Tackling barriers in Canadian medical school admissions for students with disabilities

Stereotyping and ableist culture

Ableism has long been entrenched in the culture of medicine,11 driven by an illusion of a binary between sick and well that is perpetuated by societal, social and psychological influences.12 A commonly reported concern regarding admitting students with disabilities is the assumption that they will not be able to withstand the rigours of medical training or be able to undertake a broad scope of practice upon graduation. This argument does not consider the heterogeneity of disability nor the utility of and options for accommodation in training and practice. Stereotyping may occur when assumptions about limitations of a disability are made without a complete understanding of the student’s scope of abilities.3 Applicants to American medical schools have described being instructed by admissions officers to hide their disabilities during interviews to minimize the risk of bias, and report being asked inappropriate questions about their personal health when they cannot.11 Indeed, trainees with disabilities frequently take steps to hide their disabilities to avoid prejudice, perpetuating the illusion that they do not exist.

Inflexible admission criteria and technical standards

We reviewed publicly available, accessibility-related admission policies for the 2022–2023 admission cycle at all English-speaking Canadian medical schools.13 Exclusionary eligibility criteria that may disproportionately affect students with disabilities are summarized in Table 1.

Criteria used to evaluate applicants for admission to medical school typically include grade point average (GPA), extracurricular activities, standardized testing (e.g., Medical College Admission Test [MCAT], Computer-Based Assessment for Sampling Personal Characteristics [CASPer]) and requirements for full-time course loads for all or part of the applicant’s undergraduate degree.13 Certain disabilities may affect grades or test scores if the learning environment is not adequately accessible, making these measures poor predictors of future performance as a physician in a properly adapted workplace. Although some schools offer opportunities for applicants to explain circumstances that affected such elements of their applications,13^,14 others state explicitly that “the Admissions Office will not make any exceptions to declared policies.”15 This inflexible approach preferentially selects for applicants unaffected by illness or disability. However, the merits of a student who persevered through their undergraduate degree with serious illness are not captured in restrictive forms if, for instance, that student was unable to participate in many extracurricular activities,14 and the student may be outright disqualified if they studied on a part-time basis.15

Canada’s medical schools also require applicants to confirm that they meet technical standards to ensure that matriculants will be capable of medical practice once they graduate.16 These documents include statements that students with disabilities are “entitled to reasonable accommodation;”17 however, certain standards may not be met by applicants with some disabilities despite accommodations. In these cases, it may be possible to find alternatives that ensure the competence of the future practitioner. For example, for the technical skill of observation, students in Ontario must be able to “acquire all relevant sensory information,” such as auscultating heart sounds.17 Yet, Deaf physicians have been successfully trained in Canada with access to interpreters.1 Students must “execute motor movements reasonably required to provide general and emergency medical care,”17 raising the question as to whether it is enough to be able to direct cardiopulmonary resuscitation or whether the individual must physically be capable of performing it independently.11 Medical school has long been structured around the notion that to be any type of physician, you must be capable of being every type of physician. 12 In this way, generic technical standards deny students entry into fields in which they may excel.

Admission policies directly addressing accessibility vary considerably among medical schools. Several notable policies are highlighted in Table 2 and Table 3. The Ontario Medical School Application Service (OMSAS) has recently introduced a space for disability-based consideration requests in the application to Ontario medical schools.14 However, several aspects of this policy may limit its effectiveness in facilitating applications from applicants with disabilities. The consideration requests are available only to students who were unaccommodated during their undergraduate training, assuming that previously received accommodations sufficiently mitigated adverse effects of disabilities. The request applies only to the initial phase of file review, meaning that the consideration may not apply to full post-interview file review, potentially disadvantaging applicants with disabilities. The request requires an additional statement describing a plan to ensure success in the practice of medicine, putting the onus on the student to outline a plan without knowledge of available institutional resources. The request also requires provision of medical documentation, raising privacy challenges and risking further discrimination.

Lack of information regarding accommodations

We found no information on admissions websites about what types of accommodations may be possible during interviews or medical training for students to view without personal disclosure. Many students avoid disclosure for fear of stereotyping, discrimination and even outright exclusion.4^,11 As with the OMSAS accommodation request, 1 school asks students to inform them of future accommodation needs for medical school before interviews, warning that matriculation is dependent on review by an accommodations committee.18 Given the time and cost involved in applying to medical school, this absence of information may discourage students from applying at all.5