majored in music and Chinese and a Deaf student who majored in Spanish. That’s downright crazy, to most people. But if I’ve learned anything from this line of work…Possibility is ultimately defined by an individual; whereas, limitations are often defined by society.

As a service provider and tech solution coordinator, my role is a matter of finding and offering tools that will ensure equal access to the education.

Certainly every Deaf medical student will have distinct accommodation needs and preferences, but the point of writing this report is to provide a template for those who may be facing a similar task of accommodating a Deaf medical student for the first time.

It’s been 19 weeks. You may ask. How’s it going so far?

We’re not out of the woods by any means. We haven’t even cleared the first of four years. We expect the changing nature of the curriculum (such as the clerkship) to throw us more curveballs.

Except for a few minor hiccups though, I’d say it’s going pretty damn well.

The student says the combination of accommodations is working well and he’s doing well on exams. He’s so easy-going and amiable that it makes our job that much easier. The DHH team prepared to get all the elements in place on time. Overall we’re very pleased with the quality and timeliness of service, but we still have to be vigilant and ready to respond to anything that drops.

The Preparation

The core DHH service team consisted of a Service Coordinator, University Interpreter and myself – the AT Specialist. We heard about the student’s acceptance to the program in June and hustled for two months to prepare for Orientation, August 1st. Our plan was to essentially provide numerous accommodation options to start, then pare back as needed after learning what was working best for the student.


  1. Find interpreters with medical expertise who would be a good fit for the student.
  2. Find live captioning vendors with medical expertise.
  3. Find closed captioning vendors with medical expertise. (Automatic Sync Technologies has been extremely valuable with their responsive support.)
  4. Set up university purchase orders for vendors
  5. Meet the curriculum director: review the typical day, the classroom environment, the inventory of course materials, the detailed schedules, the key med school contacts. We found a true champion here at the UVa School of Medicine.
  6. Tour the classrooms and labs to determine audio tech needs and blocking for interpreters
  7. Meet the student and interpreters and provide tech orientation and training

Checklist Recommendations

  • Hold online auditions for interpreters. Announce the opportunity through targeted online channels. Prepare an audio sample for prospective interpreters to sign. Ask the student to rank the interpreters, as they will be spending lots of quality time together for the next 4 years.
  • Consult the DSSHE ListServ (SUNY at Buffalo) and follow recommendations to secure live captioning and closed captioning vendors with a medical specialty.
  • Reach out to the medical school key players (system leaders, instructional coordinators and classroom tech support) and develop team unity.
  • Obtain weekly schedules and contact info; Coordinate Q&A sessions for each System.
  • Test network access and connection speed and device setup (talk with med school IT Dir)
  • Obtain visual access to classroom and live transcription, via classroom webcams and Streamtext
  • Establish communication channels – chat windows, cell phone texting & face-to-face meetings -well in advance.
  • Purchase AT Phone to communicate with student, interpreters and Class Techs; Critical for troubleshooting on the fly
  • Check on status periodically with the student, transcriber and interpreters and ensure that the system is working well.

What Has Worked Well

The Q & A with faculty is critical and we continue to conduct interactive sessions with each new group of system leaders every 6 weeks or so. It helps allay fears: Fear the instructor won’t be able to give everything the student needs; Fear of entering uncharted territory; Fear the instructor will have a lot more work to do.

(Aside: We’re fortunate to find a true champion in the curriculum director at the medical school who has been tremendous in supporting and promoting our efforts. His conviction and positive attitude has provided a leverage to inspire his instructional colleagues beyond what we could ever dream of doing.)

Key points

1. You have to instill confidence that you’ve got this handled. It’s your expertise. It’s what you do.

2. You have to impart that the goal is equal access, not extra privilege. It may require a little extra work, but Disability Services will be doing all the heavy lifting and provide support.

3. You have to encourage and appreciate the communication and cooperation. The experience is new to everybody, so the challenges are unique and the solutions will likely require group effort.

What Has Worked Less Well

Biggest Service Challenge: Audio difficulties persistently challenge uninterrupted service. Sometimes instructors don’t position the microphone properly (or use the microphone at all). Sometimes table microphones are open and student laptops interfere, causing reverberation or tinny noise. Consequently the audio can be irritating to the captionist over long periods of time.

Solutions: One solution to the audio challenge is providing an interpreter who is able to provide breaks for the transcriber when needed. The interpreter is present anyway for small group discussions and labs which are not as amenable to remote captioning. Alerting the System Leaders and Classroom Techs on-site is helpful too.

The Perfect Storm

Recently, we had what I call the Perfect Storm – everything that could go wrong went wrong. Normally, the student reads live captions on an iPad. The captionist works remotely (from Vermont) and gets an audio feed from the hard-wired classroom’s livestream on the Web. If audio troubles arise, the interpreter with medical training steps up and signs.

Here’s how it went down:

  1. I logged into the webstream. I could see the professor talking but I couldn’t hear any audio.
  2. I texted the student, interpreter and captionist, simultaneously to alert them of the situation and find out their status.
  3. The Interpreter was stuck in traffic due to a highway accident.
  4. The Remote Captionist was driving home (10 minutes away) after being locked out of the restricted university network system she happened to be using that morning. (So even if the audio was immediately fixed, she wouldn’t be available to transcribe.)
  5. The student was sitting patiently in the classroom, holding tight.
  6. I ran to the University Interpreter who amazingly happened to be available.
  7. She booked over to the medical school building to fill in. She happened to know something about the esoteric subject that day since her husband had taken medical classes.
  8. I texted the Classroom Tech and he resolved the audio issue right away.
  9. Within 20 minutes all the regulars were settled and back online. All was well again. Shortage of service was minimized.
  10. Hiccup

Other Hiccups

Hiccup: During the first month of school, last minute videos were assigned and students were being tested on the material the following day, despite being told earlier that this would be unacceptable practice. It turned out to be an oversight.

Solution: Since Closed-Captioning vendors do not offer same-day service, I recruited all available staff transcribe a portion of video. The University Interpreter offered to sign the content while the material was projected on a screen behind her. Fortunately, this occurred in August before the regular University students returned to school. Therefore, others in the office had some downtime to pitch in.

After we seamlessly pulled off that fire drill, we sent out stern messages to the medical school faculty and administrators reiterating how that exercise was a prime example of what not to do. We couldn’t guarantee that we’d have the resources to respond that way in the future. We disseminated further detailed guidelines of our expectations.

Hiccup: When Professors learned that they could correct the closed captions on their pre-recorded videos, they took the opportunity to revise – adding and deleting sentences – without considering how that would affect the synchronization process.

Solution: We drew up guidelines for the System Leaders and Support Coordinators emphasizing the goal of corrections was to edit not revise, and further explained the synchronization impact in future System Leader meetings.


Other potential barriers that ultimately have not affected service include negative attitudes. Occasionally we encounter someone who believes that all the ambition and accommodation is just not feasible or justified. Listening, not arguing but thoughtfully disagreeing and turning the focus back on the student and what truly can be achieved has been helpful. Regardless of discrimination laws, who are we to deny a student the education? For all we know, he could be a future Nobel laureate.

Some worried about video copyright permissions, while others wondered how the student was going to use a stethoscope. A conversation with General Counsel, and steering the student to other Deaf doctors was an easy fix. If you can isolate concerns and address them one at a time, it completely takes the wind out of overwhelming anxiety.

When I showed this report to the student for feedback, he responded with appreciation and said, “By the way…You and everyone else make it easy for me to just focus on studying.”

Doctor, what is that? I just got a chill down my spine.


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