The Unexamined Diversity: Disability Policies and Practices in US Graduate Medical Education Programs

Abstract

Background Graduate medical education (GME) institutions must ensure equal access for trainees with disabilities through appropriate and reasonable accommodations and policies. To date, no comprehensive review of the availability and inclusiveness of GME policies for residents with disabilities exists. Objective We examined institutions' compliance with Accreditation Council for Graduate Medical Education (ACGME) requirements and alignment with Association of American Medical Colleges (AAMC) policy considerations. Methods Between June and August 2019, we conducted a directed content analysis of GME institutional policies using the AAMC report on disability considerations and the ACGME institutional requirements as a framework. Results Of the 47 GME handbooks available for review, 32 (68%) included a disability policy. Forty-one of the 47 (87%) handbooks maintained a nondiscrimination statement that included disability. Twelve of the 32 (38%) handbooks included a specific disability policy and language that encouraged disclosure, and 17 (53%) included a statement about the confidential documentation used to determine reasonable accommodations. Nineteen of the 32 (59%) maintained a clear procedure for disclosing disabilities and requesting accommodations. Conclusions While disability policies are present in many of the largest GME institutions, it is not yet a standardized practice. For institutions maintaining a disability policy, many lack key elements identified as best practices in the AAMC considerations.

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“…8 In addition to disability-specific requirements, the ACGME added a set of Common Program Requirements that directly impact diversity and inclusion including: that the program in partnership with its sponsoring institution must engage in practices that focus on mission-driven, ongoing, systematic recruitment and retention of a diverse and inclusive workforce of residents... 9 Efforts to increase diversity suggest that institutional mission statements must align with program efforts and messaging (Table 1). 4,[7][8] A recent study suggests that the majority of GME sponsored institutions neither fully comply with requirements, nor align with current recommendations, 10 while a similarly-focused commentary offered best practice for inclusive policies in GME. 5 As the number of medical students with disabilities grows, 11 the disconnect between the potential applicants for residency and residency preparedness may serve as a barrier to the stated goals of increasing diversity in GME.…”

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“…17 Finally, graduate medical education must also embrace holistic approaches to admissions, recruitment, education, and professional development that provide equitable learning for primary and specialty care across all fields for graduating medical students with disabilities. 18,19…”