Training Is Where Equity Begins
Why Medical Education Must Change
By Dr. Seth Keller
Summary: Adults with intellectual and developmental disabilities often struggle to find clinicians prepared to meet their needs. Gaps in disability-inclusive training and the risk of diagnostic overshadowing can lead to delayed diagnoses, preventable illness, and poorer health outcomes. National efforts to strengthen medical education aim to make disability competency a core part of equitable, respectful care across the lifespan.
Introduction
For decades, medicine has celebrated its success in helping children with complex neurologic and developmental disabilities survive and live longer lives. Advances in pediatric neurology, epilepsy care, rehabilitation medicine, genetics, surgery, and community supports have transformed what was once unimaginable into something increasingly common: adulthood.
But while medicine helped create this new reality, our healthcare system has not fully prepared for it.
Across the country, adults with intellectual and developmental disabilities, autism, cerebral palsy, Down syndrome, neuromuscular disorders, complex epilepsies, and other childhood-onset neurologic conditions often enter adult healthcare systems that were never truly designed with them in mind. Families describe exhausting searches for clinicians who feel comfortable caring for them. Pediatric providers continue caring for patients far into adulthood because appropriate adult options are limited. Adult clinicians, meanwhile, frequently acknowledge that they were never formally trained for many of the situations they now encounter.
The result is not simply inconvenience or fragmentation.
It is inequity.
And sometimes, it is harm.
Research has repeatedly shown that people with disabilities experience profound healthcare disparities, including poorer access to care, higher rates of preventable disease, worse health outcomes, and premature mortality (National Council on Disability, 2025; Iezzoni et al., Health Affairs, 2021).
A Gap Hidden in Plain Sight
One of the most persistent problems is diagnostic overshadowing — the tendency for new medical symptoms to be incorrectly attributed to an existing disability rather than investigated as a potentially separate condition.
A person’s pain may be mistaken for “behavior.” A new gait problem may be dismissed as baseline cerebral palsy. Cognitive decline may be overlooked because intellectual disability was already present. Communication differences may obscure serious illnesses.
These experiences are familiar to many individuals with disabilities and their families. They are also familiar to clinicians who care deeply, but who often recognize that their training left them underprepared for the complexity of lifespan disability care.
This is not a reflection of indifference.
It is a reflection of a healthcare system that has not kept pace with the population it now serves.
The Proceedings of the 2025 ACGME Summit specifically highlighted diagnostic overshadowing, anchoring bias, adaptive communication, trauma-informed care, and lifespan transition issues as core competencies necessary for disability-inclusive healthcare education (Proceedings of the 2025 ACGME Summit on Fostering Disability-Inclusive Health Care in Resident Education, 2025).
A National Movement Is Emerging
What makes this moment feel different is that disability equity is no longer being discussed only within advocacy circles.
National organizations across medicine, public health, education, and disability policy are increasingly recognizing that people with disabilities experience healthcare inequities not because disability itself is the problem, but because healthcare systems, training structures, communication methods, and institutional assumptions often fail to meet their needs.
In 2023, the National Institutes of Health formally designated people with disabilities as a health disparity population.
The National Council on Disability has repeatedly called for stronger disability competency within healthcare education and systems reform (NCD Framework to End Health Disparities of People with Disabilities, 2025).
Project D.I.M.E. (Disability Inspired Medical Education), led by Rick Rader, has amplified the urgency of mandatory disability competency training across medicine, nursing, physician assistant, and allied health education.
The American College of Physicians has also called for stronger disability inclusion and competency within healthcare education and clinical practice (ACP Position Statements on Disability Equity in Healthcare, 2026).
In 2025, the Accreditation Council for Graduate Medical Education convened a national summit focused specifically on disability-inclusive healthcare education. The resulting Summit Proceedings and Journal of Graduate Medical Education publication emphasized that residency training is the critical period for developing disability-inclusive clinical competence, communication skills, adaptive clinical thinking, and awareness of diagnostic overshadowing (Holton, Hitchell, & Combes, JGME, 2026).
Importantly, these concerns are not limited to physician education alone. Graduate nursing education, nurse practitioner training, physician assistant education, social work, psychology, rehabilitation, and other allied health professional programs face many of the same gaps related to disability competency, lifespan care, communication, transitions, and diagnostic overshadowing.
While ACGME specifically oversees physician residency and fellowship training, similar conversations are increasingly occurring throughout healthcare education more broadly. The larger goal is not simply reforming one educational pathway but helping ensure that the entire healthcare workforce is better prepared to care for individuals with developmental and neurologic disabilities across their lifespan.
In many ways, neurology’s current effort may serve as an important model for how disability-inclusive competency can be more intentionally integrated throughout healthcare education.
Why Neurology Is Speaking Up
Neurology sits at the center of many of these issues.
Neurologists care for people with epilepsy, autism, cerebral palsy, intellectual disability, neuromuscular disorders, genetic syndromes, dementia in Down syndrome, traumatic brain injury, and countless other conditions that begin in childhood but continue across the lifespan.
Yet formal residency training requirements in adult neurology currently contain little required exposure focused specifically on adults with pediatric-onset neurologic and developmental disabilities.
A growing coalition within the American Academy of Neurology has recently come together to address this issue more formally. Leaders from multiple AAN sections — including the Adults with Intellectual and Developmental Disabilities Section, Child Neurology Section, Neurogenetics Section, and additional collaborators across neurology education and advocacy — have convened to develop a national position statement and Statement of Need focused on gaps in residency training related to the adult care of pediatric-onset neurologic and neurodevelopmental disabilities.
The coalition effort builds upon broader national conversations already underway across medicine, including efforts led by the NIH, NCD, ACP, Project D.I.M.E., disability advocacy organizations, and the recent ACGME Summit on disability-inclusive healthcare education.
Importantly, this effort is not being framed as the creation of a new subspecialty or isolated curriculum track. Rather, it reflects a broader recognition that disability competency and lifespan neurologic care are increasingly central to mainstream neurology practice itself.
The Human Side of the Gap
The Child Neurology Foundation has described how many families struggle to find adult clinicians who feel comfortable caring for individuals with pediatric-onset neurologic disabilities across the lifespan (Child Neurology Foundation Advocacy Statement, 2026).
Families report fragmented transitions, prolonged delays establishing adult care, and experiences in which symptoms are dismissed rather than properly evaluated.
Within many disability communities, families have even developed informal language for the rare clinician who truly understands their needs: the “Unicorn Provider.”
That phrase should stop all of us in our tracks.
No patient population should have to rely on searching for mythical providers simply to receive competent care.
And yet this scarcity reflects a reality many clinicians themselves acknowledge. Studies have shown that physicians frequently report discomfort and inadequate preparation when caring for people with disabilities (Iezzoni et al., Health Affairs, 2021).
These issues are not simply educational gaps.
They are equity issues.
Why ACGME Reform Matters
Training standards shape generations of clinicians.
They influence comfort, confidence, diagnostic thinking, communication, and ultimately patient outcomes.
If disability competency remains optional, inconsistent, or absent, disparities will continue no matter how many conferences, articles, or awareness campaigns emerge.
That is why ACGME reform matters.
The Proceedings of the 2025 ACGME Summit specifically emphasized that residency is the “critical period” for physician identity formation and for developing the values, skills, and attitudes necessary to provide inclusive healthcare (Proceedings of the 2025 ACGME Summit on Fostering Disability-Inclusive Health Care in Resident Education, 2025).
Not because a curriculum change alone will solve healthcare inequities — it will not — but because training is one of the most powerful upstream mechanisms for changing culture, competence, and systems of care.
This is especially important for populations that have historically been devalued, excluded, or overlooked within medicine.
Disability inclusion is not charity. It is not a niche issue. It is a core healthcare equity issue.
How to Take Action
One of the most important realities about graduate medical education reform is that change does not happen only behind closed doors.
The Accreditation Council for Graduate Medical Education regularly opens formal “Review and Comment” periods when proposed revisions to residency training requirements are publicly posted and individuals and organizations are invited to submit feedback.
Learn more about the ACGME Requirements Review and Approval Process.
When neurology-related review periods and public comment opportunities open, organizations and individuals will be able to submit formal written comments, endorse proposed revisions, provide patient and family perspectives, and encourage specialty societies and training programs to participate.
Importantly, advocacy voices matter.
Data and policy language alone rarely drive systems change. Stories from individuals with disabilities, families, caregivers, and clinicians help demonstrate the real-world consequences of training gaps and healthcare inequities.
Readers can help now by:
sharing this article and related advocacy efforts,
engaging their professional societies and organizations,
discussing disability competency within their own institutions,
identifying gaps in training and care within their specialties,
and preparing to participate once public comment periods open.
This effort is not solely about neurology.
It reflects a broader national movement recognizing that disability competency and disability-inclusive care must become part of the foundation of healthcare education across medicine.
Change in healthcare often begins long before policy is finalized. It begins when enough people decide that the status quo is no longer acceptable.
About the Author
Seth Keller, MD
Neurologist, Neurology Associates of South Jersey
Dr. Seth Keller specializes in the evaluation and care of adults with Intellectual and Developmental Disabilities (IDD) with neurologic complications. Dr. Keller is on the Executive Board of the Arc of Burlington County as well as on the board for The Arc of New Jersey Mainstreaming Medical Care Board. He is the co-president of the National Task Group on Intellectual Disabilities and Dementia Practices (NTG). He is also the founder and past chair of the Adult IDD Section with the American Academy of Neurology.
Dr. Keller is actively involved in national and international IDD health education as a speaker, and webinar and workshop participant. He is a co-author on a number of articles and book chapters relating to aging and dementia in those with IDD.
Selected References
Holton L, Hitchell KS, Combes JR. Advancing Disability-Inclusive Education in Graduate Medical Education: Findings From the 2025 ACGME Summit. Journal of Graduate Medical Education. 2026.
Proceedings of the 2025 ACGME Summit on Fostering Disability-Inclusive Health Care in Resident Education. Accreditation Council for Graduate Medical Education. 2025.
Iezzoni LI, Rao SR, Ressalam J, et al. Physicians’ Perceptions of People with Disability and Their Health Care. Health Affairs. 2021;40(2):297-306.
National Council on Disability. Framework to End Health Disparities of People with Disabilities. 2025.
Child Neurology Foundation Advocacy Statement on Transition and Lifespan Neurologic Care. 2026.
Coalition Position Statement Submitted to the ACGME Review Committee for Neurology in Support of a Modification to the Program Requirements for Graduate Medical Education in Neurology and Child Neurology. (PENDING)