Medical education programs must do more to support residents with disabilities

Medical education programs aren't doing enough to meet the needs of residents with disabilities, a new study suggests.

Medical residents with disabilities who said their needs aren’t being met are more likely to suffer depression and report medical errors, according to a new study published in JAMA Network Open. Graduate medical education programs must do more to meet the mental health needs of residents and to protect patients, the authors stated.

The study is a rarity in that it focuses on medical residents with disabilities. However, with more students in medical schools reporting they have disabilities in recent years, it’s a topic gaining more attention.

Lisa Meeks and Karina Pereira-Lima, two researchers from the University of Michigan, were the lead authors of the study. They said the study highlights the importance of supporting residents with disabilities.

Healthcare leaders have repeatedly expressed the importance of adding more diversity to medical schools, particularly in light of the ongoing physician shortage. Advocates stress attracting more medical students with disabilities is an important step toward that goal.

About 7.5% of 1,273 medical residents surveyed self-reported some type of disability, according to the study. Most said they had ADHD but some reported chronic health conditions.

Residents with disabilities who said their needs were not met were far more likely to report medical errors than those without disabilities. About 43% of residents with disabilities and unmet needs self-reported major medical errors, compared to about 14% of residents without disabilities.

The study found no significant difference in symptoms of depression or medical errors among residents with disabilities who had adequate support compared to residents without disabilities.

All medical residents face an enormous amount of stress. The study suggests some programs are making it harder on students with disabilities.

“Resident physicians work long work hours, have immense responsibility, loss of autonomy, sleep deprivation, and the need to exponentially grow their knowledge in a field that is constantly being updated,” Meeks wrote in an email.

“When we add access barriers to this scenario, this long list of stressful demands becomes even more challenging, with residents with barriers in place likely working even harder and longer (given the barriers) to complete their work.”

Some residents with disabilities may not be disclosing them due to fear of bias or stigma, the authors note. They said those residents also suffer because they can’t bring their authentic selves to their work.

“This places additional burdens on the resident to try and function in a system that historically has been unfriendly to people with disabilities, and to go through training not having their access needs met,” Meeks wrote in an email.

In 2021, about 8% of medical school graduates reported having a disability, according to the Association of American Medical Colleges. But less than half of those students with disabilities said their medical schools gave them accommodations to assist them, students said in an AAMC survey.

Graduate medical education programs need to implement policies to meet the needs of students with disabilities, the authors said. Such policies should include welcoming language, specific accommodations and statements that emphasize the value of diversity.

While most graduate medical programs have a policy of some kind, Meeks and other researchers found in a 2020 study that about one-third of programs examined didn’t include a disability policy.

Even those with policies have room for improvement, the researchers said. The 2020 study found 41% of the policies lacked a procedure for disclosing disabilities and requesting accommodations.

Graduate medical education (GME) programs need to appoint a specialized expert to assist with such policies, the authors said.

“GME offices should establish a process for disability disclosure that includes a confidential point of contact with expert knowledge of disability law and clinical accommodations who can assist with determining reasonable accommodations,” Meeks wrote via email. “This should be someone other than a colleague, supervisor, or anyone else who would evaluate the resident's performance.”

The researchers note that medical residents with disabilities offer great value in the field of healthcare.

“Residents with disabilities have the lived experience of being a patient,” Meeks stated. “Along with this experience, they have gained some insight into how the healthcare system engages with these patients (the good and the bad).”

Residents with disabilities offer “increased empathy, increased rapport with patients, and informed care for individuals with disabilities that result in enhanced responsiveness to clinical recommendations.”