A study published in JAMA Network Open found that nearly one in 10 internal medicine residents reported having a disability of some kind, and those new physicians are not always asking for, or getting, the kind of accommodations they need in their training programs.
“That’s a pervasive aspect of the culture of medicine and the culture of residency training in particular, where any request for accommodation or any latitude is perceived as weakness,” said John Andrews, MD, the AMA’s vice president for medical education and professional development. “The history of residency training is that you have to be yoked to this thing and commit your entire being to it or you won't be successful, and I think that culture persists.”
In the study, “Disability Accommodation Access and Requests in U.S. Internal Medicine Residents With Disabilities,” researchers offered a survey to the 30,927 residents who took the 2023 American College of Physicians Internal Medicine In-Training Examination and 19,205—or 62.1%—responded. Of those, 9.5%, or 1,824 residents, said they had at least one disability.
“Disability-related challenges are often rooted in insufficient disability education among residency program leaders and the absence of standardized guidance on supporting” residents with disabilities, the study’s authors wrote. “As a result, program directors may not view accessibility as a fundamental component of medical training, but as an optional enhancement, leading to inconsistent or inadequate support across programs.”
Cognitive disabilities most commonly reported
When it came to the type of disability the residents reported having, the most frequently named were (respondents could select more than one):
- Any cognitive disability—76.6%.
- Any chronic health disability—12.6%.
- Any motor and/or sensory disorder—8.7%.
- Psychological disability—8.7%.
- Learning disability—6.1%.
The most reported cognitive disability was attention-deficit/hyperactivity disorder (ADHD), at 68.3% of the respondents with a disability.
Of those with a disability who completed the survey regarding their program’s accommodations, 77.1% said they had program access, which was defined as either receiving accommodations or not needing them because the environment was inherently accessible to those with disabilities. More than one-quarter of the residents who reported needing accommodations, though, did not ask for them, with the most common reasons for not doing so being a fear of stigma, at 82%, and unclear institutional processes for doing so, at 30%.
Of those who had adequate access, 59.4% said they received accommodations through their training program and 40.6% reported that they did not request accommodations because the program was already accessible to them. Among those categorized as “not having access”:
- 83% said they had not requested accommodations despite needing them.
- 4.1% said their accommodation requests had been denied.
- 2.9% reported that their requests were still under review.
- 10% said they were unsure about why they had not received accommodations.
Dr. Andrews said that there can be “cultural silence” in residency training around the topic of disability accommodation, and that breaking that silence is up to the program administration or directors.
One key step would be “for program directors, perhaps referencing their own experience, perhaps referencing the experience of others, to say: We recognize that everybody's journey through residency is going to be different and some residents may require accommodation or different supports than others, and I want to invite you to discuss those with me,” he noted. “Just opening that door could help a lot.”
Residents were less likely to request accommodations if they had cognitive disabilities, were a member of a historically excluded ethnic or racial group, or identified as a woman, Asian, genderqueer or nonbinary.
That aspect of the study results did not surprise Dr. Andrews, who surmised those residents might think to themselves: “I'm already at a disadvantage, and this will just make it worse.”
A topic worthy of attention
With so many internal medicine residents reporting having a disability of some kind, he said, program leaders should tackle the matter early.
“The right time to address it is during orientation in residency to say, it’s OK to ask for accommodations and here's the process. … The fact that it's a black box for people is another thing that puts them off,” Dr. Andrews said. “For someone to be transparent about the process of seeking accommodation and what's going to happen in the face of a request would go a long way toward facilitating people coming forward.”
He found it likely that the results of the study would be broadly applicable to the circumstances of residents in other specialties as well. The leaders of residency training programs need the human resources skills to be able to navigate these situations in a way that preserves access for all future physicians.
“Residency is stressful enough without feeling like you have to shoulder a burden while you go through it,” Dr. Andrews said.
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