Residents with learning disabilities
Lately, I have been thinking about the best way to work with residents who have learning disabilities.
If a resident comes to the program and discloses his or her learning disability, it’s fairly cut and dry. For example, maybe they’ve already secured the required documentation necessary for being granted more time to take exams, including the Boards. Whatever the case, the issue is on the table for discussion and accommodations are made.
However, I’ve found that residents may not know that they have a learning disability. When a resident isn’t achieving his or her full potential, we do consider whether a learning disability is present and send the resident to be tested.
I’m surprised how often a learning disability seems to be at the root of poor performance. Often, the residents have no clue because they have spent years just working around the issue.
I think it is helpful for programs to have a standard mechanism in place to both identify and provide adequate support for those with learning challenges. In a 2007 article about psychiatry residents with ADHD (source below), the authors suggest the following when approaching such cases:
“…training programs should be proactive and have a procedure in place that 1) requires adequate documentation; 2) ensures confidentiality; 3) grants accommodations which measure core knowledge and not the limits of the disability; and 4) does not alter the core curriculum of the program.”
I have found that the confidentiality issue is the most crucial for residents. Being referred outside the department for testing (because it is not appropriate for us to diagnose), and having the resulting conversations and accommodations kept strictly between the resident, program director, and perhaps the adviser or mentor, seems to be paramount for their self-esteem and success.
How do you handle residents with learning disabilities in your program? Do you pay for testing because most insurances do not? Do you draw up a remediation contract? Bring in special resources? Please share in the comment box below.
Source: Attention Deficit Hyperactivity Disorder Accommodations for Psychiatry Residents, Harold Walker Elliott, M.D., Elizabeth Mayfield Arnold, Ph.D., Gretchen A. Brenes, Ph.D., Loretta Silvia, Ph.D. and Peter B. Rosenquist, M.D. Acad Psychiatry 31:290-296, July-August
doi: 10.1176/appi.ap.31.4.290
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Diane Farineau
Diane W. Farineau is the director of administration for graduate medical educational and faculty affairs at the University of Virginia Health System in the Department of Medicine.
Diane has written 35 posts.
Comments
Dear Diane, I am impressed with your comments re ADHD,My son is in a residency program where he is unable to score well in ITE exams and does not like to attend MKSAP because they are so distracting. He is being failed in PGY3 even though he passed all core competencies.I treat ADHD patients in my practice and really wish this topic was addressed with Program Directors before someones career is destroyed.
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