Dhanani Zainub, Rastogi Suchita, Sullivan Matthew, Betchkal Rylee, Poullos Peter, Meeks Lisa M
Z. Dhanani is a recent graduate, Stanford University School of Medicine, Palo Alto, California, and founder and board president, Medical Students with Disability and Chronic Illness; ORCID: https://orcid.org/0000-0003-2276-5840.
S. Rastogi is an MPH student, University of Illinois at Chicago, Chicago, Illinois, and co-founder and CEO, Disability in Medicine Mutual Mentorship Program; ORCID: https://orcid.org/0000-0001-7808-1777.
Acad Med. 2025 Jun 30. doi: 10.1097/ACM.0000000000006150.
Limited guidance on and access to clinical accommodations pose significant barriers to disabled learners' full participation in medical education. The lack of standardized accommodation language and institutional expertise leads to inconsistent implementation, creating barriers for medical students. This study aimed to establish a consensus-based, standardized language for clinical accommodations to improve clarity, consistency, and accessibility for learners with disabilities in U.S. medical schools.
A modified Delphi approach was employed to achieve consensus on clinical accommodation language. A committee of nine disability resource professionals (DRPs) compiled a list of 271 accommodations, which were refined to 89 unique accommodations after eliminating redundancies. These were categorized into six domains: adaptive equipment, assistive technology, communication access, location, individualized adjustment/need, and scheduling. Two groups (disability inclusion experts and clinical-phase medical students with lived disability experience) engaged in four Delphi rounds between October 2024 and February 2025. Consensus was defined a priori as 80% agreement on accommodation language.
In Round 1, none of the accommodations met the 80% consensus threshold. Revisions were made, reducing the list to 75 accommodations for Round 2, where 65 accommodations met the threshold. In Round 3, nine additional accommodations achieved consensus, leaving one accommodation for final revision in Round 4, after which complete consensus was reached. The outcome was a list of 75 vetted clinical accommodations with standardized accommodation language.
The study produced a consensus-based list of clinical accommodations to educate and empower students, faculty, and DRPs. By standardizing the language used in accommodations, this work seeks to promote accessibility and advance equity within medical education. Future research should explore the effectiveness and feasibility of implementing these accommodations in clinical settings. Additional efforts should include expanding the guidance to DO-granting institutions, incorporating faculty perspectives, and evaluating the long-term impact of standardized accommodation language on clinical training outcomes.
临床便利措施的指导有限且获取途径不畅，这给残疾学习者充分参与医学教育带来了重大障碍。缺乏标准化的便利措施用语和机构专业知识导致实施不一致，给医学生造成了障碍。本研究旨在建立基于共识的临床便利措施标准化用语，以提高美国医学院残疾学习者的清晰度、一致性和可及性。
采用改良的德尔菲法就临床便利措施用语达成共识。一个由九名残疾资源专业人员组成的委员会编制了一份包含271项便利措施的清单，在消除冗余后精简为89项独特的便利措施。这些措施被分为六个领域：适应性设备、辅助技术、沟通途径、地点、个性化调整/需求和日程安排。两组人员（残疾融入专家和有残疾生活经历的临床阶段医学生）在2024年10月至2025年2月期间进行了四轮德尔菲调查。事先将共识定义为对便利措施用语达成80%的一致意见。
在第一轮中，没有一项便利措施达到80%的共识阈值。进行了修订，将清单缩减至第二轮的75项便利措施，其中65项便利措施达到了阈值。在第三轮中，又有九项便利措施达成共识，第四轮只剩下一项便利措施进行最终修订，之后达成了完全共识。结果是一份包含75项经过审核的临床便利措施及标准化便利措施用语的清单。
该研究得出了一份基于共识的临床便利措施清单，以教育并增强学生、教师和残疾资源专业人员的能力。通过规范便利措施中使用的语言，这项工作旨在促进医学教育中的可及性并推动公平。未来的研究应探讨在临床环境中实施这些便利措施的有效性和可行性。其他努力应包括将指导扩展到授予博士学位的机构，纳入教师的观点，并评估标准化便利措施用语对临床培训结果的长期影响。
