Abstract
This study explored factors that affect disabled occupational therapy students and describes what helps and hinders them throughout their education.
Promotion of disability diversity in the field of occupational therapy begins with inclusive education, where students with disabilities have equal access and supports for success and opportunities to thrive. Literature shows that including and supporting disabled students improves health care education by modeling cultural humility, inclusive practice, and well-informed care for clients with disabilities (Meeks et al., 2022; Taff & Blash, 2017). Disabled students offer distinct value and unique lived experiences to education; however, without an equitable learning environment, they experience exclusion.
Medical education literature argues that ableism—unequal treatment because of presumed nontypical functioning—is present in health care and education settings, perpetuating medicalized notions of how disability is viewed and treated within a person (Feldner et al., 2022; Lindsay et al., 2023). In health care education, ableism is manifested as minimizing disability and viewing disabled people as subjects to fix rather than experts of their own experience. This medical discourse of disability marginalizes disabled students and perpetuates the stigma of disabled people being seen as incapable and less worthy of respect.
Although scarce, available literature examining experiences of occupational therapy students with disabilities has shown similar experiences with ableism. This includes reports of stigma related to disability and accommodation use, difficulty accessing accommodations and other resources for learning, and environmental barriers related to accessibility on campus (Jung et al., 2014; Ozelie et al., 2019; Velde et al., 2005). Disability simulation experiences can also perpetuate stigma and feelings of pity toward disabled students (VanPuymbrouck et al., 2017). Barriers faced by disabled occupational therapy students throughout their education negatively affect students’ learning experience, mental health (i.e., increased stress and anxiety), and sense of belonging (Jung et al., 2014). Despite the need to support disabled students better, the literature is insufficient. More evidence is needed to document the lived experiences of disabled occupational therapy students and identify ways to support them.
Therefore, in this study, we aimed to better understand the lived experience of disabled students regarding their entry-level occupational therapy education. We used the social model of disability as a guiding framework, acknowledging that societal barriers exclude and discriminate against people and, therefore, disable them (Oliver, 1990). This focus helped us to critically analyze the education system and external factors influencing students’ experiences in occupational therapy education.
Method
Study Design
In this study, we used a qualitative descriptive approach to provide a comprehensive summary of experiences with low-inference descriptions from the research team (Sandelowski, 2010). This study was part of a larger research project—with three categories of participants, including disabled students, faculty, and Disability Resources for Students (DRS) staff—which aimed at understanding the accommodations process for disabled students in occupational therapy education. This article focuses on the experiences of student participants. This study was granted exempt status by the University of Washington Institutional Review Board.
Participants
Study participants included current and recently graduated occupational therapy students with disabilities in a Master of Occupational Therapy program that consisted of interdisciplinary courses as well as occupational therapy–specific classes. Participants were required to meet the following inclusion criteria: ▪ current enrollment in the University of Washington entry-level Master of Occupational Therapy program or graduation within the past 18 mo ▪ identification as disabled/a person with a disability, neurodivergent, d/Deaf, and/or having a chronic health condition (disclosure of specific disability was not required) ▪ having engaged in the process of exploring or obtaining accommodations through the DRS department.
A recruitment email was sent to all students and recent graduates using email distribution lists, and students who responded were screened for eligibility. Verbal consent was obtained at the time of interview.
Data Collection
Data were obtained through virtual focus group sessions using a semistructured interview guide consisting of open-ended questions that explored students’ experiences throughout their occupational therapy education, including the process of obtaining reasonable accommodations, challenges and supports during their education, and recommendations for change to better support disabled occupational therapy students. An individual interview format was offered to accommodate scheduling needs and address potential discomfort with group setting discussions. The length of focus group sessions ranged from 60 to 90 min, and the individual interview lasted 40 min. All interviews were recorded and transcribed verbatim.
Data Analysis
Data were analyzed using an inductive approach to thematic analysis (Braun & Clarke, 2022). All research team members coded the first focus group independently; then individual codes were reviewed as a group to develop a codebook. All other transcripts were coded by two team members alternating between primary and secondary coder roles. The two coders addressed disagreement through discussions, and the third team member assisted with any discrepancies. The codebook was updated intermittently throughout the coding process, requiring the recoding of parts of the transcripts to ensure consistency across the data. The research team collaboratively reviewed the codes to determine and refine themes.
Trustworthiness
Triangulation of the data occurred at the participant level by including participants from a variety of student cohorts and at the researcher level by using three members of the research team (Danbi Lee, Emma Gregg, and Keri DeGroot) to analyze the data. Throughout data collection and analysis, research team members actively practiced reflexivity through team discussions and individual reflections to navigate their positionality and dynamic relationship with students. The complex dynamics between students and research team members were explicitly addressed at the start of each focus group and interview, and participants were assured that the topics discussed would have no impact outside of the research project.
Results
Participants
Four focus group sessions (with 3–4 participants in each group) and one individual interview were completed with 14 participants. Most participants (n = 10; 71%) were enrolled in the didactic portion of the Master of Occupational Therapy program (Table 1). Across participants, six cohorts were represented.
Participant Cohort (N = 14)
Findings
Three main themes regarding faculty support, peer support, and professional education culture were established to describe what matters to disabled occupational therapy students.
Faculty Support Matters
Most of the participants reported that a supportive faculty demonstrating compassion, approachability, and collaboration made it easier for them to focus on their education. Many participants valued when the faculty was willing to provide accommodations and worked with students to best support them. Participant (P)7 stated: “[faculty member’s name] was the most on top of my accommodations, would check in with me every test, every quiz. And it was really, really lovely.” Participants also appreciated when faculty went beyond being responsive to formal accommodation requests by proactively supporting students. P14 shared: Most [faculty members] made some specific mention of it in an intro or the first day of class to reach out if you need support, even if you’re not officially connected with DRS. That made it easier to have an understanding that it was something I could approach faculty with.
Another participant shared,
Both of the lab settings that I was the most worried about having to test and where I went in expecting that I wasn't going to be getting testing accommodations, I was given them with absolutely zero issue whatsoever between the two lab instructors, which was extremely helpful. (P1)
In addition to responding positively to student requests, some faculty members proactively integrated universal approaches to support all students, which lessened student burden and created an inclusive learning environment. Describing how occupational therapists are naturally holistic problem solvers and how that was demonstrated by the faculty, P7 said, Just because we’re [occupational therapists], the setup of an OT [occupational therapy] framework of curriculum is sort of set up to be supportive of all students anyway, so I didn’t even feel like I was getting that much more stuff than the other students were also getting reasonably.
P6 shared, “I think that’s true to a lot of other OT professors is that I don’t really need to activate my accommodations, because of how classes are designed and coursework.” Another student described the use of universal approaches to teaching: There are some accommodations such as lecture recordings that I was glad to see are just universally offered in a lot of our classes. . . . It was helpful to just have that as a go-to and also great because everyone benefits from universal accommodations. (P5)
In other cases, participants experienced interactions with the faculty that had a negative impact on their educational experience. Some participants described instances where faculty members did not convey compassion or sensitivity to students’ access needs and were not willing to adjust beyond official accommodations. For example, sometimes faculty members made adjustments sound like an inconvenience, with comments such as “Well, then we’d have to start really early in the morning” in response to a request for an alternate testing time (P6) or “Well, I’ll try [to record using Zoom], but you just record it yourself. . . . I don’t see why you would want to [record the lecture]” in response to a request for faculty to record lectures and to keep all recordings in a central place (P3). These comments discouraged students from using beneficial learning strategies or accommodations. P3 also stated, “just the attitudinal discouragement using [my accommodation] made me reconsider if that was going to actually be something helpful for me this quarter.”
A few participants also reported specific ableist interactions and stigma by faculty members. P10 shared their experiences with faculty members who minimized the experience of disability: I definitely heard from some [faculty members] like, ‘Oh, well, this is hard for everybody when you’re learning.’ And I’m like, ‘Yes, but I also have a learning disability, so it’s going to be extra hard to me.’ And I’d have to say that a lot. And it felt really demoralizing.
P6 described their recollection of a test-taking experience in a separate space with an instructor who was proctoring the test. The response of the faculty member to the student’s explanation of their regulation needs during testing had a negative impact on the student’s testing experience: And [the faculty] was like, ‘Yeah, I know you're not normal. Not that that's a bad thing, but I'm just calling it like it is.’ So, then I had to spend two hours locked in the room basically with [the faculty] just with that riddling through my mind. (P6)
Participants who did not feel believed or supported experienced increased burden and decreased opportunities to succeed.
Peer Support Matters
As with faculty, participants also described interactions with peers that illuminated the importance of peer support. Most participants felt supported by fellow disabled students in the program who expressed solidarity and shared experiences. P4 shared, Having peers showing you that you are not the only one that needs this, that was really helpful for me just to feel good about my decision. . . . I wasn’t standing out. This is something I need and there’s no shame in that.
P11 shared a similar experience of solidarity among peers:
I’ve noticed that it’s funny when we all see each other at the DRS building, we’re always like, ‘Oh, hey,’ like it’s nothing. It’s very nice to not feel obligated to share what’s ‘wrong with you,’ and it just makes it feel more normalized, as it should be.
Participants agreed that sharing experiences with other peers with disabilities helped to normalize the accommodations process and made students feel supported and included throughout their education.
Participants also described feelings of support from nondisabled peers during their education. P6 reported, “I’ve found my entire cohort to be very supportive and I never feel uncomfortable,” and P12 described being emotional in front of other students, saying, “I felt really comfortable crying in front of everybody and I also felt supported.” The feelings of support were also attributed to the culture of inclusion of the program. One participant expressed how the culture helped combat their internalized stigma: I think there’s just a climate in the OT community, maybe a culture, that it’s okay to need accommodations. . . . I think that my own internalized judgments and feelings about it were a hindrance, so having that understanding and accepting culture felt . . . it just made it easier. (P12)
Although most participants experienced support from peers, a few described a noticeable split among students with differing epistemological beliefs about health that was apparent through their attitudes and actions. P6 described, There is a divide [in my cohort] between folks that are disability justice and inclusion-oriented and folks that seem to have more of a medical model of disability… When I need to stim or have something going on, there is some stigma in the class and only among certain people.
Aside from views about health, one participant also shared experiences with classmates who were unwilling to support them because of stigma or lack of empathy: “When I would say, ‘Hey, I would really benefit from note taking,’ I think some people still thought I was lying [about my disability] because I did well” (P10). Differing views about health and disability created barriers to participants’ sense of belonging in the community and success during their education.
Culture of the Occupational Therapy Profession Matters
Participants spoke to the broader culture of occupational therapy and how it influenced their experience as students with a disability. Some participants pointed to ableism in health care and the underlying problems when there is persistent medicalization of disability in foundational occupational therapy education. One participant shared how the notion of seeing people with disabilities as people to fix, instead of viewing them as capable professionals, caused feelings of exclusion: I think it is interesting how much [physical therapy] and OT education seems still to be really structured in this like “the-patients-are-the-ones-with-the-problem” kind of mindset and not understanding that there are disabled providers. . . . I feel like it led to more than a few awkward or uncomfortable moments. (P2)
Some participants felt that the profession of occupational therapy presents specific expectations that are not inclusive of diverse students. A student who entered the field from a different profession (P8) described feeling “disabled for probably the first time in [their] life” because of the focus on physical and cognitive skills required in the training to become an occupational therapist. They further described how the technical standards shaped their first impression of the profession when starting the program: I remember receiving in our intake paperwork, some list about capabilities or something you had to have [technical standards], and there was something about physical capabilities. I had been diagnosed with a chronic degenerative physical condition after I’d applied for grad school, and I never saw it as a disability. . . . But then I saw this list and got really worried. I was like, “Oh no, can I not be an OT?” (P8)
The structure of the program and the learning environment (e.g., fast-paced learning environment because of the quarter system, teaching approaches) designed for the mainstream also contributed to the lack of belonging experienced by some disabled students. P13 stated, It’s a program that’s set up for a very specific type of person to succeed, and that person is not me. Someone with a lot of social supports, someone who’s really outgoing, somebody who thrives in crowded, busy environments and are going to be the most vocal, push themselves. . . . I realize I’m using negative language here, and I don’t mean it like that, but it is set up for one type of personality.
Opportunities for (re)framing disability and critically reflecting on biases toward disability supported participants’ educational experiences. P9 shared, “We had a really awesome lecture about just disability studies. . . . That was really helpful [. . .] just recognizing societal barriers, stigma, and ableism.” P4 also highlighted how reframing disability can change the culture of a program, saying, “something that’s really been supportive too is our [program] and how we talk about disability. And I think generally, it’s neutral to positive.” Introducing and framing disability from an equity and justice perspective also helped participants rethink their own disability identity. P2 described the impact of exposure to disability justice frameworks on their views about their own disability and needs: I think there’s been an evolution while I’ve just been in school and been exposed to a lot more disability justice stuff than I had before. I think I started probably from a place that was kind of like a supplicant role. I was like, “Is there anything that you could do to help me? Oh, thank you so much.” And the longer that I’ve been in, the more I feel like I think my attitude has changed. . . . I think my role is now an agitator, and now I have a bit more respect for, my role should just be being a student. And that’s enough.
These experiences capture the challenges that the participants faced in their occupational therapy education and highlight the benefits of reframing disability in occupational therapy curriculum.
Discussion
The study aimed to explore the disabled occupational therapy student educational experience through the lens of the social model of disability. This lens provided a critical view of the external factors that affect the experience and success of students with disabilities. Participants shared the importance of faculty and peer support throughout their education and described the role that the profession’s culture plays in disabled students’ feelings of inclusion. Their experiences underscore the importance of creating an inclusive and equitable learning environment by making changes to faculty and peer support as well as the overall culture in occupational therapy education and practice.
The results highlight both positive and negative experiences that students had during their interaction with faculty in the occupational therapy program. Participants acknowledged that, by virtue of being occupational therapists, faculty members often provided a more supportive environment, compared with faculty members who were not occupational therapists. This finding is consistent with previous studies suggesting that faculty members who were occupational therapists were often open to and supportive of accommodations for students with disabilities (Jung et al., 2014). However, participants also highlighted some negative interactions with individual faculty members who were occupational therapists and those who were not, including interactions that were insensitive or lacking compassion, faculty members’ hesitancy to provide supports beyond official accommodations, and explicit biases toward disability. Whether the interaction demonstrated subtle or explicit ableism, the impact on disabled students was profound, contributing to feelings of marginalization and lack of support for their academic success. In accordance with literature, these negative experiences often stemmed from the faculty’s lack of understanding regarding disability and the specific learning needs of students with disabilities (Becker & Palladino, 2016; Jung et al., 2014). This result emphasizes the critical role of faculty in a student’s educational experience and the importance of raising faculty awareness on implicit and explicit stigma against disability and competency in integrating anti-ableist educational practices.
Opportunities to improve faculty support could include addressing known barriers such as lack of knowledge, biases toward disability, time constraints, insufficient resources, and support from the institution (Bettencourt et al., 2018). Faculty trainings on inclusive and anti-ableist educational practices for students with disabilities can be effective in raising awareness of disability biases, building competency in creating an inclusive learning environment, and meeting the learning needs of disabled students (Carballo et al., 2021; Feldner et al., 2022). It is also important to note that faculty members often experience heavy workloads and may be constrained by time, which can lead to an apathetic attitude in student interactions or an inability to offer the support they hoped to provide (Cabatan et al., 2019). It is critical that institutions recognize these barriers and provide adequate resources, such as teaching assistants or time relief, to allow the faculty to offer both proactive and responsive support for disabled students.
One of the recurring themes from students was the positive impact on the culture of normalizing disability and accommodation, which made them feel included in the program. Participants identified the integration of universal approaches in teaching, the culture of occupational therapy as a profession, the critical disability framing in the curriculum (e.g., introduction to the social model of disability and disability justice), allyship from peers without disabilities, and peer support from other disabled occupational therapy students as factors that facilitated the normalization of disability. Recognizing disability as both a social construct and an integral part of both clients’ and clinicians’ identities can reduce the notion of “us versus them” and help neutralize negative perceptions of disability as a deficit. A recent study has shown that occupational therapy education can reinforce negative perceptions of disability (Friedman & VanPuymbrouck, 2021), highlighting the need for the integration of critical disability framing within the context of cultural humility. Current research does not support the efficacy of limited exposure to critical disability frameworks in effectively addressing implicit bias or producing sustained, long-term change (Crane et al., 2021; Ioerger et al., 2019). Therefore, it is critical to select anti-ableist frameworks to inform the entire curriculum and to expose students to critical and justice-oriented perspectives frequently throughout their education (Havercamp et al., 2021; Lee et al., 2023).
Aligned with existing critiques, the study findings suggest that the current education system and health professional training curricula are typically designed for the mainstream, which can result in inherent ableism and exclusion of students with certain backgrounds or those with less support and resources (Lindsay et al., 2023; Nieminen, 2024). This result highlights the importance of proactively establishing an inclusive learning environment and curricular structure to support not only disabled students but all students with different backgrounds, life experiences, and learning preferences. If the field aims to diversify the workforce, then the admissions process, learning environment, and professional expectations should be re-evaluated from an inclusive perspective rather than adhering to conventional norms (Meeks et al., 2022). For example, providing equitable and inclusive technical standards, using Universal Design for Learning, and normalizing different life experiences and diversity among students, educators, and clinicians can create an environment where all students feel they belong.
Limitations and Future Research
Limitations of this study suggest areas for future research. Data were collected from a small sample of students from one occupational therapy program, which limits the transferability of the findings to other occupational therapy students, faculty, and programs. Future research could also include a larger and more nationally representative sample for better understanding of the disabled occupational therapy student experience throughout the United States. Another limitation is that the participants in this study spanned multiple cohorts. Participants who enrolled in the program at different times may have experienced different faculty and programming. Future research that systematically explores larger cohort representation from different time points might elucidate trends over time. Longitudinal studies that follow individual student experiences throughout their education might provide insight into key time points in a student’s educational experience. This study did not collect or present information regarding the specific nature of participants’ disabilities. This decision was made intentionally by the research team to focus on understanding the collective experiences of disabled students. However, future research could focus on specific disability groups or collect more detailed disability information to better identify specific strategies to support certain groups.
Implications for Occupational Therapy Education
The results of this study have the following implications for occupational therapy education: ▪ Participants reported positive experiences with faculty who not only implemented formal disability accommodations but also worked to make the implementation of accommodations easy and welcoming for students. Conversely, students reported negative experiences with faculty who were not knowledgeable about or supportive of their needs. ▪ Participants highlighted the benefits of critically framing disability throughout the curriculum. By embedding disability frameworks and perspectives into coursework, occupational therapy education can promote inclusion for disabled students and cultural humility for all future practitioners. ▪ Occupational therapy programs have opportunities to self-examine and create cultures of inclusion and justice for disabled students. These include examining and revising technical standards to be more equitable and inclusive, incorporating Universal Design for Learning principles into courses, and working to normalize diversity within all aspects of the program. ▪ A faculty training—including information about disability awareness and ableism, the accommodations process, and inclusive teaching practices for supporting disabled students—may change faculty perspectives on disability and foster more supportive and collaborative relationships with students.
Conclusion
This qualitative study revealed that faculty support, peer support, and program culture are important factors that shape the educational experiences of disabled occupational therapy students. The varied experiences highlight supports and barriers encountered by students as well as opportunities for systematic change to better support them. Better supporting disabled occupational therapy students will promote inclusion and lead to a better informed and more diverse workforce.
Footnotes
Acknowledgments
We thank the participants in this study for their time and sharing their experiences. We also acknowledge our funding source, the University of Washington Diversity and Inclusion Seed Grant.