Department of Neurology, University of Michigan Medical School, Ann Arbor.
Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor.
JAMA Netw Open. 2023 May 1;6(5):e239981. doi: 10.1001/jamanetworkopen.2023.9981.
Ensuring access to accommodations is critical for resident physicians and their patients. Studies show that a large proportion of medical trainees with disabilities do not request needed accommodations; however, drivers of nonrequests are unknown.
To assess the frequency of accommodation requests among first-year resident physicians (ie, interns) with disabilities and to identify possible drivers of nonrequest for needed accommodations.
DESIGN, SETTING, AND PARTICIPANTS: As part of the Intern Health Study, a longitudinal cohort study of first-year resident physicians, residents at 86 surgical and nonsurgical residency programs in 64 US institutions provided demographic and training characteristics 2 months prior to matriculation (April-May 2021). At the end of their intern year (June 2022), participants completed a new survey with questions about disability-related information, including disability status, disability type, whether they received accommodations, and if not, reasons for nonaccommodation. Poststratification and attrition weights were used to estimate the frequency of accommodation requests and reasons for not requesting accommodations. Interns reporting at least 1 disability were included in the analysis.
Prevalence of reported disabilities, residency specialties distribution, frequency of accommodation requests, and reasons for nonaccommodation among resident physicians with disabilities.
Among the 1486 resident physicians who completed the baseline survey, 799 (53.8%) replied to the disability questions. Of those, 94 interns (11.8%; weighted number, 173 [11.9%]) reported at least 1 disability and were included in the present study (weighted numbers, 91 [52.6%] men, 82 [47.4%] women, mean [SD] age, 28.6 [3.0] years). Among interns with reported disability and need for accommodations (83 of 173 [48.0%]), more than half (42 [50.6%]) did not request them. The most frequently reported reasons for not requesting needed accommodations were fear of stigma or bias (25 [59.5%]), lack of a clear institutional process for requesting accommodations (10 [23.8%]), and lack of documentation (5 [11.9%]).
Program directors should investigate cultural and structural factors within their programs that contribute to an environment where residents do not feel safe or supported in disclosing disability and requesting accommodation and review their disability policies for clarity.
确保残疾住院医师及其患者能够获得适当的住宿条件至关重要。研究表明，很大一部分残疾医学实习生并未提出所需的住宿条件；然而，导致这种情况的原因尚不清楚。
评估残疾住院医师（即实习医生）提出住宿条件申请的频率，并确定可能导致未提出所需住宿条件申请的原因。
设计、设置和参与者：作为住院医师健康研究的一部分，这是一项针对美国 64 所机构的 86 个外科和非外科住院医师培训项目的第一年住院医师的纵向队列研究，住院医师在入学前 2 个月（2021 年 4 月至 5 月）提供人口统计学和培训特征。在他们的实习年结束时（2022 年 6 月），参与者完成了一项新的调查，其中包含有关残疾相关信息的问题，包括残疾状况、残疾类型、是否获得了住宿条件，如果没有，未获得住宿条件的原因。使用后分层和流失权重来估计住宿条件申请的频率和未申请住宿条件的原因。报告至少有一种残疾的住院医师被纳入分析。
残疾报告率、住院医师专业分布、残疾住院医师提出住宿条件申请的频率以及未提出住宿条件申请的原因。
在完成基线调查的 1486 名住院医师中，有 799 名（53.8%）回答了残疾问题。其中，94 名实习医生（11.8%；加权人数，173 [11.9%]）报告了至少一种残疾，并被纳入本研究（加权人数，91 [52.6%]为男性，82 [47.4%]为女性，平均[SD]年龄为 28.6 [3.0]岁）。在报告残疾且需要住宿条件的实习医生中（173 人中的 83 人[48.0%]），超过一半（42 人[50.6%]）没有提出申请。未提出所需住宿条件的最常见原因是担心受到歧视或偏见（25 人[59.5%]）、缺乏明确的申请住宿条件的机构流程（10 人[23.8%]）和缺乏文件记录（5 人[11.9%]）。
项目负责人应调查项目内导致住院医师在披露残疾和申请住宿条件时感到不安全或得不到支持的文化和结构性因素，并审查其残疾政策的明确性。
