Best Practices for Supporting Occupational Therapy Students With Disabilities During Clinical Education: Results From a Three-Round Delphi Study.
Courtney Gohean, Katie McLaughlin, Aster Harrison
PMID 42681917WHAT IT FOUND
A Delphi consensus panel of OT educators, clinicians, and disabled students and practitioners agreed on 53 recommended practices for supporting disabled OT students on clinical placements.
These are expert recommendations, not tested interventions. No study here shows they improve outcomes.
Key findings
01The final consensus list comprised 53 items: 41 best practices for supporting disabled OT/OTA students on Level II fieldwork and 12 suggested available accommodations, organised into six themes (communication and transparency, advance planning, disability-affirming approach, education of all parties, individualized and flexible accommodation, and addressing structural barriers and institutional ableism).
02Ten of the best practices received the maximum median score of 7 out of 7 for both importance and feasibility, making them the panel's strongest consensus items.
03US OT productivity standards (the ratio of direct patient-care time to documentation time) were identified as a structural barrier: they penalise clinical educators for teaching time and disadvantage students who need more documentation time, and two related items received median feasibility scores of only 3 or 4 despite high importance ratings.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
All 30 experts were recruited from the United States, so the practices reflect US legal and institutional contexts (ADA, Section 504, US productivity standards) and may not transfer directly to other countries. Participants were purposively sampled and likely skewed toward those most passionate about disability inclusion in OT education, which the authors acknowledge as a selection bias. The Delphi questionnaires were not pilot-tested before use. The 'slower increase in caseload' item did not receive feasibility ratings in Round 3 due to a questionnaire error, so its feasibility is unknown. The reminder to separate importance from feasibility ratings appeared only in Round 3, so items that reached consensus in Round 2 may have been rated lower for importance than they would have been had the reminder been present. These are consensus opinions about what should be done, not evidence that doing so produces better student outcomes. No implementation or effectiveness data are reported. Dropout reduced the panel from 30 to 23 over three rounds; all Round 2 dropouts were practitioners and all Round 3 dropouts were AFWCs or FWEs, which may have shifted the composition of the final consensus.
Declared interests
Funded by Faculty Development and Nexus Learning at Thomas Jefferson University. The authors declare no conflicts of interest. Two of the three authors identify as disabled, and one author is a current OT faculty member at a US institution.
The easy way to misread this
Do not read the 53 consensus items as evidence that these practices improve student outcomes. This is a Delphi consensus of expert opinion, not a tested intervention. No study in this paper measured whether implementing these practices changed student performance, satisfaction, or retention. Additionally, the productivity-standard findings are specific to US OT practice and the legal framework of the ADA and Section 504, so they may not apply to your regulatory context.