Academic Medicine Open Forum

Good afternoon;

I am reaching out with a question regarding "Competence Committees"

I understand that these committees meet to assess the overall progress of each resident and their achievement of the objectives of the training as well as their entrustable professional activities (EPAs).  

One of these committees has asked two questions:

• The accommodation plan is not meant to be shared with the Competence Committee.  Without this information, how do they account for the accommodation in their assessment of the resident?
• Programs are required to provide accommodation to the point of undue hardship.  How should a program manage accommodations that do not pose undue hardship, but would prevent a resident from meeting the objectives of training?  

In my role I always contact the Program Director of the specific department (psychiatry, family medicine) and outline the accommodation plan to see what, if any issues they may see arising.   There may be specific accommodations such as "no overnight call" or "only day time clinical duties - no call past 6 pm".

I'm wondering if anyone has run into questions like this before and what your responses were to these questions.

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Melissa Pafford
Accessibility Advisor
*Other or Unlisted
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Good morning, Melissa,

Great questions and you may want to post them specifically in the Disability Inclusion focused AAMC community (which you can search and join on this platform) for more responses.

I've responded to each question below but preface this by saying I am not an attorney, and this is my interpretation as a scholar of disability inclusion in meded.

I've also listed additional resources below.

Happy to chat more!

Lisa

• The accommodation plan is not meant to be shared with the Competence Committee.  Without this information, how do they account for the accommodation in their assessment of the resident?

Accommodations are designed to reduce barriers for trainees. Once these barriers are in place, the assessment of skill should be completed in the same manner for all trainees. There are no modifications to the required competencies (if truly required). If the trainee requires an accommodation for assessment by the competency committee, then by virtue of them conducting the assessment, they would have a "need to know" the legal threshold for sharing accommodations information. At no time should specifics about the disability DX be shared.

• Programs are required to provide accommodation to the point of undue hardship.  How should a program manage accommodations that do not pose undue hardship, but would prevent a resident from meeting the objectives of training? 

If an accommodation would prevent the resident from meeting a competency, then the accommodation would be a fundamental alteration of the curriculum or for residents, a fundamental alteration of the essential functions. This is a highly nuanced decision that must be justified and well documented. I would offer than fundamental alteration is viewed differently across the training continuum by varied parties. I would seek additional information before coming to this conclusion and would absolutely seek guidance of your legal counsel if, after doing an exhaustive review of the facts and the landscape, you determine that this is a fundamental alteration. 

There are considerable resources available to aid you in working through this process including: 

AAMC Community: Disability Inclusion (including the ability to post questions) 

UME and GME listservs on the topic 

A free text on the topic 

AAMC report on Disability 

AAMC and AMA Webinars on Disability 

ACGME Modules on Disability Inclusion-including how decisions are made and reasonable accommodations.

And multiple chapters and articles on the topic of promotions committees, determining "not otherwise qualified" or "fundamental alteration." Happy to send those.

Lisa M. Meeks, PhD, MA (She, her, hers)

Clinical Associate Professor

https://medicine.umich.edu/dept/learning-health-sciencesClick to follow link." target="_blank" rel="noopener">Department of Learning Health Sciences

Department of Family Medicine-MDisability Program

https://disabilityhealth.medicine.umich.edu/Click to follow link." target="_blank" rel="noopener">UM Center for Disability Health and Wellness

University of Michigan Medical School

Executive Director: DocsWithDisabilities Initiative

Co-Host:Docs with Disabilities Podcast

Email: Meeksli@med.umich.edu

Administrative Support: Janelle Burleigh (jburl@med.umich.edu)

https://scholar.google.com/citations?user=h7B7ZWAAAAAJ&hl=en&oi=sraClick to follow link.">Recent Publications

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Lisa M. Meeks, PhD, MA
Associate Professor
Learning Health Sciences
Family Medicine
University of Michigan Medical School
Executive Director, Docs With Disabilities Initiative
Host, DocsWithDisabilities Podcast
Website: https://www.docswithdisabilities.org
Email: meeksli@med.umich.edu

Original Message:
Sent: 11-14-2023 12:59:25 PM
From: Melissa Pafford
Subject: Competence Committees

Good afternoon;

I am reaching out with a question regarding "Competence Committees"

I understand that these committees meet to assess the overall progress of each resident and their achievement of the objectives of the training as well as their entrustable professional activities (EPAs).  

One of these committees has asked two questions:

• The accommodation plan is not meant to be shared with the Competence Committee.  Without this information, how do they account for the accommodation in their assessment of the resident?
• Programs are required to provide accommodation to the point of undue hardship.  How should a program manage accommodations that do not pose undue hardship, but would prevent a resident from meeting the objectives of training?  

In my role I always contact the Program Director of the specific department (psychiatry, family medicine) and outline the accommodation plan to see what, if any issues they may see arising.   There may be specific accommodations such as "no overnight call" or "only day time clinical duties - no call past 6 pm".

I'm wondering if anyone has run into questions like this before and what your responses were to these questions.

------------------------------
Melissa Pafford
Accessibility Advisor
*Other or Unlisted
------------------------------