L.M. Meeks is adjunct assistant professor of family medicine, University of Michigan Medical School, Ann Arbor, Michigan, and researcher, Center for a Diverse Healthcare Workforce, UC Davis School of Medicine, Sacramento, California; ORCID: https://orcid.org/0000-0002-3647-3657 .
M. Plegue is statistician, Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-6032-534X .
Acad Med. 2022 Mar 1;97(3):389-397. doi: 10.1097/ACM.0000000000004510.
To conduct a post-Americans with Disabilities Act Amendments Act of 2008 multisite, multicohort study called the Pathways Project to assess the performance and trajectory of medical students with disabilities (SWDs).
From June to December 2020, the authors conducted a matched cohort study of SWDs and nondisabled controls from 2 graduating cohorts (2018 and 2019) across 11 U.S. MD-granting medical schools. Each SWD was matched with 2 controls, one from their institution and, whenever possible, one from their cohort for Medical College Admission Test score and self-reported gender. Outcome measures included final attempt Step 1 and Step 2 Clinical Knowledge scores, time to graduation, leave of absence, matching on first attempt, and matching to primary care.
A total of 171 SWDs and 341 controls were included; the majority of SWDs had cognitive/learning disabilities (118/171, 69.0%). Compared with controls, SWDs with physical/sensory disabilities had similar times to graduation (88.6%, 95% confidence interval [CI]: 77.0, 100.0 vs 95.1%, 95% CI: 90.3, 99.8; P = .20), Step 1 scores (229.6 vs 233.4; P = .118), and match on first attempt (93.9%, 95% CI: 86.9, 100.0 vs 94.6%, 95% CI: 91.8, 97.4; P = .842), while SWDs with cognitive/learning disabilities had lower Step 1 scores (219.4; P < .001) and were less likely to graduate on time (81.2%, 95% CI: 69.2, 93.2; P = .003) and match on first attempt (85.3%, 95% CI: 78.0, 92.7; P = .009). Accommodated SWDs had Step 1 scores that were 5.9 points higher than nonaccommodated SWDs (95% CI: -0.7, 12.5; P = .08).
Structural barriers remain for SWDs with cognitive/learning disabilities, which could be partially mitigated by accommodations on high-stakes exams.
开展一项名为“Pathways 项目”的、基于《2008 年美国残疾人法案修正案》的多地点、多队列研究，以评估残疾医学生（SWD）的表现和轨迹。
在 2020 年 6 月至 12 月期间，作者对来自 11 所美国医学博士授予机构的 2 个毕业队列（2018 年和 2019 年）的 SWD 和非残疾对照进行了匹配队列研究。每位 SWD 与 2 名对照者匹配，其中 1 名来自他们所在的机构，而尽可能的情况下，另一名来自他们所在队列的对照者，其匹配依据是医学院入学考试（MCAT）成绩和自我报告的性别。结果衡量标准包括最终尝试的 Step 1 和 Step 2 临床知识成绩、毕业时间、休假、首次尝试匹配以及匹配至初级保健。
共有 171 名 SWD 和 341 名对照者纳入研究；大多数 SWD 患有认知/学习障碍（118/171，69.0%）。与对照组相比，患有身体/感官障碍的 SWD 毕业时间相似（88.6%，95%置信区间[CI]：77.0，100.0 与 95.1%，95%CI：90.3，99.8；P=.20），Step 1 成绩（229.6 与 233.4；P=.118），以及首次尝试匹配（93.9%，95%CI：86.9，100.0 与 94.6%，95%CI：91.8，97.4；P=.842），而患有认知/学习障碍的 SWD 的 Step 1 成绩较低（219.4；P<.001），按时毕业的可能性较低（81.2%，95%CI：69.2，93.2；P=.003），且首次尝试匹配的可能性较低（85.3%，95%CI：78.0，92.7；P=.009）。接受了适应性措施的 SWD 的 Step 1 成绩比未接受适应性措施的 SWD 高 5.9 分（95%CI：-0.7，12.5；P=.08）。
对于患有认知/学习障碍的 SWD 而言，结构性障碍仍然存在，而在高风险考试中采取适应性措施可能部分缓解这些障碍。
