Unintended consequences of focusing on accommodations and supports as barriers for medical trainees with disabilities

CMAJ is to be commended for calling attention to gaps in the provision of accommodations for trainees with disabilities.1 One topic not mentioned in its recent news report is provision of accommodations on the Medical College Admissions Test (MCAT), which serves as a major bottleneck in the medical education pipeline for persons with disabilities. Without accommodations (usually 50% extra time), the MCAT could selectively eliminate many otherwise qualified individuals with attention-deficit/hyperactivity disorder, specific learning disorders and other disabilities from the medical profession altogether.

Yet we have no up-to-date or publicly available data available on the provision of accommodations for taking MCAT. In 2006,2 Rajaram reported that one-third of those who apply for extra time on the MCAT (presumably all have documented disabilities) are not approved. It would be useful to know what percentage of those who apply for at least 50% extra time on the MCAT receive it without a letter from an attorney or a court order.

There are also some possible unintended consequences of focusing on one limiting aspect for trainees with disabilities (lack of accommodations) to the exclusion of another (avoiding discrimination against trainees with real or suspected physical and mental disorders or disabilities).3 It may reinforce stereotypes that these trainees are economically burdensome and demand special treatment. Yet many trainees with these conditions or disabilities just want to be treated the same as everyone else. They do not want to be the target of physician impairment policies, prohibited medical inquiries and unwarranted negative attention within the biomedical literature.3^–5 Academic medical journals are still framing burnout, mental disorders and disabilities as meaningful causes of medical errors and preventable adverse events in a way that simply does not accord with the available evidence.4

Continuing to neglect these barriers and focus disproportionately on accommodations will not lead to further inclusion of these learners.