This is My Learner, Not My Patient: Addressing Concerns in Learners With Attention Deficit Hyperactivity Disorder

Abstract

With the increasing number of medical students diagnosed with adult ADHD, residency programs face an imperative task to handle accommodations effectively. As medical residents occupy unique roles as learners and employees, defining a clear process to protect residents and programs can be challenging. This article will review legal requirements, disclosure processes, and sample accommodations that can help family medicine programs make sense of their responsibilities and support residents. Collaboration, clear boundaries, and effective documentation increase the likelihood of a predictable process to facilitate inclusion of learners with ADHD into graduate medical education and residency.

Attention Deficit Hyperactivity Disorder in Medical Learners and Physicians and a Potentially Helpful Educational Tool

“…Accommodation-based interventions for medical students and residents with ADHD, guided by interpretations of the Americans with Disabilities Act (ADA) of 1990 and subsequent Americans with Disabilities Amendments Act (ADAAA) of 2008, have been reported or suggested in the literature to include task management strategies (such as detailed instruction and templates for guiding task completion), environmental modifications (such as quiet, distractionfree environments for testing, learning, charting, or phone calls), and self-management strategies (such as frequent reorientation to tasks, pacing of workflow, use of timers and alarms to help with time management, and scheduling explicit time each day to organize tasks using tools like checklists and filing systems). 21,51…”

“…Accommodation-based interventions for medical students and residents with ADHD, guided by interpretations of the Americans with Disabilities Act (ADA) of 1990 and subsequent Americans with Disabilities Amendments Act (ADAAA) of 2008, have been reported or suggested in the literature to include task management strategies (such as detailed instruction and templates for guiding task completion), environmental modifications (such as quiet, distraction-free environments for testing, learning, charting, or phone calls), and self-management strategies (such as frequent reorientation to tasks, pacing of workflow, use of timers and alarms to help with time management, and scheduling explicit time each day to organize tasks using tools like checklists and filing systems). 21 , 51 Other accommodation-based strategies have included direct daily feedback to residents regarding time management, task prioritization, and areas for improvement, review of daily task lists by residents, guidance by the resident to staff members as to when and how to provide instruction and non-urgent teaching, assistance by faculty for residents to develop a comprehensive reading plan, time allowance by faculty for residents’ personal health-care appointments, and coordination between residents’ care providers, program supervisors, and residents regarding helpful accommodations and any changes in these over time. 52 …”

Neurodiversity in the general practice workforce

“…Research on neurodiversity in healthcare workers has looked primarily at dyslexia, likely fuelled by an increase in early recognition and support in schools and universities. Neurodiversity has become an increasingly hot topic in medical education, often with a focus on ‘doctors in difficulty’ (Cadick et al., 2022; Giroux and Pélissier-Simard, 2021). However, although it is important to consider neurodiversity in doctors experiencing difficulties at work, those who advocate for neurodivergent staff emphasise that many are working without formal support.…”

Identification and Accommodation of ADHD in Family Medicine Residencies: A CERA Study

“…6 Given the stigma around disclosure and accommodation of disabilities, many residents experience adversity before receiving accommodations. 7 Like other adults with ADHD, many learners with ADHD will display problems with executive function, including attention problems and difficulty with time management. For resident physicians, this could create problems with completing charts on time, organizing and prioritizing tasks while on the inpatient service, and managing long-term tasks.…”

“…However, asking a candidate whether they have a disability is forbidden, and the learner is responsible for informing programs of a need for accommodation once they have been hired. 7,14 Residents with disabilities who have access to accommodations have fewer depressive symptoms and are more likely to complete residency. 1,2,15,16 Moreover, Meeks and colleagues found medical students with disabilities who received accommodations achieved higher Step 1 scores than their unaccommodated peers with disabilities.…”