Research Voices from the Field is a new feature that showcases cutting-edge research that breaks barriers and promotes inclusion in medicine. Each edition spotlights a research publication and includes insights directly from the authors—revealing their motivations, the significance of their findings, and why the research matters for healthcare professionals everywhere.
In this edition, Cheryl Holmes, Associate Dean of Undergraduate Medical Education and Clinical Professor of Critical Care in the Department of Medicine reflects on why she co-authored “Core Competencies for Students Entering Medical School: Reaching Pan-Canadian Consensus for Inclusive and Accessible Medical Education” — a must-read for leaders and educators seeking to embed disability justice into medical education.
In this edition, Cheryl Holmes, Associate Dean of Undergraduate Medical Education and Clinical Professor of Critical Care in the Department of Medicine reflects on why she co-authored “Core Competencies for Students Entering Medical School: Reaching Pan-Canadian Consensus for Inclusive and Accessible Medical Education”— a must-read for leaders and educators seeking to embed disability justice into medical education.
Read Cheryl Holmes‘ bio
Cheryl Holmes, MD FRCPC MHPE (she, her/s)
Dr. Cheryl Holmes is Associate Dean, Undergraduate Medical Education at the University of British Columbia (UBC) and Clinical Professor and former Head of the UBC Department of Medicine’s Division of Critical Care. Dr. Holmes is committed to fostering respectful, compassionate, and health-promoting environments in academic medicine—where excellence is strengthened by equity, decolonization, diversity, inclusion, accessibility, belonging, and social justice. Her scholarly interests include supporting learner wellbeing, creating inclusive and accessible learning environments, and advancing the social accountability of medical schools.
My journey began with a question about our technical standards that brought to my attention that I didn’t actually know what technical standards were. As I investigated, it became clear to me that the widely adopted traditional “organic” technical standards were not neutral descriptions of competence—they had, whether intentionally or not, been used to exclude people with disabilities from medical training. What were assumed to be objective expectations were, in fact, grounded in deeply ableist ideas about who is deemed “fit” to become a physician. This realization was profoundly unsettling, and it compelled me not only to undertake a project at UBC to re-envision technical standards but also to confront how little I had previously questioned the structures and assumptions I had inherited.
As I began discussing this project with colleagues, it became clear that other institutions were also interested in re-examining their technical standards, leading to the formation of a national coalition. Working alongside disabled colleagues, scholars, learners, and patient partners to re-envision these standards, I found myself reflecting on the hidden curriculum of my own specialty—critical care. At the time I was trained, the implicit message was clear: be tireless, be invulnerable, be more-than-human. I had absorbed this culture and, without realizing it, had carried those expectations into my assumptions about what all learners must be able to do.
It has been humbling to recognize the ways in which my own beliefs aligned with the very ideas that had marginalized disabled learners in our system. Listening to the experiences of colleagues who had navigated these barriers has been profoundly transformative. Their insights changed not only how I understood ableism in medicine, but also how I understood my role as a leader, an educator, and a human.
The functional Core Competencies we ultimately developed reflect a collective effort grounded in disability affirmation, universal design, and justice. But the deeper impact for me was personal: learning that disability inclusion requires ongoing unlearning—of old norms, old assumptions, and old definitions of ability—and the humility to grow because of what others so generously teach us.
Key Take-Home Messages
- Traditional technical standards were shaped by ableist norms rather than true measures of competence.
- Canada has adopted new functional Core Competencies, shifting from “organic” requirements to inclusive, outcome-focused expectations that support accommodations and assistive technologies.
- A disability-affirming, transparent, and inclusive process—centered on disabled physicians, learners, and scholars—guided the creation of these competencies.
- Medical schools have legal duties to reduce barriers, provide accommodations unless undue hardship is proven, and ensure accessible admissions and learning environments.
- This national shift advances social accountability, promotes universal design, and strengthens the diversity and well-being of the future physician workforce.
Core Competencies for Students Entering Medical School: Reaching Pan-Canadian Consensus for Inclusive and Accessible Medical Education
Authors: Cheryl L Holmes, Laura Yvonne Bulk, Naomi Lear, Lynn Ashdown, Quinten K Clarke, Laura Farrell, Rachel Giddings, Lisa Graves, Julia Ersilia Hanes, George Kim, Michael Quon, Saleem Razack, Francesco A Rizzuti, Ginger Ruddy, Alex Scott, Erene Stergiopoulos, Lee Toner, Laura Nimmon
Abstract
A socially accountable physician workforce must include disabled learners and providers. However, current Canadian Technical Standards (TS) for medical school admissions create barriers to their inclusion. These standards overlook advances in assistive technology, universal design, evolving inclusion practices, and legal protections. Replacing the TS required consensus, but traditional methods of achieving consensus on disability inclusion risk reinforcing ableism in medical education. To address challenges with existing TS, the Association of Faculties of Medicine of Canada (AFMC) formed the “Re-envisioning TS Working Group,” using a novel consensus approach grounded in disability inclusion and critical disability discourse. Guided by transparency, accessibility, and respect for disability as diversity, the group prioritized engagement with disabled physicians, educators, scholars, and learners. The WG followed 5 stages: (1) identifying key concepts and reviewing literature on TS reform and ableism; (2) examining relevant legislation and case law; (3) drafting functional Core Competencies; (4) consulting partners across the medical education continuum; and (5) presenting outcomes to the AFMC Board, highlighting a commitment to disability inclusion in undergraduate medical education. The AFMC Board unanimously endorsed the “Report on Re-Envisioning Technical Standards,” including the “Desired Outcomes” and the “Core Competencies for Entering Medical Students.” The AFMC’s adoption of functional Core Competencies is a significant step toward inclusion and support for learners with disabilities in Canadian medical education. Medical schools should adopt these competencies, combat ableism, and invest in universal design to promote access. Accommodation support should extend from admission through postgraduate training to independent practice. Finally, efforts to foster an inclusive culture and contribute to a healthy, diverse physician workforce must be evaluated as part of medical schools’ social accountability mandate.
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We especially welcome submissions of research articles that explore equity, diversity, inclusion, justice, decolonization, Indigenization, or trauma-informed practices in medicine and healthcare.