Promoting Disability Inclusion Through an Expanded Conceptual Framework of the Learning Environment.

Abstract: The inclusion of people with disabilities in medicine is imperative to ensuring a diverse, culturally adept physician workforce. Despite increasing representation in U.S. medical schools, medical students with disabilities (MSWD) continue to face considerable challenges in pursuing medical education due to systemic discrimination, entrenched biases, and insufficient support and program accessibility. To systematically address the disparities and challenges faced by MSWD, there is a pressing need for a comprehensive framework to design, implement, and evaluate the breadth of initiatives employed across learning contexts needed to promote disability equity, inclusion, and belonging. Here, the authors expand on Gruppen and colleagues' existing conceptual framework of the Learning Environment (LE) in the health professions by considering the role of societal influence on students' educational experiences. The authors offer this updated conceptualization of the LE as an approach to perform detailed assessments of the broader educational climate, identify areas for improvement, implement interventions that advance equity and inclusion, and evaluate these important initiatives.The framework conceptualizes the LE as consisting of 2 dimensions-the material, which includes physical and virtual components, and the psychosocial, which adds personal, social, organizational, and societal components. These 6 components profoundly affect medical students' educational opportunities and learning outcomes. By thoughtfully considering these factors, medical schools can assess the LE in a dynamic, iterative manner. Furthermore, medical schools can foster disability equity and inclusion through the development of interventions that strategically address a spectrum of LE domains. This framework can be applied in real-world settings to support the design, implementation, and evaluation of accessibility and equity initiatives across diverse institutional contexts. By leveraging this systems-oriented framework to guide these efforts, medical schools can thoughtfully create inclusive environments that support the success of all learners.