Document Type : Original Article


1 Department of General and Specialized Surgery, Faculty of Medicine, Postgraduate Maternal Child Health Program, Federal Fluminense University, Niterói (RJ), Brazil

2 Department of Primary Care, Health Municipal Office, Itabuna (BA), Brazil

3 Faculty of Medicine, Federal Fluminense University, Niterói (RJ), Brazil


Introduction: The affirmative policies in Brazil guarantee the provision of undergraduate medical education to People with Disability (PWD). The objective was to estimate the prevalence of PWD undergraduate medical students in Brazil in 2019.
Methods: This is an exploratory, descriptive study that used census data from the total population of the undergraduate
medical students (N=183,646) who were enrolled at the Brazilian medical schools, in 2019. The data are secondary, unidentified and accessed online, and were originally collected by the Higher Education Census conducted by Anísio Teixeira National Institute of Educational Studies and Research (INEP), which used a questionnaire designed to capture information from students and medical courses. The descriptive analysis was based on absolute and relative frequencies.
Results: The prevalence of medical students that were PWD was 0.80% (1,460/183,646), and this includes both Brazilian and foreign students. The latter includes people from 76 different countries. Foreign students who are PWD came from eight different countries: Bolivia, Burundi, Cabo Verde, Republic of Congo, Paraguay, Philippines, Singapore and Spain. Most of the PWD were male (51.37%), aged 20 to 24 years (46.78%) and of non-white ethnicity (52.26%). Most students were enrolled in public medical schools (73.97%). A fraction of PWD students (6.51%) was enrolled in medical schools with no specific resource or assistance for PWD. The highest prevalence was the physical disability (39.11%), followed by low vision accuracy (24.45%), intellectual (15.41%), low hearing (14.11%), blindness (3.97%), multiple disabilities (2.47%) and deafness (1.51%).
Conclusions: The prevalence of PWD medical students in Brazil is low, and is dominated by students with physical and sensory disabilities but lacks the deaf-blind. Despite the existence of legal regulations favoring PWD to study medicine, some medical schools have not done adequate adjustments to accommodate them. This suggests that affirmative policies for the inclusion of PWD in higher education, particularly in medicine, still need improvement.





There is a worldwide ongoing inclusive movement to promote diversity in medical schools by integrating students who are people with disability (PWD) ( 1 ). The increase in the number of physicians who are PWD can increase the visibility of these individuals, and this can be augmented when done in concert with the implementation of policies that enforce the introduction and continuity of faculty mentors who identify themselves as PWD ( 2 ).

A PWD-physician can improve the quality of care offered to patients who are also PWD, simply because they have a greater understanding of the challenges and singularities that are part of the lives of those with a disability. The benefit of this is also enhanced by the interaction between PWD professionals who work in the healthcare workforce. They help to deconstruct the misconceptions that fuel disparities that are induced by stigmas and stereotypes that harm the lives of PWD ( 3 ).

In Brazil, there are legislations in force to increase the access of minority groups to higher education ( 4 ). The population of people with disability in 2010 was estimated at 6.7% (12,748,663) of the total Brazilian population ( 5 ). This data demonstrates that PWD retain a non-negligible fraction of the population, and highlights the importance of including PWD in various areas or sectors of society. The vacancy reservation policy was expanded in 2016 to increase the access of PWD to various opportunities, chief among them, higher education ( 6 ).

This manuscript provides information about People with Disability (PWD) and medical education, using Brazil as a model country to demonstrate a situation potentially occurring in developing countries. This is facilitated by an annual census that provides statistical records regarding the enrollment of individuals at various educational levels, and includes various factors such as race, age, and disability. This study aimed to (i) estimate the prevalence of people with disabilities enrolled in undergraduate medical courses in Brazil in 2019, (ii) characterize these students in terms of demographic profile, access to higher education and type of disability.


Study design

This is a descriptive study designed to measure the prevalence and characterize people with disability who are undergraduate medical students in Brazil. According to the Association of American Medical Colleges an individual with a disability is “someone with limitation in one or more major life activities such as walking, seeing, hearing, speaking, working or learning” ( 7 ). It was conducted using primary data collected from the higher education census, coordinated by the Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira (INEP) ( 8 ). INEP is an institution of the Ministry of Education that is responsible for producing statistics and education indicators in Brazil ( 9 ). The annual census is an official source of de-identified data that was established in 1995, and is made available annually via the web.

Setting and participants

Brazil is the third largest country in the Americas surpassed only by Canada and the United States of America. Constitutionally, Brazil is a federal republic formed by five macro regions (North, Northeast, Southeast, Midwest and South), one Federal District and 26 states. According to the 2019 INEP data ( 8 ), there were 340 medical schools distributed across the 26 federative units and the Federal District, of which a total of 199,478 undergraduate medical students were actively enrolled.

Participants of the study are undergraduate medical students whose data were transmitted from medical schools to INEP (N=199,478) in 2019. The inclusion criterion was based on the complete information about having or not having disability. The absence of information on whether the students had motor or sensory limitations determined his or her exclusion from this study (N=15,832). The study population comprised 183,646 undergraduate medical students.

Data collection

The primary database of the INEP is fed annually via a higher education census. The present study was conducted with secondary, unidentified, publicly accessible data, which are freely available online through the INEP website.

Data collection was carried out by the following steps: “statistical surveys and educational indicators”, “higher education census”, “results”, “higher education microdata 2019” ( 10 ). The data analyzed belong to two independent databases that store information from the higher education census. Course microdata (“DM_CURSO_2019”) were analyzed after selecting the variable NO_COURSO == ‘MEDICINA’. The selection of the subset of medical students was made in the “DM_ALUNO_2019” database, following the INEP instructions for the use of big data and selecting the variable “CO_CINE_ROTULO” registered as “0912M01”, a code that corresponds to “medicine” ( 11 ).

Selected Variables

The characterization of the demographic profile was carried out by considering the variables (i) gender (female and male), (ii) age (<20, 20-24, 25-29, ≥30 years), (iii) race/ethnicity (white, non-white, missing data), (iv) nationality (Brazilian, Naturalized Brazilian, foreign nationality). The characterization of students in relation to access to enrollment into the medical course performed by describing the variables (i) management and funding of the school where the student attended high school (public/private), (ii) management and funding of the higher education institution where the student is enrolled (public/private), (iii) mode of enrollment through the “quota system” (yes/no) and (iv) accommodation for PWD at the medical school (yes/no). The characterization of the types of disability was carried out considering the following types of disability reported in the INEP census: hearing loss, physical impairments, intellectual, multiple, deafness, deaf-blindness, low vision and blindness.

Data analysis

We used the RStudio program and the ffbase package ( 12 ) to import higher education census microdata and select the subset of medical students following the step-by-step process recommended by INEP ( 11 ). Data analysis consisted of descriptive statistics of ordinal variables presented as counts and proportions. The age variable was transformed into a nominal variable and presented in categories. The prevalence of the 'PWD' students was presented with their respective 95% confidence intervals (95%CI) estimated for proportion of the finite population. The comparison between complete data about having or not having disabilities and missing data about disabilities was done using the chi square test (categorical variables) and student t-test (continuous variable). The analyses were conducted using the RStudio program.

Ethical Considerations

The present study was conducted in accordance with the principles established by the Declaration of Helsinki. The study protocol was assessed and approved by the Research Ethics Committee of the University Hospital, with file No. 3,490,540, issued on 08/07/2019. As the data used in the study are secondary, unidentified and freely available on the internet, the study was exempted from presenting and signing an Informed Consent Statement.


The Higher Education Census revealed that a total of 199,478 individuals were enrolled in medical schools in Brazil. A high rate of them (183,646/199,478) (92.06%; 95% CI: 91.94%; 92.18%) of the students had indicated if they had some type of disability (N=1,460) or if they did not have (N=182,186), indicating a study population of 183,646 participants.

The differences between complete data about having or not having disabilities (N=183,646) and missing data about disabilities (N=15,832) showed that the absence of information about disability was higher among students who did not also inform their skin color (p<0.01) and who were male (p<0.01), but it was lower among older individuals (p=0.02). The prevalence of PWD (1,460/183,646) enrolled in undergraduate medical education in Brazil was 0.80% (95% CI: 0.75%; 0.84%) in 2019.

The medical school data in Brazil recorded a higher frequency for: female students (59.52%; 95% CI: 59.29%; 59.74%), the age range of 20-24 years (56.78%; 95% CI: 56.56%; 57.01%), and for those with white skin color (61.79%; 95% CI: 61.56%; 62.01%). A small proportion of the students were of Naturalized Brazilian nationality (0.13%; 95% CI: 0.11%; 0.14%). Foreigners (0.39%; 95% CI: 0.36%; 0.42%) came from 76 different countries. The largest contingents are from Paraguay (n=100), Cabo Verde (n=85) and the United States of America (n=62). Foreign students who are PWD came from eight different countries: Bolivia, Burundi, Cabo Verde, Republic of Congo, Paraguay, Philippines, Singapore and Spain. The demographic profile of the study population is summarized in Table 1.

Variable Total PWD* Non-PWD
N (183,646) % (95%CI**) N (1,460) % (95%CI) N (182,186) % (95%CI)
Female 109,308 59.52 (59.29; 59.74) 710 48.63 108,598 59.61
Male 74,388 40.48 (40.25; 40.70) 750 51.37 73,588 40.39
Age (Years)
< 20 20,510 11.17 (11.02; 11.31) 122 8.36 20,388 11.19
20-24 104,288 56.79 (56.56; 57.01) 683 46.78 103,605 56.87
25-29 39,954 21.75 (21.56; 21.94) 320 21.92 39,634 21.75
≥ 30 18,894 10.29 (10.14; 10.42) 335 22.95 18,559 10.19
White 113,477 61.79 (61.56; 62.01) 618 42.33 112,859 61.95
Non-White 51,220 27.89 (27.68; 28.09) 763 52.26 50,457 27.70
Missing data 18,949 10.32 (10.17; 10.45) 79 5.41 18,870 10.36
Brazilian 182,693 99.48 (99.44; 99.51) 1,450 99.32 181,243 99.48
Naturalized*** 234 0.13 (0.11; 0.14) 2 0.14 232 0.13
Foreigner 719 0.39 (0.36; 0.42 8 0.55 711 0.39
*People With Disability. **Confidence Intervals, ***Naturalized Brazilian.
Table 1.Demographic profile of actively enrolled undergraduate medical students in Brazil, 2019

Information regarding the route of enrollment into the medical course showed that most students who are PWD used the quota system (n=865) and most of the vacancies accessed by them were really intended/reserved for PWD (n=705). With regards to the guarantee of accommodation for PWD by schools, it was observed that 6.5% of PWD-students were enrolled in medical schools that did not offer resources or help to students with disability. Table 2 shows the conditions/route of access to medical education in Brazil.

Variable Total PWD* Non-PWD
N (183,646) %(95%CI) N (1,460) % (95%CI) N (182,186) % (95%CI)
Funding of high school
Public 52,108 28.37 917 62.81 51,191 28.10
Private 131,243 71.47 539 36.92 130,704 71.74
Missing 295 0.16 4 0.27 291 0.16
Funding of medical school
Public 58,485 31.85 1,080 73.97 57,405 31.51
Private 125,161 68.15 380 26.03 124,781 68.49
Use of quota system
Yes 18,055 9.83 865 59.25 17,190 9.44
No 165,591 90.17 595 40.75 164,996 90.56
Yes 175,880 95.77 1,365 93.49 174,515 95.79
No 7,766 4.23 95 6.51 7,671 4.21
*PWD: People with Disability.
Table 2.Medical schools and People With Disability-students: mode of enrollment, and the provision of accommodation

Regarding the different types of disability reported by INEP, a higher frequency (43.6%) of sensory alterations was detected (hearing loss, deafness, deaf-blindness, low vision and blindness), followed by physical disability (38.7%), intellectual disability (15.3%), and multiple disabilities (2.5%). There was no record of students with simultaneous deaf-blindness. Public schools absorbed most of the PWD-students, with the exception of intellectual disability since it was the only type that predominated in private schools (69.78% versus 30.22%). The distribution of PWD-students according to type of disability, enrolled in public and private institutions is shown in Figure 1.

Figure 1. Distribution of students with different types of disabilities according to public or private medical schools

With the exception of the state of Amapá, the process for the enrollment and training of physicians in Brazil registered the inclusion of PWD in all federative units in 2019. The lowest prevalence of PWD students was registered in the Federal District (0.18%) and the state of São Paulo (0.25%). The highest prevalence of PWD students was found in the state of Acre (8.95%) which is located in the northern region of the country and borders Peru and Bolivia (Table 3).

Federative state Medical students 95%CI** Absolute number of the different types of disability
Total (n) PWD* (n) PWD (%) Low-hearing Physical Intellectual Multiple Deafness Deaf-blindness Low-Vision Blindness
Rondônia 2479 11 0.44 0.18 0.70 2 3 2 0 1 0 3 0
Acre 1128 101 8.95 7.28 10.62 8 27 65 2 0 0 8 0
Amazonas 1890 17 0.90 0.47 1.33 2 6 5 0 0 0 4 0
Roraima 570 40 7.02 4.92 9.12 6 22 3 0 0 0 9 0
Pará 4173 27 0.65 0.41 0.89 3 16 1 1 0 0 4 2
Amapá 370 0 0.00 0.00 0.00 0 0 0 0 0 0 0 0
Tocantins 3335 21 0.63 0.36 0.90 3 7 4 2 1 0 4 0
Maranhão 3176 63 1.98 1.50 2.46 8 31 1 1 0 0 16 6
Piauí 3690 18 0.49 0.26 0.72 2 13 1 1 0 0 0 1
Ceará 6142 57 0.93 0.69 1.17 6 26 9 1 1 0 14 0
Rio Grande do Norte 2778 50 1.80 1.31 2.29 8 32 0 0 0 0 10 0
Paraíba 6767 109 1.61 1.31 1.91 13 40 9 1 1 0 40 6
Pernambuco 7602 46 0.61 0.43 0.79 7 20 4 1 1 0 5 9
Alagoas 2854 28 0.98 0.62 1.34 1 5 1 1 0 0 17 3
Sergipe 1967 41 2.08 1.45 2.71 3 22 3 0 1 0 12 0
Bahia 10715 55 0.51 0.38 0.64 11 18 7 1 3 0 16 2
Minas Gerais 24932 202 0.81 0.70 0.92 30 74 40 7 1 0 42 8
Espirito Santo 3899 13 0.33 0.15 0.51 1 3 1 1 0 0 6 1
Rio de Janeiro 16869 91 0.54 0.43 0.65 11 37 7 4 5 0 15 12
São Paulo 36169 91 0.25 0.20 0.30 15 35 19 3 2 0 18 0
Paraná 11235 55 0.49 0.36 0.62 7 13 16 3 1 0 13 2
Santa Catarina 6543 45 0.69 0.49 0.89 10 22 2 1 0 0 8 2
Rio Grande do Sul 9588 133 1.39 1.16 1.62 30 58 5 3 0 0 35 2
Mato Grosso do Sul 2240 49 2.19 1.58 2.80 6 17 3 1 3 0 19 0
Mato Grosso 1864 35 1.88 1.26 2.50 6 9 4 0 0 0 14 2
Goiás 7265 56 0.77 0.57 0.97 6 12 13 1 1 0 23 0
Distrito Federal 3408 6 0.18 0.04 0.32 1 3 0 0 0 0 2 0
Brazil 183.646 1.460 0.80 0.76 0.84 206 571 225 36 22 0 357 58
*People With Disability. **Confidence Intervals
Table 3.Prevalence of actively enrolled PWD undergraduate medical students, according to the Federative Unit, Brazil, 2019


The present study showed that PWD students are reaching the highest level of education and enrolling in very competitive courses such as medicine. However, the representation of these students in medical schools is still small. Estimates indicate that there are less than 8 PWD for every 1,000 undergraduate medical students in Brazil. About 60% of them gained access to the Medicine course via the quota system, but a portion of them enrolled in schools that are not fully prepared to have PWD. This scenario suggests that affirmative policies aimed at the inclusion of PWD in higher education, particularly in Medicine, still need improvement, and effective implementation.

The prevalence of the PWD medical students in Brazil seems to be even lower in comparison to those of developed countries. At the University of Aberdeen (UK), 4% of medical school applicants admitted have a disability, but the frequency increased to 13% when they realized that learning difficulties, mental disorders, sensory differences, chronic illnesses and mobility problems were part of the list supported by the legislation of that country ( 13 ). The same happens in the United States, where estimates point that about 4.6% of PWD students are enrolled in allopathic medical schools, in which the classification includes various conditions such as mental health and chronic diseases ( 14 ).

In the United Kingdom, it was also observed that 2% of physicians had some type of disability ( 15 ). In countries within the United Kingdom, medical schools are giving importance to diversity ( 1 ). Diversity is a broad term that encompasses race/ethnicity, gender, religion, social class, sexual orientation, abilities, age, identity, nationality and health/disease ( 16 ). Under the culture of inclusion and diversity, medical training benefits both in terms of reducing disparities in health and in increasing the health of minorities, since PWD is the most underrepresented group in medicine ( 17 ).

Implications of study

The low representativeness of PWD students in Brazil can be attributed to the strong competition that historically marks the selection of students entering medicine courses, but it can be, above all, the reflection of the disproportionate relationship between PWD and the level of education required to gain entry into higher education, in comparison to the non-PWD population. In 2019, Brazilian data showed that there was a higher prevalence among the PWD, of those with “lack of formal education or incomplete primary education” in the age group of 18 years or older (67.6%), compared to the equivalent age group without a disability (30.9%). In the same age group, the differences also remained in relation to higher education (5.0% versus 17%) and secondary education (16.6% versus 37.2%) ( 18 ). Despite the current legislation aimed at increasing access to higher education, it is necessary to put a spotlight on secondary education and better understand the preparation, adjustments and support for PWD students being executed/performed at this level of education in Brazil.

The data drawn from medical schools in Brazil shows that physical disability was the most prevalent in 2019. A comment on barriers faced by Canadian medical students draws attention to the lack of information about the presence of people with physical disability studying in the medical schools in Canada ( 19 ). The authors believe that learning environments suitable for this type of disability are lacking or perhaps candidates decline from studying medicine due to the barriers against people with physical disabilities. As shortcomings, they cite: (i) lack of space in the examination rooms that allow adequate movement, (ii) lack of examination tables equipped with height adjustment for people on wheelchairs, (iii) lack of automatic doors and (iv) hand washing equipment in sufficient numbers and suitable for people on wheelchairs ( 19 ). Given the high number of students with physical disabilities in Brazil, such issues require further investigation in the country.

In addition to the absence of students who are deaf-blind, an issue to be highlighted is the almost invisible presence of people with deafness in medical schools in Brazil. McKee, et al. highlighted some motivating issues that can open doors to people who have hard-of-hearing: (i) improved communication between physicians and patients who are deaf-blind, (ii) educational effect due to interaction with other students and teachers, (iii) inclusion of PWD to contribute at an academic level as opposed to being patients, thereby increasing their representation, and consequently diversity in the workforce, and (iv) by the late deafened sharing their own experience with colleagues who are losing their hearing as they age ( 20 ).

An interesting observation was that PWD students with intellectual disability were the third most represented group, only behind those with physical disability and low-vision. In the United States, an estimated 6,000 students with intellectual disabilities are enrolled in American colleges and universities ( 21 ). Although the definition of intellectual disability lacks precision, an important feature is that it is a functional alteration not always manifested by learning difficulties, but always requiring special education and adaptation of the school to meet the students’ needs ( 22 ).

As mentioned earlier, affirmative policies seem to be discreetly promoting access for some PWD-students; however, there is need to investigate their maintenance in medical schools, and consequent graduation in Brazil. Data from 2010/2011 provided by 86 American medical schools showed that the ratio of graduated-to-matriculated students with disability was 0.76. Although the list of needed emergent assistive technologies are long, medical schools more frequently implement non-complex accommodations such as extra time to perform tasks, ramps/lifts/entrances and dictated or audio-recorded lectures, and suggest that these changes help maintain PWD students within the faculty of Medicine ( 23 , 24 ). In addition, there is lack of information in Brazil regarding the existence of assistive technology such as amplified stethoscopes, digital stethoscopes, height-adjustable chairs, adjustable examination table, and assistant for physical examination, which can optimize and potentiate the theoretical and practical learning of PWD medical students. These questions remain to be addressed by future researches.


The present study has the merit of presenting a theme that is less studied in the national and international literature. However, it does have some limitations. One issue to point out is the quality of the information since the microdata are transmitted to INEP after the collection is performed within educational institutions, and this has received criticism. However, in 2019 various legislations were enforced and may have motivated greater commitment in the collection and transmission of data. Despite the provision of some mechanisms by Brazilian legislation for the inclusion of the minorities, discrimination, stigma and stereotypes still exists, potentially leading to the omission of information by the students, consequently underestimating prevalence measures. This problem needs to be better investigated by future studies.


The prevalence of PWD medical students in Brazil is low and includes both Brazilians and foreigners. The PWD group is dominated by students with physical and sensory disability but lacks the deaf-blind. Despite the existence of legal regulations favoring PWD to study medicine, some medical schools have not done adequate adjustments to accommodate them. This scenario suggests that affirmative policies aimed at the inclusion of PWD in higher education, particularly in medicine, still need improvement.

Authors’ Contributions

All authors contributed to the discussion, read and approved the manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated resolved.

Conflict of interest:

None declared.


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