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

Zainub Dhanani; Suchita Rastogi; Matthew Sullivan; Rylee Betchkal; Peter Poullos; Lisa M Meeks

doi:10.1097/ACM.0000000000006150

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

Acad Med. 2025 Jun 30. doi: 10.1097/ACM.0000000000006150. Online ahead of print.

Authors

Zainub Dhanani¹, Suchita Rastogi², Matthew Sullivan³, Rylee Betchkal⁴, Peter Poullos⁵, Lisa M Meeks⁶

Affiliations

¹ 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.
² 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.
³ M. Sullivan is a disability resources professional research practitioner, Washington University in St. Louis School of Medicine, St. Louis, Missouri; ORCID: https://orcid.org/0009-0001-7385-4934.
⁴ R. Betchkal is a student, Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, New York; ORCID: https://orcid.org/0009-0003-6573-6043.
⁵ P. Poullos is clinical professor of radiology, Stanford University School of Medicine, and founder and co-chair, Stanford Medicine Alliance for Disability Inclusion and Equity, Stanford Medicine, Palo Alto, California; ORCID: https://orcid.org/0000-0002-8335-5725.
⁶ L.M. Meeks is professor of medical education, University of Illinois College of Medicine, Chicago, Illinois, and adjunct associate professor, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-3647-3657.

PMID: 40577171
DOI: 10.1097/ACM.0000000000006150

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.