Benjamin Case

Purpose: As a requirement for accreditation, medical schools must have technical standards to outline essential abilities for admission, progression, and graduation. In the absence of national guidance, the AMA published recommendations in 2021 for schools to use “functional” technical standards language (focused on achieving outcomes), as opposed to “organic” (focused on body functions). This study benchmarks the extent to which U.S. MD- and DO-granting programs have adopted functional language and assesses public availability of technical standards. Method: In 2023, the authors conducted a national cross-sectional content analysis of technical standards from all fully accredited U.S. MD- and DO-granting medical schools (N = 192) using AMA-endorsed criteria. Three technical standard domains—observation, communication, and motor—were coded as “functional,” “organic,” or “mixed,” generating a composite score for each school. Descriptive analysis was used to identify patterns and associations. Results: Of 192 eligible schools, 99.4% of MD and 100.0% of DO programs provided their technical standards online; one school did not have technical standards. The mean composite score was 1.24 (95% confidence interval, 1.02–1.46; SD = 1.55) out of a possible 6 for fully functional standards. MD programs were more likely to use functional language than DO programs, reflected in the higher overall mean score of 1.43 (SD = 1.59) for MD programs compared to 0.37 (SD = 1.00; P < .001) for DO programs. Schools established in 2010 or after were less likely to have functional technical standards than older schools ( P = .01), and schools reporting updates to their technical standards in 2022 or later had slightly higher functional scores than schools with less recent updates. Conclusions: Adoption of functional technical standards is varied. Most medical schools maintain restrictive organic language despite AMA recommendations. Greater alignment with functional standards could enhance inclusion of people with disabilities in medicine.

Purpose: Negative learning environment experiences may contribute to burnout for medical students with disabilities (MSWD). This study explores MSWD’s perceptions of the learning environment and the effects of program access (having received or not needing accommodations). Method: The authors analyzed the Association of American Medical Colleges Year Two Questionnaire data from 2019 and 2020, comparing nondisabled students, MSWD with program access, and MSWD without program access (having not received or requested an accommodation, despite a need). Three learning environment measures were examined: how schools fostered students’ personal and professional development; a shortened Medical School Learning Environment Scale (MSLES); and subscales on emotional climate, student–faculty interactions, and student–student interactions. Responses were compared across the 3 groups using chi-square and ANOVA tests with post-hoc pairwise comparisons. Results: Of the 23,898 respondents, 10.2% (2,438) self-reported a disability. Among those, 83.6% (2,039) reported program access, and 13.9% (340) reported lack of program access. Students without disabilities (21,008) reported higher agreement that their school fostered their development as a person (72.2%, 15,172) and physician (90.9%, 19,089) compared with MSWD with access (65.6%, 1,312 and 89.0%, 1,778, P < .001). MSWD without access reported lower agreement than both groups (43.7%, 149 and 80.1%, 273, P < .001). There were no differences regarding the MSLES statement about high-performance standards ( F (2, 23742) = 2.35, P = .095). For the 8 remaining MSLES statements and for all 3 subscales, nondisabled students reported significantly higher agreement than MSWD with and without access, and MSWD with access had higher agreement than those without. Conclusions: This nationally representative study demonstrates that MSWD perceive the learning environment less favorably than their nondisabled peers. Program access partially mitigates these differences, underscoring the critical role of accommodations and the need to address structural barriers to access.

With the impending removal of third-party cookies from major browsers and the introduction of new privacy-preserving advertising APIs, the research community has a timely opportunity to assist industry in qualitatively improving the Web's privacy. This paper discusses our efforts, within a W3C community group, to enhance existing privacy-preserving advertising measurement APIs. We analyze designs from Google, Apple, Meta and Mozilla, and augment them with a more rigorous and efficient differential privacy (DP) budgeting component. Our approach, called Cookie Monster, enforces well-defined DP guarantees and enables advertisers to conduct more private measurement queries accurately. By framing the privacy guarantee in terms of an individual form of DP, we can make DP budgeting more efficient than in current systems that use a traditional DP definition. We incorporate Cookie Monster into Chrome and evaluate it on microbenchmarks and advertising datasets. Across workloads, Cookie Monster significantly outperforms baselines in enabling more advertising measurements under comparable DP protection.

Purpose: To conduct a post–Americans with Disabilities Act Amendments Act multisite, multicohort study called the Pathways Project to assess the performance and trajectory of medical students with disabilities (SWD). Method: From June to December 2020, the authors conducted a matched cohort study of SWD and nondisabled controls from 2 graduating cohorts (2018 and 2019) across 11 U.S. MD-granting medical schools. Each SWD was matched with 2 controls, one from their institution and, whenever possible, one from their cohort for Medical College Admission Test score and self-reported gender. Outcome measures included final attempt Step 1 and Step 2 Clinical Knowledge scores, time to graduation, leave of absence, matching on first attempt, and matching to primary care. Results: A total of 171 SWD and 341 controls were included, the majority of SWD had cognitive/learning disabilities (118/171, 69.0%). Compared to controls, SWD with physical/sensory disabilities had similar time to graduation (88.6%, 95% confidence interval [CI]: 77.0, 100.0 vs 95.1%, 95% CI: 90.3, 99.8; P = .20), Step 1 scores (229.6 vs 233.4; P = .118), and matched on first attempt (93.9%, 95% CI: 86.9, 100.0 vs 94.6%, 95% CI: 91.8, 97.4; P = .842), while SWD with cognitive/learning disabilities had lower Step 1 scores (219.4; P < .001) and were less likely to graduate on time (81.2%, 95% CI: 69.2, 93.2; P = .003) and match on first attempt (85.3%, 95% CI: 78.0, 92.7; P = .009). Accommodated SWD had Step 1 scores that were 5.9 points higher than nonaccommodated SWD (95% CI: –0.7, 12.5; P = .08). Conclusions: Structural barriers remain for SWD with cognitive/learning disabilities, which could be partially mitigated by accommodations on high-stakes exams.