Standardized Language for Clinical Accommodations in U.S. Undergraduate Medical Training: Results From a National Modified Delphi Consensus Study.

Abstract

Purpose: 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.

Method: 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.

Results: 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.

Conclusions: 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.