From Policy to Practice: Building the Disability Inclusion Infrastructure in Graduate Medical Education.

Abstract: Disability inclusion in graduate medical education (GME) remains understudied despite its importance for equity and patient care. Recent data reveal a significant attrition of disabled trainees between medical school and practice, with disclosure barriers-such as stigma and unclear policies-compounding the issue. For learners with multiple marginalized identities, such as those underrepresented in medicine and disabled, compounded barriers may exist. While the Accreditation Council for Graduate Medical Education (ACGME) has strengthened diversity and accommodation requirements, many GME programs still lack formal disability policies and transparent processes. This case study follows an African American woman psychiatry fellow with ADHD and a reading disorder as she navigates disability accommodations in GME. After successful experiences in undergraduate medical education and residency, she encountered significant challenges in fellowship due to the absence of a clear accommodations process. Her program director and institutional resources were supportive but lacked coordinated protocols, leading to inconsistent, discretionary accommodations that undermined legal protections and caused significant distress. This experience highlights how administrative failures and ableism intersect with other systemic biases, creating barriers to success for disabled trainees. Drawing on this case, the authors recommend establishing formal accommodation protocols, faculty training, legally binding accommodations, peer mentorship networks, and regular policy review. Implementing these recommendations can help GME programs operationalize ACGME's diversity and inclusion standards, ultimately improving equity and retention for disabled trainees. This case illustrates the urgent need for standardized, inclusive policies to ensure disabled physicians-in-training receive the support they need to thrive.