The Call is Coming from Inside the House: Racism and Ableism in US Medical Education

While ableism and racism have been acknowledged separately as harming, marginalizing, and excluding medical students, research has not explored their interconnected workings in the lives of disabled and racially marginalized medical students. In this qualitative interview study, we used theoretical and heterogenous sampling to recruit US racially marginalized disabled medical students. The semi-structured interview guide and analysis process used the seven DisCrit tenets as sensitizing lenses to identify counterstories, further using horror story tropes as analytic metaphors to deepen analysis and strengthen the narrative. The 12 participants included first- through fourth-year medical students ages 24-29, with a range of disability experiences, races and ethnicities, and gender identities. Participants were impacted by both racism and ableism inside a house of horrors while strategically fighting those horrors. Participants entered medical school despite edicts against trespassing, indicating their intersection of race and ability was not welcome. Once inside, learners found themselves trapped in a hall of mirrors, fighting for accommodations and survival in medical school. Navigating the house, it became clear that, as in horror stories, the call was coming from inside the house: those responsible for support were often agents of discriminatory systems. Yet participants fought systemic injustices and built misfit squads with others for protection. Participants intentionally left something akin to an apocalyptic log, to show that they existed and to help future generations of trainees. Our analysis illuminates horrifying experiences and resistant action at the nexus of racism and ableism in U.S. medical education. Rather than offer solutions, we invite readers to grapple with the discomfort of this horror.