Barriers to Disclosure of Disability and Request for Accommodations Among First-Year Resident Physicians in the US

Abstract

ImportanceEnsuring access to accommodations is critical for resident physicians and their patients. Studies show that a large proportion of medical trainees with disabilities do not request needed accommodations; however, drivers of nonrequests are unknown.ObjectiveTo assess the frequency of accommodation requests among first-year resident physicians (ie, interns) with disabilities and to identify possible drivers of nonrequest for needed accommodations.Design, Setting, and ParticipantsAs part of the Intern Health Study, a longitudinal cohort study of first-year resident physicians, residents at 86 surgical and nonsurgical residency programs in 64 US institutions provided demographic and training characteristics 2 months prior to matriculation (April-May 2021). At the end of their intern year (June 2022), participants completed a new survey with questions about disability-related information, including disability status, disability type, whether they received accommodations, and if not, reasons for nonaccommodation. Poststratification and attrition weights were used to estimate the frequency of accommodation requests and reasons for not requesting accommodations. Interns reporting at least 1 disability were included in the analysis.Main Outcomes and MeasuresPrevalence of reported disabilities, residency specialties distribution, frequency of accommodation requests, and reasons for nonaccommodation among resident physicians with disabilities.ResultsAmong the 1486 resident physicians who completed the baseline survey, 799 (53.8%) replied to the disability questions. Of those, 94 interns (11.8%; weighted number, 173 [11.9%]) reported at least 1 disability and were included in the present study (weighted numbers, 91 [52.6%] men, 82 [47.4%] women, mean [SD] age, 28.6 [3.0] years). Among interns with reported disability and need for accommodations (83 of 173 [48.0%]), more than half (42 [50.6%]) did not request them. The most frequently reported reasons for not requesting needed accommodations were fear of stigma or bias (25 [59.5%]), lack of a clear institutional process for requesting accommodations (10 [23.8%]), and lack of documentation (5 [11.9%]).Conclusions and RelevanceProgram directors should investigate cultural and structural factors within their programs that contribute to an environment where residents do not feel safe or supported in disclosing disability and requesting accommodation and review their disability policies for clarity.

Medical Student Burnout by Race, Ethnicity, and Multiple Disability Status

“…Access to accommodations have shown to improve burnout metrics among students with disabilities . Fear of stigma and lack of clear institutional processes are substantial barriers to disability disclosure and requesting accommodations . Limitations of this study include our inability to cluster results by medical school and to examine prevalence of multiple disabilities and burnout across other demographic groups, including sexual and/or gender minority and socioeconomic status .…”

“… 2 Fear of stigma and lack of clear institutional processes are substantial barriers to disability disclosure and requesting accommodations. 5 Limitations of this study include our inability to cluster results by medical school and to examine prevalence of multiple disabilities and burnout across other demographic groups, including sexual and/or gender minority 2 and socioeconomic status. 6 This study highlights the necessity to address burnout among Asian and URiM students with multiple disabilities through applying critical intersectional, antiracist, and antiableist lenses to promote equity in medical training.…”

Informed Inclusion Model: Medical Student Wheelchair User in an Obstetrics and Gynecology Clerkship

“…Increasing the number of students with disabilities matriculating into medical schools and mitigating barriers through reasonable accommodation(s) are essential commitments by medical associations and obstetrics and gynecology (Ob/Gyn) medical education committees toward realizing the goal of a diverse physician workforce 2,3 . Despite these commitments, the number of medical students with mobility disabilities, including wheelchair users, remains low 4,5 …”

“…2,3 Despite these commitments, the number of medical students with mobility disabilities, including wheelchair users, remains low. 4,5 In 2021, 5.9% of MD-granting medical school students reported a disability, a significant increase from 2019 (4.6%) and 2015 (2.8%), 5 whereas a 2020 study identified that 4.27% of osteopathic (DO) students reported a disability. 4 These findings highlight the dearth of disability representation in medical education, specifically the small proportion of students with mobility disabilities in MD (2.6% in 2015, 3.5% in 2019, and 3.2% in 2021) 5 and DO (4.5% in 2020) programs.…”

“…4,5 In 2021, 5.9% of MD-granting medical school students reported a disability, a significant increase from 2019 (4.6%) and 2015 (2.8%), 5 whereas a 2020 study identified that 4.27% of osteopathic (DO) students reported a disability. 4 These findings highlight the dearth of disability representation in medical education, specifically the small proportion of students with mobility disabilities in MD (2.6% in 2015, 3.5% in 2019, and 3.2% in 2021) 5 and DO (4.5% in 2020) programs. 4 Despite demands for greater inclusion, 2,3 successful experiences training students with physical disabilities, representation of physicians who use wheelchairs in their practices, [6][7][8][9][10][11][12][13][14][15][16][17] and research that unequivocally demonstrates no difference in the performance or match rates of students with physical disabilities, 18 the number of medical students with mobility disabilities remains low, 4,5 The student was scheduled to rotate through Ob/Gyn 7 months into the clerkship year, giving the Ob/Gyn team time to plan effectively.…”