Catch ’em Early!
by Molly Rideout, M.D. | September 15, 2026
Article Citation: Nguyen M, Green CK, Mason HRC, Pereira-Lima K, Sheets ZC, Schroth SL, Smeltz L, Moreland CJ, Betchkal R, Grabowski C, Boatright D, Kim MH, Meeks LM. Timing of Disability Diagnosis and Accommodations During Medical School by First-Generation Status, Race, Ethnicity, and Gender. Acad Med. 2025 Oct 1;100(10S Suppl 1):S124-S130. doi: 10.1097/ACM.0000000000006147.
What is this article about?
This retrospective cohort study investigates whether the timing of a disability diagnosis in medical school is associated with a student’s race, ethnicity, first-generation-college-graduate status, and gender, and whether that timing affects how successfully students receive accommodations. Authors pulled demographic and accommodation-request data from 362 students with disability concerns across nine medical schools over one year, then used Poisson regression to calculate rates and relative risk.
Of those 362 students, disability categories broke down as ADHD (23%), learning (13%), psychological (34%), physical/sensory (8%), chronic illness (19%), and other (3%). Nearly half (46%) were diagnosed after matriculation. First-generation-college graduates were 1.33 times more likely to be diagnosed after matriculation than peers with at least one parent holding a bachelor’s degree (59% vs 43%). Male students were diagnosed after matriculation more often than female students (50% vs 44%), and among racial/ethnic groups, Black students had the highest rate of post-matriculation diagnosis (67%) versus White students, who had the lowest (42%). Students diagnosed before matriculation were far more likely to receive preclinical accommodations (79% vs 46% for those diagnosed later); timing made no significant difference for clinical-setting accommodations.
Why should you read the article?
It puts numbers behind a pattern many educators suspect but rarely see quantified: disability diagnosis and accommodation access in medical school aren’t evenly distributed. First-generation students, male students, and Black students are disproportionately diagnosed later, and later diagnosis is tied to a real drop in preclinical accommodation access — with likely downstream effects on things like USMLE performance. The article also reinforces a point worth internalizing: the large majority of these diagnoses (over 70%) are “invisible” disabilities — ADHD, learning, and psychological conditions — which are easy for educators to overlook precisely because they don’t present physically.
How can you use this article?
For anyone working in medical education, this is a prompt to build earlier, lower-barrier pathways to disability screening and diagnosis, particularly for first-generation students and students from groups shown here to be diagnosed later. Because invisible disabilities make up the bulk of cases, it’s worth training faculty and advisors to recognize their signs and proactively normalize disclosure and accommodation-seeking, rather than waiting for students to self-identify after they’re already struggling. The preclinical-accommodation gap in particular suggests that outreach and screening efforts should be front-loaded early in the curriculum, before the point where late diagnosis has already cost students access to support.
Review Author: Molly Rideout, M.D., Vice Chair of Education and Professor of Pediatrics, University of Vermont Larner College of Medicine, Burlington, VT. Organization: Council on Medical Student Education in Pediatrics