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January 7, 1998

Coping With a Learning Disability in Medical School

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JAMA. 1998;279(1):81. doi:10.1001/jama.279.1.81-JMS0107-5-1

The first time I ever thought about learning disabilities (LDs) was when a fellow student described her experiences in a postbaccalaureate psychology class. I had never before considered how learning styles could differ and what some people might do to compensate for those differences. Never did I imagine that just a few years later I myself would be diagnosed with an LD and be faced with academic difficulties in my own career.

The diagnosis of an LD is based on standardized test data, when the performance expected from a person based on age, education, and intelligence level differs substantially from the person's actual performance. My LD is called an auditory and visual information processing deficit, which means that my brain processes information in a manner different from other people. My LD affects my reading—I comfortably read below the first percentile in standardized reading tests—and it affects my ability to memorize information.

This description is not satisfactory to some people. It seems everyone has heard of dyslexia and can easily associate it with reversing letters, a simple concept demonstrating how reading is affected by an LD. In fact, the spectrum of LDs includes many other disabilities. In addition, LDs do not always fall into neatly comprehensible categories, although the false preciseness of the Diagnostic and Statistical Manual of Mental Disorders might convince one otherwise.1 That few have heard of my LD is likely due to the complexity of establishing clinical categories for the very subtle manifestations of a slightly different brain chemistry.

I was not diagnosed with an LD until the year before I started medical school, after an abysmal experience with the Medical College Admissions Test. My situation is not unusual. Many bright individuals with LDs learn to compensate for their weaknesses.2 Often it is not until they reach higher levels of education that their compensatory abilities are overwhelmed, thereby exposing a previously unrecognized LD.

The accommodations I receive for my LD are double time on my exams and a semiprivate testing room where I can read aloud. As for studying the large amounts of material required in medical school, I knew I had to consider how to maximize my learning, which involves conceptualizing, organizing, visualizing, and discussing material. Reading and attending lectures are inefficient because they provide only one modality of processing information, either visual or auditory. Therefore, I chose an option offered at my school to extend the first 2 preclinical years to 3.

Besides requiring that I take more time to learn, my LD seems to affect me mostly in testing situations—specifically in standardized and multiple-choice formats. I have spent much time trying to understand this phenomenon. Often I wonder whether I simply do not know the material as well as other students. However, in essay format tests, which accounted for the vast majority of my exams as an undergraduate and were occasionally offered in medical school, I perform without any difficulties. The unfortunate consequence of this testing bias is that I spent much of my second and third years practicing exam formats, leaving less time for class material.

As my past performance could have predicted, I obtained strong evaluations in my clinical rotations but poor scores on the required National Board shelf exams. In my second required clinical rotation, I did not pass a shelf exam and was placed on academic probation, despite obtaining honors in 5 of 8 categories of my clinical evaluation and an 85% mark on my oral examination. Obviously, it is distressing to feel competent and perform well clinically but be in academic jeopardy.

I often wonder how my experiences as a person with a LD differ from those of other medical students. I also occasionally wonder to what greater degree, if any, I am impacted since many of my struggles are shared by students without LDs. Since I have always functioned in this way, successfully for the most part, I cannot comprehend how it might be to learn in a modality other than my own. I have struggled with feelings of frustration in a way that seems common to many medical students, although in my case to a much greater degree.

Some might argue that because of my LD I am less fit to be a doctor and that my disability might cause me to miss some critical piece of information. I reply that I have successfully compensated for my learning differences and am affected in ways that have not been related to patient care. Indeed, in my patients' and preceptors' eyes, I am like any other student. My LD, like many LDs, is invisible, and few suspect that a medical student like myself could have an LD.

I believe that because I have struggled with these issues in medical school, I will ultimately relate better to the daily struggles of my patients. I hope for others like myself that the medical education system will devise better means for educating, evaluating, and assisting students with LDs.

American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC American Psychiatric Association1994;
Walters  JACroen  LG An approach to meeting the needs of medical students with learning disabilities. Teaching Learning Med.;. 1993;529- 35Article