Online Poster Portal

Background: Medical students with disabilities represent a growing population in undergraduate medical education, yet little is known about how they navigate the clinical learning environment. While formal accommodation frameworks exist, the hierarchical and fast-paced nature of clinical clerkships creates unique barriers to consistent implementation. Prior research suggests that students with disabilities frequently experience stigma and fear of disclosure, yet their perspectives on accommodation use across clerkship training remain understudied. This study sought to qualitatively explore how medical students with disabilities experience disclosure, accommodation implementation, and barriers to participation during clinical clerkships.

Methods: This study employed a qualitative needs assessment design using semi-structured interviews. Medical students with self-identified disabilities across multiple clinical rotations were recruited through the UCLA Disability and Chronic Illness group (DCI). Participants represented a range of disability types, including physical, chronic illness, and neurodivergent conditions.

Interviews were conducted using a standardized guide exploring experiences with accommodation implementation, disclosure, professionalism, and clinical evaluation. Interviews were recorded, transcribed verbatim, and de-identified prior to analysis.

Data were analyzed using thematic analysis following Braun and Clarke's six-phase framework and additionally using an inductive approach to identify recurrent patterns and themes. Themes were organized into broader domains reflecting structural, cultural, and interpersonal factors influencing the clerkship experience. This study was approved by the UCLA Institutional Review Board.

Results: Six medical students with self-reported disabilities or chronic illnesses participated (median age 26), including two with chronic illnesses, two with physical disabilities requiring mobility aids, and two who were neurodivergent. Four major themes emerged: (1) disclosure was a calculated, context-dependent decision; (2) accommodations were formally approved but inconsistently implemented; (3) students self-regulated accommodation use to avoid perceptions of disengagement; and (4) clerkship environments influenced the ability to utilize accommodations.

Participants described selective disclosure based on perceived need and receptivity, with one noting, “I just thought maybe I don’t need to tell them, just show them what I need,” while another emphasized proactive communication: “I wanted to be very clear about what I needed.” Despite formal approval, implementation varied across sites, with support described as dependent on context. No single clerkship was uniformly challenging; in some cases, less physically demanding rotations were more difficult, as “the team felt it should be easier.” Attendance accommodations were “the most common, yet the hardest one to get respected.” Students also reported internal pressure to minimize use accomodations, being careful not to “miss any learning opportunities.” Participants emphasized the need for individualized approaches, noting that “even with the same disability, people’s needs are very different.”

Conclusions: Medical students with disabilities navigate complex decisions around disclosure and accommodation use that extend well beyond formal institutional processes. Addressing these challenges requires a multifaceted approach including individualized faculty support, consistent site-level implementation, and a cultural shift toward inclusivity across clinical training environments.