A Master Adaptive Learner Approach to Cognitive Disability Support in a U.S. Urology Residency.

Medical education is witnessing a growing need for disability support, particularly for cognitive and psychiatric disabilities, yet many medical learners do not receive the necessary accommodations. These barriers may arise from uncertainty in how to approach multifaceted challenges, lack of disability recognition by both learners and educators, fear of stigma, and unclear or inadequate institutional policies and support systems. This case study about a urology resident in a U.S. training program, presented from the viewpoint of his competency development coach and residency program leadership with case description and insights from the resident, explores how adopting a Master Adaptive Learner (MAL) approach to identifying multiple intertwined challenges enables targeted remediation and disability support efforts. While situated in a U.S. surgical graduate medical education program, this case offers insights that can be helpful to medical educators in a variety of settings about how to effectively support struggling learners, while emphasizing the importance of early identification, tailored accommodations, and the value of creating an inclusive learning environment for all medical learners. By modeling how the ability to be vulnerable is a strength in the learning environment, this case aims to reduce the stigma associated with having learning requirements that fall outside a program's standard curriculum. Ultimately, this paper advocates for shifting the remediation process from a stigma-laden experience to one that fosters growth, helping both learners and programs evolve.