Timing of Disability Diagnosis and Accommodations During Medical School by First-Generation Status, Race, Ethnicity, and Gender

Abstract

Purpose: Timely diagnosis of disability is essential to student success. This study assesses the association between disability type; first-generation college graduate status; and race, ethnicity, and gender and the timing of disability diagnosis among medical students, and whether the timing of diagnosis is associated with likelihood of receiving accommodations in the preclinical and clinical phases of medical training.

Method: The authors conducted a retrospective cohort study between April 2023-April 2024 across 9 U.S. MD-granting programs. Data were obtained from individual student records in collaboration with administrators and designated staff who support students with disability-related concerns and accommodation requests. Modified Poisson regression was utilized to estimate the relative risk of diagnosis timing after matriculation and preclinical and clinical accommodations to account for potential variability across schools.

Results: Among the 362 medical students in the study, 167 (46.1%) were diagnosed after medical school matriculation. Compared to continuing-generation students, first-generation college graduates were significantly more likely to have a disability diagnosis after medical school matriculation (59.0% vs 43.2%, aIRR: 1.33, 95% CI: 1.01-1.77). Across all racial and ethnic groups, Black students were significantly more likely to be diagnosed after matriculation compared to their White peers (66.6% vs 41.5%, aIRR: 1.58, 95% CI: 1.21-2.06). Female students were less likely to be diagnosed with a disability after matriculation (aIRR: 0.85, 95% CI: 0.73-0.98). Overall, 232 (64.1%) and 284 (78.4%) participants received preclinical and clinical accommodations, respectively. Students who received a disability diagnosis before medical school matriculation were significantly more likely to receive preclinical accommodations (79.4%) compared to those diagnosed after matriculation (46.1%, aIRR: 0.60, 95% CI: 0.50-0.72). No significant association was found between timing of diagnosis and clinical accommodations.

Conclusions: This study highlights the challenges medical students with disabilities face in requesting accommodation, particularly for those who are diagnosed after medical school matriculation.