The Americans with Disabilities Act (ADA) is a civil rights law designed to ensure that qualified individuals with disabilities are not discriminated against by covered entities. Under the ADA, colleges of medicine were expected to focus their attention on implementing policies that facilitated equal educational opportunity, not on the threshold question of whether an individual was considered "disabled enough" to be protected by the law. In this issue, Allen and Smith examine the implications of the 2008 ADA Amendments Act (ADAAA) for medical education, focusing on the potential for the ADAAA to eliminate the threshold question and allow individuals seeking protection to bring their cases to trial.The authors of this commentary argue that the ADAAA also has important implications for institutions like colleges of medicine and the National Board of Medical Examiners that must not be overlooked. The impact of the ADAAA on colleges of medicine will depend in large part on how they historically viewed their obligations under the ADA. Those institutions that focused on eliminating all vestiges of disability discrimination by implementing comprehensive, system-wide, evidence-based policies, practices, and procedures related to reasonable accommodations and academic modifications/adjustments will experience little or no impact under the ADAAA. Those colleges that attempted to avoid or minimize compliance with the ADA by focusing on whether an individual achieved sufficient disability status to be protected by the law will need to pay closer attention to the development and implementation of nondiscrimination policies, particularly policies relating to reasonable accommodations and academic modifications/adjustments.