A case study from a 2024/25 Education Development Project completed by David Rogers (Medical Programme Co-Director in the Bristol Medical School)
The practice
The Medical School admits up to 300 students annually, with a growing number identifying as neurodivergent. Although higher education has improved accessibility, many reasonable adjustments fail to carry over into clinical placements, where inflexible, high stimulus environments can disadvantage neurodivergent learners. This contributes to increased burnout and concerns about disproportionate referrals for perceived professionalism issues. Given heightened sensitivity to interpersonal feedback, including conditions like Rejection Sensitivity Dysphoria, students may struggle without appropriate support. While systemic reform is needed, practical, small-scale adaptations can enhance inclusion. With rising requests for adjustments, formal guidance for supporting neurodivergent learners in clinical settings is increasingly essential.
Findings
This scoping literature review examines current evidence on supporting neurodivergent medical students in clinical education, highlighting the gap between legal expectations and real-world practice. Neurodiversity refers to natural variations in human cognition, encompassing conditions such as autism, ADHD, dyslexia, dyspraxia, and Tourette syndrome. Although neurodivergent individuals contribute valuable strengths to healthcare—such as creativity, empathy, and innovative problem-solving—medical education remains largely designed around neurotypical norms.world practice. Neurodiversity refers to natural variations in human cognition, encompassing conditions such as autism, ADHD, dyslexia, dyspraxia, and Tourette syndrome. Although neurodivergent individuals contribute valuable strengths to healthcare—such as creativity, empathy, and innovative problemsolving—medical education remains largely designed around neurotypical norms.
Under the Equality Act 2010, UK medical schools must provide reasonable adjustments to disabled students, including neurodivergent learners. However, research consistently shows that accommodations often fail to translate into clinical placements. Many students fear disclosure due to stigma, bullying, and concerns about professionalism, with surveys indicating widespread perceptions that medicine lacks a disability inclusive culture. Diagnostic barriers—such as long NHS waiting times and challenges faced by international students—mean many neurodivergent students remain undiagnosed or only identified after academic difficulties.inclusive culture. Diagnostic barriers—such as long NHS waiting times and challenges faced by international students—mean many neurodivergent students remain undiagnosed or only identified after academic difficulties.
The literature identifies recurring challenges in clinical learning environments, including sensory overload, unpredictable routines, communication differences, executive functioning demands, and negative or uninformed attitudes from clinicians and peers. These issues are compounded by intersectional factors (gender, race, mental health comorbidity) and internalised ableism. Studies with autistic and ADHD medical students and clinicians describe significant benefits from predictable structures, sensory friendly spaces, flexibility, clear communication, and supervisors with neurodiversity awareness training. Many recommend embedding neuro-affirmative culture change across medical schools and placement settings.functioning demands, and negative or uninformed attitudes from clinicians and peers. These issues are compounded by intersectional factors (gender, race, mental health comorbidity) and internalised ableism. Studies with autistic and ADHD medical students and clinicians describe significant benefits from predictable structures, sensoryfriendly spaces, flexibility, clear communication, and supervisors with neurodiversity awareness training. Many recommend embedding neuroaffirmative culture change across medical schools and placement settings.
Across professions (medicine, nursing, dentistry, veterinary science), similar themes emerge: the need for proactive support, regular checkins, mentor or buddy schemes, improved induction processes, and the creation of practical adjustment toolkits. However, evidence on effective reasonable adjustments in clinical settings remains limited, representing a recognised research gap.
The review concludes by proposing the IFSPACE framework—an adaptation of the autistic SPACE model—to guide structured discussions between neurodivergent students and clinical educators, supporting predictable, personalised, and neuro-affirmative learning environments.affirmative learning environments.
The Impact
This project has been carried into 25/26 as initial discussion with many of our clinical academies suggested that the adoption of the IFSPACE framework as a tool for use in an induction sessions may help address this gap.
Next Steps and contact
Evaluating the Real-world Impact of the IFSPACE Framework in Clinical Education (2026) World Impact of the IFSPACE Framework in Clinical Education (2026)
This study aims to investigate how the IFSPACE framework can support neurodivergent medical students during clinical placements and to assess its practical applicability within real-world clinical learning environments. The study design has been designed to focus on experiential, conversation based exploration rather than survey based data collection.world clinical learning environments. The study design has been based exploration rather than surveybased data collection.
Participants—neurodivergent medical students and clinical supervisors not directly involved in the students’ current placements—will first complete the IFSPACE template independently. They will then participate in a structured online meeting designed to simulate the practical use of IFSPACE in a typical preplacement discussion. Before this meeting, each participant will have a preparatory session with a researcher to confirm consent, clarify expectations, and ensure emotional and logistical readiness.
The central component of the study is an unrecorded discussion between each student and supervisor pair. This conversation will focus on the usability of the IFSPACE framework, its role in identifying appropriate reasonable adjustments, and its perceived impact on communication and shared understanding. The unrecorded nature of the discussion is intended to foster openness while mirroring authentic clinical conversations.
Following this, students and supervisors will take part in separate recorded semi structured interviews with different researchers. These interviews will explore their experiences of using IFSPACE, the feasibility of implementing it in clinical settings, and perceived benefits or barriers, structured interviews with different researchers. These interviews will explore their experiences of using IFSPACE, the feasibility of implementing it in clinical settings, and perceived benefits or barriers.
Participants will also complete an anonymous Microsoft Form to capture reflections in an alternative format, supporting accessibility for those who prefer written, anonymous feedback.
Subject to sufficient interest, one or two focus groups—separately for students and supervisors—will be conducted to review emerging themes and triangulate findings.
For more information conact David Rogers – david.rogers@bristol.ac.uk
Leave a Reply