Pursuing Anti-Ableism in Medical Education: A Decolonial and Disability Justice Lens

Despite growing commitments to disability inclusion, ableism remains entrenched in medical education. Too often, proposed solutions emphasize inclusion without addressing the structural forces that perpetuate exclusion. In this article, we seek to bridge this gap, drawing on Disability Justice and decolonisation to challenge the norms that define success against ableist standards. At the intersections of these theories, we illustrate how colonialism and capitalism operate to drive the systematic exclusion of disabled learners in medicine. Drawing on Jain's concept of the "capability imperative," we make these comparisons explicit as we interrogate the notion of competency in clinical assessment, specifically in Observed Structured Clinical Examinations (OSCEs). This lens challenges us to consider how colonial capitalist norms shape definitions of competence and how this affects what is valued (or devalued) in our assessment practices. Offering a series of reflexive questions to prompt collective inquiry, we invite readers to begin to re-imagine learning environments and challenge the ableist paradigms that influenced the curricula under which our healthcare leaders trained. We seek to understand: are efforts to include disabled learners predicated on simulations of work in understaffed and underfunded healthcare systems? If so, are we replicating systems that not only exclude disabled doctors but demand sacrifice in the name of conformity and minimising disruption to safeguard productivity? Finally, what does this tell us about the power structures at play when it comes to assessing competency in medical education?