Undergraduate medical education for neurodivergent students: A scoping review

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Green, Megan E.L. Brown, Gillian H.S. Vance, Iain D. Keenan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7415903/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 13 Dec, 2025 Read the published version in BMC Medical Education → Version 1 posted 11 You are reading this latest preprint version Abstract Background Recognition of the importance of the neurodiversity paradigm is growing within medical education, as is understanding of how current practices may create barriers for neurodivergent students. This review aims to explore existing empirical research regarding undergraduate medical education for neurodivergent students, in order to provide practical considerations for educators and inform planning of future research. Method Following frameworks outlined by Arksey and O’Malley and the PRISMA Extension for Scoping Reviews, six electronic databases were searched in April 2024 for empirical studies relating to neurodiversity within undergraduate medical education. Quantitative synthesis of article characteristics and a thematic analysis of qualitative studies on student experience were conducted. Results Fifteen (n = 15) studies were identified, relating to student experience, assessment, or staff perceptions. Most focused on dyslexia or specific learning disabilities, with few explicitly implementing the neurodiversity paradigm. Studies of student experience frequently identified discrimination and stigma, and studies of staff perceptions highlighted inadequate training. Barriers to neurodivergent student education were linked to certain teaching modalities and learning environments. Several perceived strengths of neurodivergence were also noted. Studies on assessment focused on the role of accommodations, with an emphasis on written rather than clinical examinations. Conclusions This review highlights a lack of empirical studies on neurodiversity within undergraduate medical education, limiting the development of pragmatic guidance. Some adaptations are suggested, but studies are limited to discussing medical education in general with few implementing the neurodiversity paradigm. Future research should explore a greater range of neurodivergent conditions, interrogate assessment practices including clinical examinations, and provide further evidence for inclusive teaching approaches. Explicit utilization of the neurodiversity paradigm is crucial, to amplify neurodivergent voices and better understand existing barriers. This work will have implications for medical educators seeking to understand neurodivergence, with a view to implementing adaptations for neurodivergent students in their educational practice. Neurodiversity Undergraduate Medical Schools Medical Students Teaching Education Figures Figure 1 Figure 2 Background Increasing numbers of students in Higher Education Institutions (HEIs) are disclosing a specific learning difficulty (SpLD) or Autism 1 – 3 , coinciding with greater recognition of the importance of the ‘ neurodiversity ’ paradigm. The implications of this paradigm for medical education have recently been outlined 4 , including requiring neurodivergence to be understood as a social justice concept that demands critical reflection of traditional perspectives. ‘ Neurodivergence’ is described as referring to “those who differ from societally perceived norms of brain or mind function—or from the majority, who are sometimes described as ‘neurotypical’” 4 . Neurodivergent students in HEIs face several challenges, including greater attrition 5 , 6 , poorer mental health 7 , 8 , and less favorable post-graduation outcomes 9 . The demands of medical curricula 10 – 12 highlight the importance of exploring existing research regarding prevalence of these challenges in neurodivergent undergraduate medical students, including any specific difficulties, and appropriate teaching and support strategies. Improving our understanding in this area is even more crucial given recent political threats to diversity, equality and inclusivity initiatives 13 . Actively including neurodivergent students is vital to create equitable and just medical education 14 , whilst developing a diverse workforce that can better support diverse patients 15 – 17 . The neurodiversity paradigm There is debate regarding the precise definition of neurodiversity 18 , 19 . The definition described here, of the neurodiversity paradigm , draws on Shaw et al., (2024) 4 and other neurodivergent-authored texts 20 , and aims to provide a clear explanation while also capturing the political essence of the paradigm. Development of the neurodiversity paradigm involved many (often online) Autism advocate communities during the 1990s – 2000s 18 , 21 , including Jim Sinclair 22 , Harvey Blume 23 and Judy Singer 24 . Singer produced sociological studies on neurodiversity, but is often incorrectly credited with coining the term, and her views have been criticized by autistic communities 21 , 25 . The neurodiversity paradigm challenges traditional ‘deficit-driven’ models of Autism 20 , that are associated with the medical model of disability by viewing Autism as a ‘deficit’ to be ‘fixed’ or better aligned with society’s perception of ‘normal’ 18,26 . Instead, the neurodiversity paradigm describes the variability in neurodevelopment 20 , 27 , 28 , echoing the social model of disability 20 by arguing that difficulties faced are the result of societal barriers 26 . Neurodiversity-aligned or - affirmative research promotes improving quality of life, social justice 4 , and including neurodivergent people within research designs 19 , 29 . The neurodiversity paradigm is applied to various conditions 20 , including ADHD (Attention-Deficit Hyperactivity Disorder), dyspraxia, and SpLDs, opposing pathologization and highlighting strengths 28 , 30 . Within the paradigm, individuals may be described as ‘ neurodivergent’ if their neurocognitive function differs from societal ‘norms’. These differences in cognitive or neurological function set neurodivergence apart from personality traits or preferences. Populations are described as ‘ neurodiverse’ if they include individuals with a variety of neurocognitive ‘styles’ 20 . ‘ Neurodivergence’ is therefore considered a broad term for a variety of diagnoses, and ‘ neurodiversity’ acts as a paradigm for viewing research though a lens of social justice and inclusivity. The neurodiversity paradigm in medical education Neurodivergence amongst medical students 31 – 37 is likely higher than reported, due to underdiagnosis and under-disclosure 31 , often resulting from stigma 38 or poor understanding from staff or peers 31 , 39 , 40 . Delayed diagnosis is common 33 , as students can often compensate until medical school demands and/or assessment procedures exceed their compensatory capacities 41 , 42 . Barriers and delays to diagnosis/disclosure are problematic, as universities often require disclosure of a formal diagnosis before providing accommodations (such as examination adjustments) 43 – 46 that allow neurodivergent students to thrive 9 and showcase their strengths 7 , 38 . Existing literature in medical education includes some discussion articles on neurodiversity 4 , 38 , 42 , 47 and some reviews regarding SpLDs 48 – 52 , but there are no existing reviews regarding neurodiversity within undergraduate medical education. A recent review by Gray et al., (2025) has scoped the literature regarding neurodivergence within the broader field of health professions education 53 , which provides a helpful overview of many studies and disciplines. This indicates growing interest in this area and marks a useful starting point in understanding the evidence base for neurodiversity within health education. However, the wide scope of the Gray et al., (2025) review means only high-level, broad conclusions can be drawn, providing fewer practical implications for educators. Furthermore, the Gray et al., (2025) review did not include detailed discussion of the definition of the neurodiversity paradigm. Therefore, our review seeks to build on the work of Gray et al., (2025), by providing more in-depth discussions of studies that have considered neurodivergence; specifically, Autism, ADHD, SpLDs, and related conditions; in undergraduate medical education. We focus on empirical studies, with a view to providing pragmatic conclusions that can guide medical educators in their daily practice. We have also sought to provide meaningful discussion of the neurodiversity paradigm, which is often lacking in existing studies. Given the growing recognition of the importance of the neurodiversity paradigm in medical education, and the diverse needs of this student population, a scoping review is required to provide an overview of existing evidence on this topic, including methodologies, key findings, and possible gaps. Definitions and language in this review The neurodiversity paradigm encompasses the variation in human minds, which drives social justice, equality and inclusion for those who fall outside of society’s definition of ‘normal’ - who may be described as neurodivergent (compared to the majority, who may be termed neurotypical) . Populations may be described as neurodiverse , capturing this variation across a group. There is debate regarding person-first versus disability-first language 54 , making it important to check for individual preferences. Here, we intentionally move between person-first and disability-first language, to attempt to include all viewpoints. Additionally, the word ‘difference’ may better align with the neurodiversity paradigm than ‘deficit’ or ‘disorder’ 55 . We use accepted medical abbreviations (‘SpLDs’, ‘ADHD’), but we acknowledge that other terms may be preferred. The authors consulted neurodivergent colleagues and neurodivergent-authored texts when developing definitions and terminology. Methods Author reflexivity The authors who carried out this review were neurotypical, which may influence interpretations of included studies, particularly for thematic analysis of qualitative studies. Review of neurodivergent-authored literature concerning the definition of the neurodiversity paradigm, and the experiences of neurodivergent individuals, was carried out prior to commencing this work, encouraging the authors of this review to challenge any pre-existing ideas or assumptions we held about neurodiversity. Reflection and discussion between authors occurred throughout thematic analysis of qualitative studies, to ensure emergent themes reflected neurodivergent voices. Furthermore, one of the review authors, who is neurodivergent, joined the project after the initial thematic analysis had been completed. Their role focused on reviewing and refining analysis, with the aim supporting a more authentic interpretation of the findings. However, it is important to acknowledge that many of the studies included in the review were themselves authored by neurotypical individuals, adding further layers of interpretation that may shape how neurodivergent experiences are represented. The authors of this review are academics and educators, which may influence interpretation of data regarding student experiences. Protocol Protocol The scoping review protocol followed frameworks by Arksey and O’Malley 56 as updated by Levac et al 57 , and the PRISMA Extension for Scoping Reviews (PRISMA-ScR) 58 . The protocol was registered with the Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/4GSYN . A completed PRISMA-ScR checklist is available as Additional File 1. This review article forms part of a wider review project regarding medical sciences and healthcare professions education. Here, we focus on studies identified within the context of undergraduate medical education. This is because several factors set medical degrees apart from other healthcare courses. For example, medical degrees are 'generalist' 59 , allowing graduates to specialize in any healthcare area, unlike dentistry, pharmacy, or midwifery, which focus on specific systems. There is typically a pre-clinical/clinical structure in medical programs 60 ; and a pre-clinical focus on foundational medical sciences is less prominent in wholly clinical-based programs, such as nursing 61 . These factors create a unique environment for medical learners. Identification of research question Our aim was to explore existing empirical research regarding undergraduate medical education for neurodivergent students, including determining which aspects of educational practice (e.g. assessment, student experience) have been studied in this context, identifying key findings and methodologies, in order to provide practical considerations for educators and identify possible evidence gaps to inform planning of future research. This is an appropriate rationale for carrying out a scoping review 56 , 57 . The research question for this review was: What is the nature and extent of empirical research available to inform medical education approaches for undergraduate students who are neurodivergent? Neurodiversity is a relatively novel concept within medical education; a brief search of existing literature prior to developing the protocol found few studies using this terminology. Therefore, we also scoped the literature for studies on commonly recognized neurodivergent conditions, including Autism, ADHD, dyspraxia, and SpLDs. Studies on the prevalence of neurodivergence and on accommodations were excluded, as both prevalence and the securing of accommodations fall outside the direct influence of educators (accommodations are usually arranged by centralized university services). This review focuses on synthesizing available empirical evidence to inform day-to-day teaching practice and research priorities related to this. The research question informed the development of the inclusion criteria and search strategy. An example search strategy is available in Table 1 , exact strategies are available in Additional File 2. Identification of relevant studies The search was not limited by date, journal, language or study type. Articles that were excluded due to study type or language were removed later in the process during the screening phase. The strategy was created with an information specialist, using both subject headings and keywords (Table 1 ). The search was conducted on 19 April 2024 in six electronic databases: Medline, Embase, PsycInfo, ERIC, Social Sciences Premium Collection and Web of Science, supplemented with a gray literature search using Google Search (first page of results only) and Google Scholar (first three pages of results). Backwards citation searching of included studies did not identify further articles. We repeated the search on 04 August 2025 with no further articles identified. Table 1 Development of inclusion criteria and search strategy, informed by the research question. The search terms given are an example, searches were adapted as appropriate for each database with the support of an information specialist. Full search strategies for each database are available as Additional File 2. Search strings for 'medical education/students' and 'neurodiversity' were joined by an 'AND' operator. An additional line, 'NOT child*' was added to the search, as initially a very high number of results regarding childhood neurodivergence were returned. ‘NOT’ operators must be used with caution to avoid excluding potentially relevant articles, this is discussed further in the limitations section. Question Element Inclusion Criteria Example Search Terms Medical Any healthcare professionals education (Medicine; Nursing; Dentistry; Pharmacy; Speech & Language Therapy) and/or medical sciences education (Biomedical Science; Anatomy; Physiology; Sport and Exercise Science; Nutrition). Only studies identified relating to medicine and dentistry are discussed in this article. ((medical OR dental OR nursing OR pharmacy) N6 school) OR ((medical OR dental OR nursing OR pharmacy) N6 education) OR ((medical OR dental OR nursing OR pharmacy) N6 student*) OR ((medical OR dental OR nursing OR pharmacy) N6 teach*) OR ((medical OR dental OR nursing OR pharmacy) N6 program*) OR ((medical OR dental OR nursing OR pharmacy) N6 curricul*) OR ((medical OR dental OR nursing OR pharmacy) N6 assess*) OR ((medical OR dental OR nursing OR pharmacy) N6 exam*) OR ((medical OR dental OR nursing OR pharmacy) N6 train*) OR ((medical OR dental OR nursing OR pharmacy) N6 study*) OR (anatomy N6 (education OR student* OR teach* OR program* OR curricul* OR assess* OR exam* OR train* OR study*)) OR (physiology N6 (education OR student* OR teach* OR program* OR curricul* OR assess* OR exam* OR train* OR study*)) OR (biomed* N6 (education OR student* OR teach* OR program* OR curricul* OR assess* OR exam* OR train* OR study*)) OR (sport* N6 (education OR student* OR teach* OR program* OR curricul* OR assess* OR exam* OR train* OR study*)) OR (nutrition N6 (education OR student* OR teach* OR program* OR curricul* OR assess* OR exam* OR train* OR study*)) OR (speech N6 (education OR student* OR teach* OR program* OR curricul* OR assess* OR exam* OR train* OR study*)) OR (“healthcare professional” N6 (education OR student* OR teach* OR program* OR curricul* OR assess* OR exam* OR train* OR study*)) OR (medicine N6 (education OR student* OR teach* OR program* OR curricul* OR assess* OR exam* OR train* OR study*)) OR (physician N6 (education OR student* OR teach* OR program* OR curricul* OR assess* OR exam* OR train* OR study*)) Education or Students Undergraduate (HE) only. Empirical research only. Teaching/learning, assessment, student experience, student support, accommodations/ adjustments/ accessibility AND Neurodivergent or Specific Learning Difficulty Any neurodivergence, for example (but not limited to) Autism, dyslexia, ADHD, dyspraxia, dyscalculia neurodiver* OR autis* OR adhd OR “attention deficit” OR “learning disab*” OR “Intellectual disab*” OR “learning difficult*” OR “learning disorder*” OR “learning disturbance*” OR “learning impairment” OR “learning problem*” OR “attention deficit*” OR “attention disturbance*” OR dyslexi* OR dyspraxi* OR dyscalcu* OR aphantasi* OR “autis* spectrum” NOT child* Study selection Citations were exported to EndNote (EndNote Version 20, Clarivate, Philadelphia, PA) and then screened using Rayyan (Rayyan, Cambridge, MA). Duplicates were identified and removed prior to study selection, which was performed in three steps: title and abstract screening, and full-text screening, according to the exclusion criteria. Studies were excluded if they: Did not relate to education or students, e.g., were related to staff who are neurodivergent/have SpLDs. Studies regarding prevalence of conditions amongst medical students were excluded. Studies relating to frequency/type of accommodations offered were excluded (e.g. studies regarding types of accommodation offered and how often) as accommodations are usually managed by centralized university services and therefore not under the influence of educators Did not relate to medical students Did not relate specifically to neurodivergent students Were related to admissions/applications to study Were related to qualified health professionals or postgraduate, rather than undergraduate students Were not empirical research/original study (e.g. opinion, commentary, literature review) Were not available in English For pragmatic reasons (including time available and researcher capacity), title and abstract screening was performed by a single researcher (EJG), who took a cautious approach, progressing studies to full-text screening if there was any doubt regarding their inclusion. Full-text screening was carried out independently by two researchers (EJG, IDK) to ensure consistent adherence to the exclusion criteria. Conflicts were resolved through discussion and consensus. Extracting and charting the data We developed a data extraction tool (available as Additional File 3) using Microsoft Excel to collate key information from included studies, including: article metadata; methodology; participants; author characteristics; key objectives and results. Extraction categories were determined through familiarity with the literature and discussion amongst the screening team (EJG, IDK). Data extraction was carried out by a single researcher (EJG); a second researcher checked the extraction for a random sample of 50% of included articles, with conflicts resolved through discussion and consensus (IDK). Collating, summarizing and reporting results We developed tables and charts to visualize characteristics of the literature, including quantitative synthesis of article meta-data and characteristics, and a thematic analysis of qualitative studies on student experience. Qualitative studies on student experiences underwent inductive thematic analysis, involving coding of these studies to identify common results through repeated reading and familiarization of included articles by a single researcher (EJG). Codes were then organized into emergent themes, that captured and summarized key findings across the articles. Themes were discussed and refined with a second researcher (IDK). Quality evaluation was not performed as this is not a requirement of scoping reviews 56 , 57 . Results Search results The search results are outlined in a PRISMA-ScR 58 flowchart (Fig. 1 ). A total of 12,941 publications (n = 12,941) were identified through database searching and 13 through grey literature searching (n = 13). After removing duplicates (n = 5185), we screened the remaining publications (n = 7769) according to exclusion criteria (Fig. 1 ). Fifteen (n = 15) included studies related to medicine 62 – 76 . Full details of the included studies are listed in Additional File 4. Study characteristics Figure 2 - Chart showing the distribution of SpLDs or neurodiverse conditions discussed by the included articles. Most articles discussed SpLDs (n = 14), with the majority of these discussing dyslexia (n = 8) or SpLDs in general (n = 5) The fifteen included studies were published between 2010 and 2023, taking place in the UK (n = 13) 62,64–67,69−76 , Australia (n = 1) 63 , and France (n = 1) 68 . Eight (n = 8) were single-center studies 63–67,69−71,75 , two were collaborative autoethnographies (n = 2) 73,76 , one involved staff members from two universities (n = 1) 68 , and three involved participants from across the UK (n = 3) 62,72,74 . Most discuss dyslexia (n = 7) 62,64,67,69,72,73,75 or SpLDs in general (n = 3) 66,70,71 . Fewer discussed ADHD (n = 2) 63,65 , Autism (n = 1) 74 , dyspraxia (n = 1) 76 or neurodevelopmental disorders (n = 1) 68 (Fig. 2). Only four (n = 4) studies referenced ‘neurodiversity’ (or related terms) 63 , 65 , 74 , 75 . Of these, two described ADHD as an example of neurodivergence without defining neurodiversity 63 , 65 , one briefly discussed neurodiversity as a theoretical lens similar to the social model of disability 75 , and one gave a more expansive definition 74 . Eight studies (n = 8) disclosed that an author was neurodivergent 62 , 63 , 65 , 72 – 76 , with four (n = 4) including contributions from a student author 63 , 65 , 73 , 76 (Table 2 ), which is important when considering the emphasis placed on inclusion of neurodivergent voices in research design within the neurodiversity paradigm 4 . Seven of the eight studies that disclosed the neurodivergence of their authors included the same author (S. Shaw) as a contributor (n = 7) 62,65,72–76 . Table 2 Characteristics of authors who contributed to studies that had disclosed neurodivergence in the study authors, and whether the neurodivergent authors were students. Study Disclosed neurodivergence of author Neurodivergent author is a student Anderson and Shaw 62 Dyslexia No Bailey, Grotowski & Bailey 63 ADHD Yes, author with ADHD is a student Godfrey-Harris and Shaw 65 ADHD, Autism, dyslexia First author is a student with ADHD Second author is a doctor/academic with ADHD, Autism and dyslexia Shaw and Anderson 72 Dyslexia No Shaw, Anderson & Grant 73 Dyslexia Autoethnography by dyslexic doctor about their time as a student Shaw, Doherty & Anderson 74 Autism (2 authors) No Shaw, Hennessy & Anderson 75 Dyslexia (2 authors) No Walker, Shaw & Anderson 76 Dyspraxia Yes, autoethnography by medical student with dyspraxia Study participants and aims Most participants were students (n = 13 studies), mainly neurodivergent undergraduates (n = 10 studies) 64–66,69−71,73–76 . Two studies involved junior doctors discussing their student experiences (n = 2 studies) 62 , 72 . One study had neurotypical student participants (n = 1 studies), examining their perceptions of dyslexia 67 . Eight studies required participants to be formally diagnosed or registered with university support services in order to participate (n = 8) 64,66,69–72,74,75 . Other studies did not require this (n = 1) 65 , did not state whether this was required (n = 1) 62 , or this was irrelevant as the participant was an already diagnosed author (n = 2) 73,76 . Two studies had staff participants (n = 2) 63,68 , including healthcare professionals involved in teaching 63 and medical teachers 68 . Included studies explored one of three areas: student experiences/perceptions 62 , 65 , 67 , 71 – 76 ; assessment/academic performance 64 , 66 , 69 , 70 ; or staff perceptions 63 , 68 . Student experiences and perceptions Eight studies investigated the experiences/perceptions of neurodivergent students (n = 8) frequently utilizing semi-structured interviews 65 , 71 , 72 , 74 , 75 . A single study investigated views of students without SpLDs towards dyslexia (n = 1) 67 . Two studies (on dyslexia and dyspraxia) used autoethnography of a single participant 73 , 76 (n = 2). Two used mixed-methods surveys 62 , 67 (n = 2). Thematic analysis of studies with neurodivergent participants identified common experiences, regardless of condition (Table 3 ). Themes included: diagnosis, disclosure and discrimination; teaching, learning environment and adjustments; mixed clinical experiences and communication; emotional impact, strengths and support. Table 3 Themes identified through thematic analysis of qualitative studies on neurodivergent student experiences and perceptions. These themes discuss experiences that were seen across studies on different diagnoses, however it is important to note that although many experiences appear common, experiences across diagnoses are not homogenous. Theme Description 1. Diagnosis, disclosure & discrimination Students noted the importance of early diagnosis and disclosure 66 , 72 , 74 . Barriers to this included poor reactions or inadequate understanding from staff 63 , 66 , 73 – 75 , experience of discrimination or stigma 66 , 73 – 75 , or bullying from staff 63 , 66 , 73 or from peers 63 , 73 , 75 , 76 . 2. Teaching, learning environment & adjustments Lectures 63 , 66 , 75 , 76 , transitions (from school, from pre-clinical to clinical years, and between placements) 63 , 66 , 77 , and timetabling changes or poor structure 66 , 75 , 77 were all notable barriers. Several studies reported neurodivergent students needing to work harder than their peers for the same outcomes, including efforts in double-checking or over-preparing 63 , 73 , 74 , 77 . Adjustments were appreciated 63 , 74 , 75 but some described these as performative and suggested they could be better individualized and tailored to the medical degree, as accommodations were generally provided via central university services rather than the medical school 66 , 74 , 75 . 3. Mixed clinical experiences & communication Four studies described clinical placement learning as important, identifying pre-clinical teaching as more challenging for neurodivergent students 74 – 77 . Three studies discussed supportive experiences with clinical staff 66 , 74 , 77 , but three reported difficulties caused by poor awareness of clinical placement staff about students’ neurodivergence 66 , 74 , 75 . Three studies found neurodivergent students felt able to communicate well with patients, aided by defined social roles and their strong sense of empathy 73 – 75 , whereas communication with neurotypical peers or staff is more difficult 66 , 75 , 77 . 4. Emotional impact, strengths & support Difficulties were compounded by ‘toxic competitiveness’ at medical school 66 , 73 , 75 , 77 , and feelings of helplessness or hopelessness when attempting to seek support 66 , 73 – 75 . Students identified feelings of stupidity, inadequacy and low self-esteem, resulting in perfectionism 63 , 66 , 73 , 74 , 77 and impacts on mental health 63 , 66 , 74 . In five studies, students described how their experiences as a neurodivergent student had affected their career choices or aspirations 63 , 66 , 72 , 73 , 77 . Students perceived strengths arising from their neurodivergence, including developing alternative approaches to learning 66 , 72 – 74 , perseverance/resilience 73 , 75 , 77 , lateral thinking 66 , 73 , 74 and enhanced empathy 66 , 74 , 75 . Students in four studies mentioned a desire for better awareness of fellow neurodivergent students (e.g. via support groups), or role-modelling from neurodivergent educators or doctors 63 , 66 , 73 , 75 . These themes were seen across studies on varying conditions, but some experiences appeared to be unique to particular diagnoses. It is important to note that although many experiences appear common, experiences across diagnoses are not homogenous, and being too quick to generalize may erode this nuance. For example, the study on autism noted strengths such as attention to detail and organizational skills, but difficulties or differences in sensory processing which created challenges in some learning environments, that were not mentioned in studies on other conditions 74 . Challenges in group work, as a result of managing social expectations and masking, were also identified in students with Autism 74 . Masking occurs when societal pressures result in neurodivergent individuals feeling as though they need to hide or reduce their neurodivergent traits, in order to be better accepted socially in environments that reward neurotypical norms 77 , 78 . The high energy expenditure associated with masking was identified in studies of both Autistic students and those with ADHD, resulting in fatigue and therefore impact on learning 65 , 74 . Despite this, students with ADHD expressed preference for small group learning compared to lectures 65 . Studies on dyslexia discussed challenges caused by assessments (such as OSCEs (Objective Structured Clinical Examinations)) not accurately reflecting the real clinical environment, and therefore not enabling students to showcase their strengths in clinical practice 72 , 73 . The dyspraxia study described physical difficulties with practical skills 76 . However, there were five studies focusing on experiences of students with dyslexia (n = 5) 62,67,72,73,75 but only a single study on SpLDs in general 71 , ADHD 65 , Autism 74 and dyspraxia 76 . The small number of included studies means further work is required to elucidate whether these examples are diagnosis-specific or common across neurodivergences, particularly as experiences can vary even within the same diagnosis 65 , 72 , 73 . The study on neurotypical student perceptions of dyslexia 67 found the majority had good understanding and supported adjustment for their peers. A small number noted feelings of jealousy or that adjustments gave an unfair advantage, which may underpin the experiences of stigma often associated with neurodivergent students avoiding disclosure or seeking a diagnosis 38 . Assessment approaches and academic performance Four single-center studies investigated assessment or academic performance for students with SpLDs 66 , 70 or dyslexia 64 , 69 . There were no studies regarding assessment for students with Autism, ADHD, or dyspraxia. One study showed SpLDs appear to have no significant effect on performance in multiple choice tests 70 , although here, students with SpLDs were given exam adjustments, such as additional time. Extra time has been reported as significantly enhancing exam performance for students with SpLDs (P = < 0.05) 66 when progress-test performance (tests taking place four times per year) is compared pre- and post- receiving this adjustment, although it was found it can take up to a year for improvements to reach significance (for example, students who were diagnosed and received extra time during second year showed significantly improved performance in third year assessments, compared with those diagnosed and given extra time within third year (P = < .05)) 66 . Another study found students with dyslexia across two cohorts were found to perform significantly worse than non-dyslexic peers in year one (P = < 0.05 and < 0.01) 64 . No significant difference was seen in later years. They also found that dyslexic students given extra time in written assessments performed significantly better in year one than those not yet receiving this due to lack of diagnosis or disclosure (P = < 0.05) 64 , emphasizing the importance of early adjustments. There were differing results regarding OSCEs for students with dyslexia. One study found dyslexic students in first year performed significantly worse in OSCE examinations across three cohorts (P = < 0.05), and when combining these cohorts found significant differences in performance on certain stations (P = < 0.01) 64 . However, another study found no significant effect of dyslexia on examination performance across all assessment types, including OSCE 69 . Staff perceptions of teaching and supporting neurodivergent students Two studies surveyed staff perceptions of teaching students with ADHD 63 (n = 2) or neurodevelopmental disorders 68 . Both identified limited understanding about these conditions and identified a desire for further training. Discussion To identify key themes and gaps in the existing literature on undergraduate medical education for neurodivergent students, this review has discussed 15 relevant studies. These studies investigated student experiences, staff perceptions, and assessment. We initially discuss studies on assessment; these positivist works quantify the impact on assessment for students who are neurodivergent, however these studies are not able to capture their broader lived experience which extends beyond that of assessment and academic achievement. We therefore then discuss the included interpretivist qualitative studies, which, when combined with positivist data, provide a more well-rounded view that can illustrate the experiences of these students and provide implications for practice. Accommodations can remediate for issues with written assessment, but work is needed to further investigate assessment practices themselves Three single-center studies found no significant difference in written exam performance between students with dyslexia or SpLDs and those without, when accommodations are provided 64 , 69 , 70 . The role and power of assessment accommodations in supporting neurodivergent students is important, as it has been widely recognized that differential attainment is a challenge faced by disabled medical students, including those with cognitive or learning disabilities 3 , 79 . The studies in this review indicate that proper provision of accommodations may be a crucial step towards remediation. However, these studies did not compare different SpLDs, and this review found no studies regarding assessment for students with Autism, ADHD or dyspraxia, meaning we cannot determine if different diagnoses affect assessment performance and the role of accommodations differently. Additionally, assessment practices vary between medical degrees 80 , meaning studies performed within the context of individual institutions are required. Two studies found differing results regarding OSCE performance 64 , 69 , demonstrating a need for further research, particularly as accommodations are less frequently offered for clinical assessments 69 . Neurodivergent students report that lack of adjustments for clinical assessments results in anxiety, in turn causing students to rush and make mistakes 81 , however some educators argue against accommodations as performing clinical tasks under pressure is essential for practicing clinicians 69 . Such arguments speak to the wider structural and cultural barriers facing neurodivergent medical students. Previous work regarding the experiences of disabled students has identified a ‘capability imperative’ within medical education 82 , whereby a historic culture of ‘ compulsory hyper-ablebodiedness and mindedness’ has created assessment standards that may themselves be inherently ableist. A simplistic view of providing accommodations to allow neurodivergent students to meet existing standards or perform under existing assessment approaches does not acknowledge the systemic exclusion that underpins these practices. None of the studies regarding assessment identified in this review sought to consider the inclusivity of assessment practices themselves, making this an important future area to explore. Neurodivergent students face barriers in medical education beyond assessment, and there is paucity in the literature regarding appropriate teaching modalities Studies on neurodivergent student experiences highlight challenges beyond assessment. Barriers to disclosure, including stigma, low self-esteem, poor reactions from staff or lack of understanding from peers 65 , 72 – 74 , 83 are common and seen amongst other healthcare students 81 , 84 – 87 . Educators often lack understanding of neurodivergence 63 , 68 , 88 , 89 , and some express concerns about non-disclosure as a patient safety issue 90 (despite limited evidence 91 ), or fear neurodivergent students may struggle to communicate with patients 88 . However, neurodivergent students are often hyper-vigilant, double-checking and taking extra time for clinical tasks 62 , 72 , 73 , 76 , 84 , 92 , and autistic doctors report finding patient interactions straightforward, due to clear behavioral expectations and guidelines 42 , 72 – 74 . Neurodivergent students suggest interpersonal relations with teachers and peers are more challenging 65 , 74 , 76 . Some argue this results from ‘weaponized professionalism’ 65 , whereby those deviating from the construct of an ‘ideal’ medical professional (grounded in ‘ white, cis-gendered, heteronormative, able-bodied [and neurotypical] male experience’ ) are viewed as unprofessional, regardless of whether their behavior actually affects their ability to practice medicine 65 , 93 . Current teaching approaches, such as lectures, present barriers for neurodivergent students 65 , 73 – 75 . Drawbacks of lectures are known 94 , but these may be more significant for students who are neurodivergent. This review did not identify any empirical research investigating the most appropriate teaching modalities for neurodivergent students (existing articles are limited to opinion/commentary 50 , 95 , 96 or generic guidance 48 ), nor any exploring specific curriculum elements (included studies only investigated medical education in general). Many neurodivergent students utilize alternative learning approaches 65 , 71 – 73 and therefore appreciated flexible teaching approaches adopted during the COVID-19 pandemic (such as online or pre-recorded sessions) 75 . Commonly, barriers identified were known issues for many learners but were identified as more likely to be important for the neurodivergent 97 . Competitive medical school cultures 98 , coupled with the ‘ invincibility myth’ , of doctors as being ‘superhuman’ and discouraged from disclosing difficulties 99 , are known challenges for all medical students. These may exacerbate difficulties faced by neurodivergent students, by discouraging disclosure of what may be perceived as ‘weaknesses’, leading to perfectionism and over-compensation 65 , 72 , 73 , 76 . None of the included studies explicitly investigated the potential intersectionality between neurodivergent student experiences and that of other minoritized groups 100 , 101 , an area certainly in need of further work within medical education. Supportive strategies that are likely to benefit all students are therefore crucial, an idea underpinning Universal Design for Learning (UDL) 102 , a popular concept 103 – 105 despite limited evidence 106 , wherein teaching is delivered using approaches that are accessible to all students and can therefore benefit a wider population. In order to implement UDL, more robust evidence underpinning the approach is required, as well as better understanding regarding suitable approaches for neurodivergent students, who are often ‘hidden’ (undiagnosed or undisclosed). This is a notable literature gap, as educators have expressed a desire for better training in supporting these students 63 , 68 , 107 . Changes may be needed on a systemic and policy level, but many educators would benefit from pragmatic and actionable guidance on how to adapt their day-to-day teaching, which could benefit all students 108 . Existing literature focuses on a small number of conditions with limited application of the neurodiversity paradigm Most included studies concerned dyslexia or SpLDs in general; there is limited empirical research regarding undergraduate medical education for other SpLDs, ADHD, or Autism. This review identified many common experiences across diagnoses, which could simplify development of supportive teaching strategies, but lack of studies on conditions beyond dyslexia and SpLDs weaken this conclusion. Compounding this gap is the lack of studies employing the neurodiversity paradigm. Most studies focus on a single condition, and this single-condition focus restricts opportunities to identify shared experiences across neurodivergences, hindering the development of educational interventions with wider applicability. The neurodiversity paradigm also encourages inclusion of neurodivergent people within research designs 29 , yet only eight included studies openly acknowledged involving neurodivergent contributors. Author reflexivity 109 and consideration of the research team is essential, particularly due to known communication differences between neurotypical and neurodivergent people (the ‘ double empathy’ problem 110 ). Neurotypical researchers should explicitly reflect on their position, so readers can consider this influence on study design and data interpretations, and so researchers can take steps to challenge their own perspectives. Researchers should also take steps to create research environments that can support empowerment of neurodivergent participants. Co-production methodologies 111 , 112 may be one way to achieve this. The medical education community cannot expect the burden of this work to solely befall neurodivergent researchers, and neurotypical educators have a responsibility to use our privilege to enact change by elevating neurodivergent voices and removing disabling barriers. Limitations The majority of authors of this review are neurotypical, which may influence the development of search terms and interpretation of studies. As discussed, the work to improve inclusivity of medical education for neurodivergent students should not solely fall on neurodivergent researchers, but authors should be explicit about their own experiences. Neurotypical authors made efforts to improve their awareness of neurodivergent experiences through familiarization with neurodivergent-authored texts and discussion with neurodivergent colleagues, but we acknowledge this is not equivalent to lived experience. The search aimed to include a range of terms used to describe neurodivergence. However, the nature of a search strategy requires a finite list of terms, which may not be in keeping with the broad definition of neurodiversity, and relevant studies may have used terms not included in the search. A ‘NOT’ operator was required to produce manageable search results, and pragmatic factors reduced capacity for full independent screening of identified articles, heightening the risk of excluding potentially relevant studies. Backwards citation searching was employed to help mitigate this. The databases searched also skew heavily to the West, so alongside limitations introduced by only including studies in English, it is likely these findings are most suited to application in a Western context. Conclusion There is a notable lack of empirical studies investigating educational practice for undergraduate neurodivergent students in medical education, with only 15 studies identified in this review. Although the barriers facing neurodivergent students are clear, there is limited research regarding how educators can best tackle these and improve support for this student group. Existing evidence suggests stigma and poor understanding by staff are present, meaning better training and awareness should be prioritized. Educators can adapt their practice, for example by relying less on traditional, didactic lectures, and being mindful of communication differences that may exist between neurodivergent students and staff, particularly during smaller group sessions. Consideration of UDL principles within teaching may be useful, although further work on this concept is necessary. These adaptations are likely to benefit all students, but will provide significant impact on enhancing inclusivity for the neurodivergent, which is vital to ensure our physician workforce is as diverse as the patient populations it serves. Future studies should further explore the learning experiences of students who are neurodivergent, for a range of conditions and for specific areas of the medical curriculum, to more clearly define their strengths and challenges, with the aim of developing clear, pragmatic, and evidence-based guidance for educators. Furthermore, research regarding assessment should extend to a variety of diagnoses beyond dyslexia and SpLDs, and interrogate our assessment approaches and standards themselves, not only the role of accommodations. In particular, assessment approaches and accommodations for practical clinical examinations should be further investigated. Explicit utilization of the neurodiversity paradigm is likely to be helpful in developing inclusive research practice, for example through use of co-production methods that can act to amplify neurodivergent voices. The limited evidence identified in this review indicates that medical education is only just waking up to the inherent and structural disabling barriers that exist for neurodivergent students, and it is vital that educators begin to consider how we might adapt our practice to celebrate and enhance the strengths that this group bring to the medical profession. Abbreviations Higher Education Institutions (HEIs) Specific Learning Difficulty (SpLD) Attention-Deficit Hyperactivity Disorder (ADHD) Preferred Reporting Items for Systematic Reviews and Meta Analyses for Scoping Reviews (PRISMA-ScR) Open Science Framework (OSF) Objective Structured Clinical Examinations (OSCEs) Universal Design for Learning (UDL) Declarations Ethics approval and consent to participate Not applicable Consent for publication Not applicable Clinical Trial Number Not applicable Competing interests The authors declare that they have no competing interests Funding Not applicable Author Contribution EJG developed the protocol. IDK and GHSV supported protocol development. EJG and IDK carried out screening and data extraction. MB supported development of qualitative themes and provided guidance on correct terminology. All authors contributed to manuscript writing, and all authors read and approved the final manuscript. 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Accessed 4 December, 2023. https://www.cast.org/impact/universal-design-for-learning-udl Cumming TM, Rose MC. Exploring universal design for learning as an accessibility tool in higher education: a review of the current literature. Australian Educational Researcher. 2022;49(5):1025–43. 10.1007/s13384-021-00471-7 . Luke K. Twelve tips for designing an inclusive curriculum in medical education using Universal Design for Learning (UDL) principles. MedEdPublish. 2021;10:118. 10.15694/mep.2021.000118.1 . Dempsey AMK, Lone M, Nolan YM, Hunt E. Universal design for learning in anatomy education of healthcare students: A scoping review. Anat Sci Educ. 2023;16(1):10–26. 10.1002/ase.2160 . Boysen GA. A critical analysis of the research evidence behind CAST’s universal design for learning guidelines. Policy Futures Educ. 2024;22(7):1219–38. 10.1177/14782103241255428 . L'Ecuyer KM. Perceptions of nurse preceptors of students and new graduates with learning difficulties and their willingness to precept them in clinical practice (Part 2). Nurse Educ Pract. 2019;34:210–7. https://dx.doi.org/10.1016/j.nepr.2018.12.004 . Jain NR, Varpio L. Designing for justice: How universal design theory could bolster health professional education research. Focus Health Prof Education: Multi-Professional J. 2023;24(4):136–50. Barrett A, Kajamaa A, Johnston J. How to.. be reflexive when conducting qualitative research. Clin Teach. 2020;17(1):9–12. 10.1111/tct.13133 . Milton DEM. On the ontological status of autism: the ‘double empathy problem’. Disabil Soc. 2012;27(6):883–7. 10.1080/09687599.2012.710008 . Dollinger M, Lodge J, Coates H. Co-creation in higher education: towards a conceptual model. J Mark High Educ. 2018;28(2):210–31. 10.1080/08841241.2018.1466756 . Stelling H, Ueda M, Tilby-Jones F, et al. From passive participants to proactive partners: How to engage students in the design, delivery and development of research using the principles of co‐production. Clin Teach. 2024;21(6). 10.1111/tct.13804 . Additional Declarations No competing interests reported. Supplementary Files AdditionalFile1.docx AdditionalFile2.docx AdditionalFile3.docx AdditionalFile4.docx Cite Share Download PDF Status: Published Journal Publication published 13 Dec, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 05 Nov, 2025 Reviews received at journal 31 Oct, 2025 Reviewers agreed at journal 20 Oct, 2025 Reviewers agreed at journal 01 Oct, 2025 Reviews received at journal 01 Oct, 2025 Reviewers agreed at journal 29 Sep, 2025 Reviewers invited by journal 28 Sep, 2025 Editor invited by journal 26 Sep, 2025 Editor assigned by journal 24 Sep, 2025 Submission checks completed at journal 24 Sep, 2025 First submitted to journal 20 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7415903","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":526755857,"identity":"973a761f-4146-4fe7-a4ae-6386e65c785a","order_by":0,"name":"Emily J. Green","email":"data:image/png;base64,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","orcid":"","institution":"Newcastle University","correspondingAuthor":true,"prefix":"","firstName":"Emily","middleName":"J.","lastName":"Green","suffix":""},{"id":526755860,"identity":"3e9fb55a-c84b-41f4-bbab-ec09eb47bc9e","order_by":1,"name":"Megan E.L. 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Keenan","email":"","orcid":"","institution":"Newcastle University","correspondingAuthor":false,"prefix":"","firstName":"Iain","middleName":"D.","lastName":"Keenan","suffix":""}],"badges":[],"createdAt":"2025-08-20 09:38:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7415903/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7415903/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-025-08447-2","type":"published","date":"2025-12-13T15:58:32+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":93266734,"identity":"42bdabc7-88c8-4edc-a4d7-f1ea21484015","added_by":"auto","created_at":"2025-10-10 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20:13:18","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":237508,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7415903/v1/dcf252d18ad62aac8f64b43a.html"},{"id":93266733,"identity":"114fbb29-b381-4f46-bd77-e8c66bd4a5a6","added_by":"auto","created_at":"2025-10-10 20:21:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":109516,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eA preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-SCR)\u003c/em\u003e\u003csup\u003e\u003cem\u003e 58\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e flowchart of the literature selection. Some articles met more than one of the exclusion criteria, meaning the listed reasons for exclusion totals more than the overall number of excluded articles. Four conference abstracts were excluded on the basis of one being an incomplete study, one concerning prevalence of neurodivergence (education was not the main focus), and two were not original studies (literature review).\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7415903/v1/9e27a7676372c5137beef2ee.png"},{"id":93266735,"identity":"fd4e6cd4-c434-43ae-8077-fa7450dec882","added_by":"auto","created_at":"2025-10-10 20:21:18","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":58707,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eChart showing the distribution of SpLDs or neurodiverse conditions discussed by the included articles. Most articles discussed SpLDs (n=14), with the majority of these discussing dyslexia (n=8) or SpLDs in general (n=5)\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7415903/v1/f93dfccf5417e70cd33125f8.png"},{"id":98245009,"identity":"95d0910e-bf73-41b4-a5a4-798433d27d99","added_by":"auto","created_at":"2025-12-15 16:16:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1528922,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7415903/v1/b0cd43ad-02ce-4d1b-946a-582b10e59baf.pdf"},{"id":93266548,"identity":"a6f0e99d-ada7-41a9-b5ab-a625da7cc9eb","added_by":"auto","created_at":"2025-10-10 20:13:18","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":26936,"visible":true,"origin":"","legend":"","description":"","filename":"AdditionalFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7415903/v1/1139b276ad6cca0af85e4ef6.docx"},{"id":93266550,"identity":"9c5b6848-7c54-4dcc-b78c-7cbee7a0cd83","added_by":"auto","created_at":"2025-10-10 20:13:18","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":27657,"visible":true,"origin":"","legend":"","description":"","filename":"AdditionalFile2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7415903/v1/82b704e3098f2bdf274c6a59.docx"},{"id":93266560,"identity":"7122f9d4-0a88-441c-8751-dc1c92f88d6a","added_by":"auto","created_at":"2025-10-10 20:13:18","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":14890,"visible":true,"origin":"","legend":"","description":"","filename":"AdditionalFile3.docx","url":"https://assets-eu.researchsquare.com/files/rs-7415903/v1/66a107a13d221d12d906aa5f.docx"},{"id":93266559,"identity":"5bff6be0-0b07-492f-ad33-6430e7b4fae1","added_by":"auto","created_at":"2025-10-10 20:13:18","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":15176,"visible":true,"origin":"","legend":"","description":"","filename":"AdditionalFile4.docx","url":"https://assets-eu.researchsquare.com/files/rs-7415903/v1/1bf96bbf15f47edcb42e70a1.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Undergraduate medical education for neurodivergent students: A scoping review","fulltext":[{"header":"Background","content":"\u003cp\u003eIncreasing numbers of students in Higher Education Institutions (HEIs) are disclosing a specific learning difficulty (SpLD) or Autism \u003csup\u003e\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e, coinciding with greater recognition of the importance of the \u0026lsquo;\u003cem\u003eneurodiversity\u003c/em\u003e\u0026rsquo; paradigm. The implications of this paradigm for medical education have recently been outlined \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e, including requiring neurodivergence to be understood as a social justice concept that demands critical reflection of traditional perspectives. \u0026lsquo;\u003cem\u003eNeurodivergence\u0026rsquo;\u003c/em\u003e is described as referring to \u003cem\u003e\u0026ldquo;those who differ from societally perceived norms of brain or mind function\u0026mdash;or from the majority, who are sometimes described as \u0026lsquo;neurotypical\u0026rsquo;\u0026rdquo;\u003c/em\u003e \u003csup\u003e4\u003c/sup\u003e. Neurodivergent students in HEIs face several challenges, including greater attrition \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e, poorer mental health \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e, and less favorable post-graduation outcomes \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. The demands of medical curricula \u003csup\u003e\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e highlight the importance of exploring existing research regarding prevalence of these challenges in neurodivergent undergraduate medical students, including any specific difficulties, and appropriate teaching and support strategies. Improving our understanding in this area is even more crucial given recent political threats to diversity, equality and inclusivity initiatives \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Actively including neurodivergent students is vital to create equitable and just medical education \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e, whilst developing a diverse workforce that can better support diverse patients \u003csup\u003e\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eThe neurodiversity paradigm\u003c/h3\u003e\n\u003cp\u003eThere is debate regarding the precise definition of \u003cem\u003eneurodiversity\u003c/em\u003e \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. The definition described here, of the \u003cem\u003eneurodiversity paradigm\u003c/em\u003e, draws on Shaw et al., (2024) \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e and other neurodivergent-authored texts \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e, and aims to provide a clear explanation while also capturing the political essence of the paradigm.\u003c/p\u003e\u003cp\u003eDevelopment of the \u003cem\u003eneurodiversity paradigm\u003c/em\u003e involved many (often online) Autism advocate communities during the 1990s \u0026ndash; 2000s \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e, including Jim Sinclair \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e, Harvey Blume \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e and Judy Singer \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. Singer produced sociological studies on neurodiversity, but is often incorrectly credited with coining the term, and her views have been criticized by autistic communities \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. The \u003cem\u003eneurodiversity paradigm\u003c/em\u003e challenges traditional \u0026lsquo;deficit-driven\u0026rsquo; models of Autism \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e, that are associated with the medical model of disability by viewing Autism as a \u0026lsquo;deficit\u0026rsquo; to be \u0026lsquo;fixed\u0026rsquo; or better aligned with society\u0026rsquo;s perception of \u0026lsquo;normal\u0026rsquo; \u003csup\u003e18,26\u003c/sup\u003e. Instead, the \u003cem\u003eneurodiversity paradigm\u003c/em\u003e describes the variability in neurodevelopment \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e, echoing the social model of disability \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e by arguing that difficulties faced are the result of societal barriers \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. \u003cem\u003eNeurodiversity-aligned\u003c/em\u003e or -\u003cem\u003eaffirmative\u003c/em\u003e research promotes improving quality of life, social justice \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e, and including neurodivergent people within research designs \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. The \u003cem\u003eneurodiversity paradigm\u003c/em\u003e is applied to various conditions \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e, including ADHD (Attention-Deficit Hyperactivity Disorder), dyspraxia, and SpLDs, opposing pathologization and highlighting strengths \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e,\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Within the paradigm, individuals may be described as \u0026lsquo;\u003cem\u003eneurodivergent\u0026rsquo;\u003c/em\u003e if their neurocognitive function differs from societal \u0026lsquo;norms\u0026rsquo;. These differences in cognitive or neurological function set neurodivergence apart from personality traits or preferences. Populations are described as \u0026lsquo;\u003cem\u003eneurodiverse\u0026rsquo;\u003c/em\u003e if they include individuals with a variety of neurocognitive \u0026lsquo;styles\u0026rsquo; \u003csup\u003e20\u003c/sup\u003e. \u0026lsquo;\u003cem\u003eNeurodivergence\u0026rsquo;\u003c/em\u003e is therefore considered a broad term for a variety of diagnoses, and \u0026lsquo;\u003cem\u003eneurodiversity\u0026rsquo;\u003c/em\u003e acts as a paradigm for viewing research though a lens of social justice and inclusivity.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eThe neurodiversity paradigm in medical education\u003c/h2\u003e\u003cp\u003eNeurodivergence amongst medical students \u003csup\u003e\u003cspan additionalcitationids=\"CR32 CR33 CR34 CR35 CR36\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e is likely higher than reported, due to underdiagnosis and under-disclosure \u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e, often resulting from stigma \u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e or poor understanding from staff or peers \u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e,\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e,\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. Delayed diagnosis is common \u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e, as students can often compensate until medical school demands and/or assessment procedures exceed their compensatory capacities \u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e,\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e. Barriers and delays to diagnosis/disclosure are problematic, as universities often require disclosure of a formal diagnosis before providing accommodations (such as examination adjustments) \u003csup\u003e\u003cspan additionalcitationids=\"CR44 CR45\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e that allow neurodivergent students to thrive \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e and showcase their strengths \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eExisting literature in medical education includes some discussion articles on neurodiversity \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e,\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e,\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e and some reviews regarding SpLDs \u003csup\u003e\u003cspan additionalcitationids=\"CR49 CR50 CR51\" citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e, but there are no existing reviews regarding neurodiversity within undergraduate medical education. A recent review by Gray et al., (2025) has scoped the literature regarding neurodivergence within the broader field of health professions education\u003csup\u003e\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u003c/sup\u003e, which provides a helpful overview of many studies and disciplines. This indicates growing interest in this area and marks a useful starting point in understanding the evidence base for neurodiversity within health education. However, the wide scope of the Gray et al., (2025) review means only high-level, broad conclusions can be drawn, providing fewer practical implications for educators. Furthermore, the Gray et al., (2025) review did not include detailed discussion of the definition of the neurodiversity paradigm. Therefore, our review seeks to build on the work of Gray et al., (2025), by providing more in-depth discussions of studies that have considered neurodivergence; specifically, Autism, ADHD, SpLDs, and related conditions; in undergraduate medical education. We focus on empirical studies, with a view to providing pragmatic conclusions that can guide medical educators in their daily practice. We have also sought to provide meaningful discussion of the neurodiversity paradigm, which is often lacking in existing studies. Given the growing recognition of the importance of the neurodiversity paradigm in medical education, and the diverse needs of this student population, a scoping review is required to provide an overview of existing evidence on this topic, including methodologies, key findings, and possible gaps.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eDefinitions and language in this review\u003c/h3\u003e\n\u003cp\u003eThe \u003cem\u003eneurodiversity paradigm\u003c/em\u003e encompasses the variation in human minds, which drives social justice, equality and inclusion for those who fall outside of society\u0026rsquo;s definition of \u0026lsquo;normal\u0026rsquo; - who may be described as \u003cem\u003eneurodivergent\u003c/em\u003e (compared to the majority, who may be termed \u003cem\u003eneurotypical)\u003c/em\u003e. Populations may be described as \u003cem\u003eneurodiverse\u003c/em\u003e, capturing this variation across a group.\u003c/p\u003e\u003cp\u003eThere is debate regarding person-first versus disability-first language \u003csup\u003e\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u003c/sup\u003e, making it important to check for individual preferences. Here, we intentionally move between person-first and disability-first language, to attempt to include all viewpoints. Additionally, the word \u0026lsquo;difference\u0026rsquo; may better align with the neurodiversity paradigm than \u0026lsquo;deficit\u0026rsquo; or \u0026lsquo;disorder\u0026rsquo; \u003csup\u003e55\u003c/sup\u003e. We use accepted medical abbreviations (\u0026lsquo;SpLDs\u0026rsquo;, \u0026lsquo;ADHD\u0026rsquo;), but we acknowledge that other terms may be preferred. The authors consulted neurodivergent colleagues and neurodivergent-authored texts when developing definitions and terminology.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eAuthor reflexivity\u003c/h2\u003e\u003cp\u003eThe authors who carried out this review were neurotypical, which may influence interpretations of included studies, particularly for thematic analysis of qualitative studies. Review of neurodivergent-authored literature concerning the definition of the neurodiversity paradigm, and the experiences of neurodivergent individuals, was carried out prior to commencing this work, encouraging the authors of this review to challenge any pre-existing ideas or assumptions we held about neurodiversity. Reflection and discussion between authors occurred throughout thematic analysis of qualitative studies, to ensure emergent themes reflected neurodivergent voices. Furthermore, one of the review authors, who is neurodivergent, joined the project after the initial thematic analysis had been completed. Their role focused on reviewing and refining analysis, with the aim supporting a more authentic interpretation of the findings.\u003c/p\u003e\u003cp\u003eHowever, it is important to acknowledge that many of the studies included in the review were themselves authored by neurotypical individuals, adding further layers of interpretation that may shape how neurodivergent experiences are represented. The authors of this review are academics and educators, which may influence interpretation of data regarding student experiences.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eProtocol\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003eProtocol\u003c/div\u003e\u003cp\u003eThe scoping review protocol followed frameworks by Arksey and O\u0026rsquo;Malley \u003csup\u003e\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u003c/sup\u003e as updated by Levac et al \u003csup\u003e57\u003c/sup\u003e, and the PRISMA Extension for Scoping Reviews (PRISMA-ScR) \u003csup\u003e\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u003c/sup\u003e. The protocol was registered with the Open Science Framework (OSF): \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.17605/OSF.IO/4GSYN\u003c/span\u003e\u003cspan address=\"10.17605/OSF.IO/4GSYN\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. A completed PRISMA-ScR checklist is available as Additional File 1.\u003c/p\u003e\u003cp\u003eThis review article forms part of a wider review project regarding medical sciences and healthcare professions education. Here, we focus on studies identified within the context of undergraduate medical education. This is because several factors set medical degrees apart from other healthcare courses. For example, medical degrees are 'generalist' \u003csup\u003e59\u003c/sup\u003e, allowing graduates to specialize in any healthcare area, unlike dentistry, pharmacy, or midwifery, which focus on specific systems. There is typically a pre-clinical/clinical structure in medical programs \u003csup\u003e\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u003c/sup\u003e; and a pre-clinical focus on foundational medical sciences is less prominent in wholly clinical-based programs, such as nursing \u003csup\u003e\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u003c/sup\u003e. These factors create a unique environment for medical learners.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eIdentification of research question\u003c/h2\u003e\u003cp\u003eOur aim was to explore existing empirical research regarding undergraduate medical education for neurodivergent students, including determining which aspects of educational practice (e.g. assessment, student experience) have been studied in this context, identifying key findings and methodologies, in order to provide practical considerations for educators and identify possible evidence gaps to inform planning of future research. This is an appropriate rationale for carrying out a scoping review \u003csup\u003e\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e,\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe research question for this review was:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eWhat is the nature and extent of empirical research available to inform medical education approaches for undergraduate students who are neurodivergent?\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eNeurodiversity is a relatively novel concept within medical education; a brief search of existing literature prior to developing the protocol found few studies using this terminology. Therefore, we also scoped the literature for studies on commonly recognized neurodivergent conditions, including Autism, ADHD, dyspraxia, and SpLDs. Studies on the prevalence of neurodivergence and on accommodations were excluded, as both prevalence and the securing of accommodations fall outside the direct influence of educators (accommodations are usually arranged by centralized university services). This review focuses on synthesizing available empirical evidence to inform day-to-day teaching practice and research priorities related to this. The research question informed the development of the inclusion criteria and search strategy. An example search strategy is available in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, exact strategies are available in Additional File 2.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eIdentification of relevant studies\u003c/h3\u003e\n\u003cp\u003eThe search was not limited by date, journal, language or study type. Articles that were excluded due to study type or language were removed later in the process during the screening phase. The strategy was created with an information specialist, using both subject headings and keywords (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The search was conducted on 19 April 2024 in six electronic databases: Medline, Embase, PsycInfo, ERIC, Social Sciences Premium Collection and Web of Science, supplemented with a gray literature search using Google Search (first page of results only) and Google Scholar (first three pages of results). Backwards citation searching of included studies did not identify further articles. We repeated the search on 04 August 2025 with no further articles identified.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDevelopment of inclusion criteria and search strategy, informed by the research question. The search terms given are an example, searches were adapted as appropriate for each database with the support of an information specialist. Full search strategies for each database are available as Additional File 2. Search strings for 'medical education/students' and 'neurodiversity' were joined by an 'AND' operator. An additional line, 'NOT child*' was added to the search, as initially a very high number of results regarding childhood neurodivergence were returned. \u0026lsquo;NOT\u0026rsquo; operators must be used with caution to avoid excluding potentially relevant articles, this is discussed further in the limitations section.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuestion Element\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInclusion Criteria\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExample Search Terms\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eMedical\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAny healthcare professionals education (Medicine; Nursing; Dentistry; Pharmacy; Speech \u0026amp; Language Therapy) and/or medical sciences education (Biomedical Science; Anatomy; Physiology; Sport and Exercise Science; Nutrition).\u003c/p\u003e\u003cp\u003e\u003cem\u003eOnly studies identified relating to medicine and dentistry are discussed in this article.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e((medical OR dental OR nursing OR pharmacy) N6 school) OR ((medical OR dental OR nursing OR pharmacy) N6 education) OR ((medical OR dental OR nursing OR pharmacy) N6 student*) OR ((medical OR dental OR nursing OR pharmacy) N6 teach*) OR ((medical OR dental OR nursing OR pharmacy) N6 program*) OR ((medical OR dental OR nursing OR pharmacy) N6 curricul*) OR ((medical OR dental OR nursing OR pharmacy) N6 assess*) OR ((medical OR dental OR nursing OR pharmacy) N6 exam*) OR ((medical OR dental OR nursing OR pharmacy) N6 train*) OR ((medical OR dental OR nursing OR pharmacy) N6 study*) OR (anatomy N6 (education OR student* OR teach* OR program* OR curricul* OR assess* OR exam* OR train* OR study*)) OR (physiology N6 (education OR student* OR teach* OR program* OR curricul* OR assess* OR exam* OR train* OR study*)) OR (biomed* N6 (education OR student* OR teach* OR program* OR curricul* OR assess* OR exam* OR train* OR study*)) OR (sport* N6 (education OR student* OR teach* OR program* OR curricul* OR assess* OR exam* OR train* OR study*)) OR (nutrition N6 (education OR student* OR teach* OR program* OR curricul* OR assess* OR exam* OR train* OR study*)) OR (speech N6 (education OR student* OR teach* OR program* OR curricul* OR assess* OR exam* OR train* OR study*)) OR (\u0026ldquo;healthcare professional\u0026rdquo; N6 (education OR student* OR teach* OR program* OR curricul* OR assess* OR exam* OR train* OR study*)) OR (medicine N6 (education OR student* OR teach* OR program* OR curricul* OR assess* OR exam* OR train* OR study*)) OR (physician N6 (education OR student* OR teach* OR program* OR curricul* OR assess* OR exam* OR train* OR study*))\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eEducation or Students\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUndergraduate (HE) only. Empirical research only.\u003c/p\u003e\u003cp\u003eTeaching/learning, assessment, student experience, student support, accommodations/ adjustments/ accessibility\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eAND\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eNeurodivergent or Specific Learning Difficulty\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAny neurodivergence, for example (but not limited to) Autism, dyslexia, ADHD, dyspraxia, dyscalculia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eneurodiver* OR autis* OR adhd OR \u0026ldquo;attention deficit\u0026rdquo; OR \u0026ldquo;learning disab*\u0026rdquo; OR \u0026ldquo;Intellectual disab*\u0026rdquo; OR \u0026ldquo;learning difficult*\u0026rdquo; OR \u0026ldquo;learning disorder*\u0026rdquo; OR \u0026ldquo;learning disturbance*\u0026rdquo; OR \u0026ldquo;learning impairment\u0026rdquo; OR \u0026ldquo;learning problem*\u0026rdquo; OR \u0026ldquo;attention deficit*\u0026rdquo; OR \u0026ldquo;attention disturbance*\u0026rdquo; OR dyslexi* OR dyspraxi* OR dyscalcu* OR aphantasi* OR \u0026ldquo;autis* spectrum\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eNOT child*\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eStudy selection\u003c/h3\u003e\n\u003cp\u003eCitations were exported to EndNote (EndNote Version 20, Clarivate, Philadelphia, PA) and then screened using Rayyan (Rayyan, Cambridge, MA). Duplicates were identified and removed prior to study selection, which was performed in three steps: title and abstract screening, and full-text screening, according to the exclusion criteria. Studies were excluded if they:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eDid not relate to education or students, e.g., were related to staff who are neurodivergent/have SpLDs. Studies regarding prevalence of conditions amongst medical students were excluded. Studies relating to frequency/type of accommodations offered were excluded (e.g. studies regarding types of accommodation offered and how often) as accommodations are usually managed by centralized university services and therefore not under the influence of educators\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eDid not relate to medical students\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eDid not relate specifically to neurodivergent students\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eWere related to admissions/applications to study\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eWere related to qualified health professionals or postgraduate, rather than undergraduate students\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eWere not empirical research/original study (e.g. opinion, commentary, literature review)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eWere not available in English\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eFor pragmatic reasons (including time available and researcher capacity), title and abstract screening was performed by a single researcher (EJG), who took a cautious approach, progressing studies to full-text screening if there was any doubt regarding their inclusion. Full-text screening was carried out independently by two researchers (EJG, IDK) to ensure consistent adherence to the exclusion criteria. Conflicts were resolved through discussion and consensus.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eExtracting and charting the data\u003c/h2\u003e\u003cp\u003eWe developed a data extraction tool (available as Additional File 3) using Microsoft Excel to collate key information from included studies, including: article metadata; methodology; participants; author characteristics; key objectives and results. Extraction categories were determined through familiarity with the literature and discussion amongst the screening team (EJG, IDK). Data extraction was carried out by a single researcher (EJG); a second researcher checked the extraction for a random sample of 50% of included articles, with conflicts resolved through discussion and consensus (IDK).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eCollating, summarizing and reporting results\u003c/h2\u003e\u003cp\u003eWe developed tables and charts to visualize characteristics of the literature, including quantitative synthesis of article meta-data and characteristics, and a thematic analysis of qualitative studies on student experience. Qualitative studies on student experiences underwent inductive thematic analysis, involving coding of these studies to identify common results through repeated reading and familiarization of included articles by a single researcher (EJG). Codes were then organized into emergent themes, that captured and summarized key findings across the articles. Themes were discussed and refined with a second researcher (IDK). Quality evaluation was not performed as this is not a requirement of scoping reviews \u003csup\u003e\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e,\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eSearch results\u003c/h2\u003e\u003cp\u003eThe search results are outlined in a PRISMA-ScR\u003csup\u003e\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u003c/sup\u003e flowchart (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). A total of 12,941 publications (n\u0026thinsp;=\u0026thinsp;12,941) were identified through database searching and 13 through grey literature searching (n\u0026thinsp;=\u0026thinsp;13).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAfter removing duplicates (n\u0026thinsp;=\u0026thinsp;5185), we screened the remaining publications (n\u0026thinsp;=\u0026thinsp;7769) according to exclusion criteria (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Fifteen (n\u0026thinsp;=\u0026thinsp;15) included studies related to medicine \u003csup\u003e\u003cspan additionalcitationids=\"CR63 CR64 CR65 CR66 CR67 CR68 CR69 CR70 CR71 CR72 CR73 CR74 CR75\" citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e\u003c/sup\u003e. Full details of the included studies are listed in Additional File 4.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy characteristics\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eFigure 2 - Chart showing the distribution of SpLDs or neurodiverse conditions discussed by the included articles. Most articles discussed SpLDs (n\u0026thinsp;=\u0026thinsp;14), with the majority of these discussing dyslexia (n\u0026thinsp;=\u0026thinsp;8) or SpLDs in general (n\u0026thinsp;=\u0026thinsp;5)\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe fifteen included studies were published between 2010 and 2023, taking place in the UK (n\u0026thinsp;=\u0026thinsp;13) \u003csup\u003e62,64\u0026ndash;67,69\u0026minus;76\u003c/sup\u003e, Australia (n\u0026thinsp;=\u0026thinsp;1) \u003csup\u003e63\u003c/sup\u003e, and France (n\u0026thinsp;=\u0026thinsp;1) \u003csup\u003e68\u003c/sup\u003e. Eight (n\u0026thinsp;=\u0026thinsp;8) were single-center studies \u003csup\u003e63\u0026ndash;67,69\u0026minus;71,75\u003c/sup\u003e, two were collaborative autoethnographies (n\u0026thinsp;=\u0026thinsp;2) \u003csup\u003e73,76\u003c/sup\u003e, one involved staff members from two universities (n\u0026thinsp;=\u0026thinsp;1) \u003csup\u003e68\u003c/sup\u003e, and three involved participants from across the UK (n\u0026thinsp;=\u0026thinsp;3) \u003csup\u003e62,72,74\u003c/sup\u003e. Most discuss dyslexia (n\u0026thinsp;=\u0026thinsp;7) \u003csup\u003e62,64,67,69,72,73,75\u003c/sup\u003e or SpLDs in general (n\u0026thinsp;=\u0026thinsp;3) \u003csup\u003e66,70,71\u003c/sup\u003e. Fewer discussed ADHD (n\u0026thinsp;=\u0026thinsp;2) \u003csup\u003e63,65\u003c/sup\u003e, Autism (n\u0026thinsp;=\u0026thinsp;1) \u003csup\u003e74\u003c/sup\u003e, dyspraxia (n\u0026thinsp;=\u0026thinsp;1) \u003csup\u003e76\u003c/sup\u003e or neurodevelopmental disorders (n\u0026thinsp;=\u0026thinsp;1) \u003csup\u003e68\u003c/sup\u003e (Fig.\u0026nbsp;2). Only four (n\u0026thinsp;=\u0026thinsp;4) studies referenced \u0026lsquo;neurodiversity\u0026rsquo; (or related terms) \u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e,\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e,\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e,\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u003c/sup\u003e. Of these, two described ADHD as an example of neurodivergence without defining neurodiversity \u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e,\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e\u003c/sup\u003e, one briefly discussed neurodiversity as a theoretical lens similar to the social model of disability \u003csup\u003e\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u003c/sup\u003e, and one gave a more expansive definition \u003csup\u003e\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eEight studies (n\u0026thinsp;=\u0026thinsp;8) disclosed that an author was neurodivergent \u003csup\u003e\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e,\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e,\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e,\u003cspan additionalcitationids=\"CR73 CR74 CR75\" citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e\u003c/sup\u003e, with four (n\u0026thinsp;=\u0026thinsp;4) including contributions from a student author \u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e,\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e,\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e,\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e\u003c/sup\u003e (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), which is important when considering the emphasis placed on inclusion of neurodivergent voices in research design within the neurodiversity paradigm \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Seven of the eight studies that disclosed the neurodivergence of their authors included the same author (S. Shaw) as a contributor (n\u0026thinsp;=\u0026thinsp;7) \u003csup\u003e62,65,72\u0026ndash;76\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of authors who contributed to studies that had disclosed neurodivergence in the study authors, and whether the neurodivergent authors were students.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDisclosed neurodivergence of author\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNeurodivergent author is a student\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnderson and Shaw \u003csup\u003e\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDyslexia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBailey, Grotowski \u0026amp; Bailey \u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eADHD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes, author with ADHD is a student\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGodfrey-Harris and Shaw \u003csup\u003e\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eADHD, Autism, dyslexia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFirst author is a student with ADHD\u003c/p\u003e\u003cp\u003eSecond author is a doctor/academic with ADHD, Autism and dyslexia\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShaw and Anderson \u003csup\u003e\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDyslexia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShaw, Anderson \u0026amp; Grant \u003csup\u003e\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDyslexia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAutoethnography by dyslexic doctor about their time as a student\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShaw, Doherty \u0026amp; Anderson \u003csup\u003e\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAutism (2 authors)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShaw, Hennessy \u0026amp; Anderson \u003csup\u003e\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDyslexia (2 authors)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWalker, Shaw \u0026amp; Anderson \u003csup\u003e\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDyspraxia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes, autoethnography by medical student with dyspraxia\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eStudy participants and aims\u003c/h2\u003e\u003cp\u003eMost participants were students (n\u0026thinsp;=\u0026thinsp;13 studies), mainly neurodivergent undergraduates (n\u0026thinsp;=\u0026thinsp;10 studies) \u003csup\u003e64\u0026ndash;66,69\u0026minus;71,73\u0026ndash;76\u003c/sup\u003e. Two studies involved junior doctors discussing their student experiences (n\u0026thinsp;=\u0026thinsp;2 studies) \u003csup\u003e\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e,\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e\u003c/sup\u003e. One study had neurotypical student participants (n\u0026thinsp;=\u0026thinsp;1 studies), examining their perceptions of dyslexia \u003csup\u003e\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e\u003c/sup\u003e. Eight studies required participants to be formally diagnosed or registered with university support services in order to participate (n\u0026thinsp;=\u0026thinsp;8) \u003csup\u003e64,66,69\u0026ndash;72,74,75\u003c/sup\u003e. Other studies did not require this (n\u0026thinsp;=\u0026thinsp;1) \u003csup\u003e65\u003c/sup\u003e, did not state whether this was required (n\u0026thinsp;=\u0026thinsp;1) \u003csup\u003e62\u003c/sup\u003e, or this was irrelevant as the participant was an already diagnosed author (n\u0026thinsp;=\u0026thinsp;2) \u003csup\u003e73,76\u003c/sup\u003e. Two studies had staff participants (n\u0026thinsp;=\u0026thinsp;2) \u003csup\u003e63,68\u003c/sup\u003e, including healthcare professionals involved in teaching \u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e\u003c/sup\u003e and medical teachers \u003csup\u003e\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIncluded studies explored one of three areas: student experiences/perceptions \u003csup\u003e\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e,\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e,\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e,\u003cspan additionalcitationids=\"CR72 CR73 CR74 CR75\" citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e\u003c/sup\u003e; assessment/academic performance \u003csup\u003e\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e,\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e,\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e,\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e\u003c/sup\u003e; or staff perceptions \u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e,\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eStudent experiences and perceptions\u003c/h2\u003e\u003cp\u003eEight studies investigated the experiences/perceptions of neurodivergent students (n\u0026thinsp;=\u0026thinsp;8) frequently utilizing semi-structured interviews \u003csup\u003e\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e,\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e,\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e,\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e,\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u003c/sup\u003e. A single study investigated views of students without SpLDs towards dyslexia (n\u0026thinsp;=\u0026thinsp;1) \u003csup\u003e67\u003c/sup\u003e. Two studies (on dyslexia and dyspraxia) used autoethnography of a single participant \u003csup\u003e\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e,\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e\u003c/sup\u003e (n\u0026thinsp;=\u0026thinsp;2). Two used mixed-methods surveys \u003csup\u003e\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e,\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e\u003c/sup\u003e (n\u0026thinsp;=\u0026thinsp;2).\u003c/p\u003e\u003cp\u003eThematic analysis of studies with neurodivergent participants identified common experiences, regardless of condition (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Themes included: diagnosis, disclosure and discrimination; teaching, learning environment and adjustments; mixed clinical experiences and communication; emotional impact, strengths and support.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThemes identified through thematic analysis of qualitative studies on neurodivergent student experiences and perceptions. These themes discuss experiences that were seen across studies on different diagnoses, however it is important to note that although many experiences appear common, experiences across diagnoses are not homogenous.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDescription\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e1. Diagnosis, disclosure \u0026amp; discrimination\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudents noted the importance of early diagnosis and disclosure \u003csup\u003e\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e,\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e,\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e\u003c/sup\u003e. Barriers to this included poor reactions or inadequate understanding from staff \u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e,\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e,\u003cspan additionalcitationids=\"CR74\" citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u003c/sup\u003e, experience of discrimination or stigma \u003csup\u003e\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e,\u003cspan additionalcitationids=\"CR74\" citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u003c/sup\u003e, or bullying from staff \u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e,\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e,\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e\u003c/sup\u003e or from peers \u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e,\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e,\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e,\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e2. Teaching, learning environment \u0026amp; adjustments\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLectures \u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e,\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e,\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e,\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e\u003c/sup\u003e, transitions (from school, from pre-clinical to clinical years, and between placements) \u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e,\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e,\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e\u003c/sup\u003e, and timetabling changes or poor structure \u003csup\u003e\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e,\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e,\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e\u003c/sup\u003e were all notable barriers. Several studies reported neurodivergent students needing to work harder than their peers for the same outcomes, including efforts in double-checking or over-preparing \u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e,\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e,\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e,\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e\u003c/sup\u003e. Adjustments were appreciated \u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e,\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e,\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u003c/sup\u003e but some described these as performative and suggested they could be better individualized and tailored to the medical degree, as accommodations were generally provided via central university services rather than the medical school \u003csup\u003e\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e,\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e,\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e3. Mixed clinical experiences \u0026amp; communication\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFour studies described clinical placement learning as important, identifying pre-clinical teaching as more challenging for neurodivergent students \u003csup\u003e\u003cspan additionalcitationids=\"CR75 CR76\" citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e\u003c/sup\u003e. Three studies discussed supportive experiences with clinical staff \u003csup\u003e\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e,\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e,\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e\u003c/sup\u003e, but three reported difficulties caused by poor awareness of clinical placement staff about students\u0026rsquo; neurodivergence \u003csup\u003e\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e,\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e,\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u003c/sup\u003e. Three studies found neurodivergent students felt able to communicate well with patients, aided by defined social roles and their strong sense of empathy \u003csup\u003e\u003cspan additionalcitationids=\"CR74\" citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u003c/sup\u003e, whereas communication with neurotypical peers or staff is more difficult \u003csup\u003e\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e,\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e,\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e4. Emotional impact, strengths \u0026amp; support\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDifficulties were compounded by \u0026lsquo;toxic competitiveness\u0026rsquo; at medical school \u003csup\u003e\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e,\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e,\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e,\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e\u003c/sup\u003e, and feelings of helplessness or hopelessness when attempting to seek support \u003csup\u003e\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e,\u003cspan additionalcitationids=\"CR74\" citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u003c/sup\u003e. Students identified feelings of stupidity, inadequacy and low self-esteem, resulting in perfectionism \u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e,\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e,\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e,\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e,\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e\u003c/sup\u003e and impacts on mental health \u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e,\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e,\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e\u003c/sup\u003e. In five studies, students described how their experiences as a neurodivergent student had affected their career choices or aspirations \u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e,\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e,\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e,\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e,\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e\u003c/sup\u003e. Students perceived strengths arising from their neurodivergence, including developing alternative approaches to learning \u003csup\u003e\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e,\u003cspan additionalcitationids=\"CR73\" citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e\u003c/sup\u003e, perseverance/resilience \u003csup\u003e\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e,\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e,\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e\u003c/sup\u003e, lateral thinking \u003csup\u003e\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e,\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e,\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e\u003c/sup\u003e and enhanced empathy \u003csup\u003e\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e,\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e,\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u003c/sup\u003e. Students in four studies mentioned a desire for better awareness of fellow neurodivergent students (e.g. via support groups), or role-modelling from neurodivergent educators or doctors \u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e,\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e,\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e,\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThese themes were seen across studies on varying conditions, but some experiences appeared to be unique to particular diagnoses. It is important to note that although many experiences appear common, experiences across diagnoses are not homogenous, and being too quick to generalize may erode this nuance. For example, the study on autism noted strengths such as attention to detail and organizational skills, but difficulties or differences in sensory processing which created challenges in some learning environments, that were not mentioned in studies on other conditions \u003csup\u003e\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e\u003c/sup\u003e. Challenges in group work, as a result of managing social expectations and masking, were also identified in students with Autism \u003csup\u003e\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e\u003c/sup\u003e. Masking occurs when societal pressures result in neurodivergent individuals feeling as though they need to hide or reduce their neurodivergent traits, in order to be better accepted socially in environments that reward neurotypical norms \u003csup\u003e\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e,\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e\u003c/sup\u003e. The high energy expenditure associated with masking was identified in studies of both Autistic students and those with ADHD, resulting in fatigue and therefore impact on learning \u003csup\u003e\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e,\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e\u003c/sup\u003e. Despite this, students with ADHD expressed preference for small group learning compared to lectures \u003csup\u003e\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e\u003c/sup\u003e. Studies on dyslexia discussed challenges caused by assessments (such as OSCEs (Objective Structured Clinical Examinations)) not accurately reflecting the real clinical environment, and therefore not enabling students to showcase their strengths in clinical practice \u003csup\u003e\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e,\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e\u003c/sup\u003e. The dyspraxia study described physical difficulties with practical skills \u003csup\u003e\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e\u003c/sup\u003e. However, there were five studies focusing on experiences of students with dyslexia (n\u0026thinsp;=\u0026thinsp;5) \u003csup\u003e62,67,72,73,75\u003c/sup\u003e but only a single study on SpLDs in general \u003csup\u003e\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e\u003c/sup\u003e, ADHD \u003csup\u003e\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e\u003c/sup\u003e, Autism \u003csup\u003e\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e\u003c/sup\u003e and dyspraxia \u003csup\u003e\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e\u003c/sup\u003e. The small number of included studies means further work is required to elucidate whether these examples are diagnosis-specific or common across neurodivergences, particularly as experiences can vary even within the same diagnosis \u003csup\u003e\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e,\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e,\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe study on neurotypical student perceptions of dyslexia \u003csup\u003e\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e\u003c/sup\u003e found the majority had good understanding and supported adjustment for their peers. A small number noted feelings of jealousy or that adjustments gave an unfair advantage, which may underpin the experiences of stigma often associated with neurodivergent students avoiding disclosure or seeking a diagnosis \u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eAssessment approaches and academic performance\u003c/h2\u003e\u003cp\u003eFour single-center studies investigated assessment or academic performance for students with SpLDs \u003csup\u003e\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e,\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e\u003c/sup\u003e or dyslexia \u003csup\u003e\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e,\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e\u003c/sup\u003e. There were no studies regarding assessment for students with Autism, ADHD, or dyspraxia.\u003c/p\u003e\u003cp\u003eOne study showed SpLDs appear to have no significant effect on performance in multiple choice tests \u003csup\u003e\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e\u003c/sup\u003e, although here, students with SpLDs were given exam adjustments, such as additional time. Extra time has been reported as significantly enhancing exam performance for students with SpLDs (P\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;0.05) \u003csup\u003e\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e\u003c/sup\u003e when progress-test performance (tests taking place four times per year) is compared pre- and post- receiving this adjustment, although it was found it can take up to a year for improvements to reach significance (for example, students who were diagnosed and received extra time during second year showed significantly improved performance in third year assessments, compared with those diagnosed and given extra time within third year (P\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;.05)) \u003csup\u003e\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e\u003c/sup\u003e. Another study found students with dyslexia across two cohorts were found to perform significantly worse than non-dyslexic peers in year one (P\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;0.05 and \u0026lt;\u0026thinsp;0.01) \u003csup\u003e\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u003c/sup\u003e. No significant difference was seen in later years. They also found that dyslexic students given extra time in written assessments performed significantly better in year one than those not yet receiving this due to lack of diagnosis or disclosure (P\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;0.05) \u003csup\u003e\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u003c/sup\u003e, emphasizing the importance of early adjustments.\u003c/p\u003e\u003cp\u003eThere were differing results regarding OSCEs for students with dyslexia. One study found dyslexic students in first year performed significantly worse in OSCE examinations across three cohorts (P\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and when combining these cohorts found significant differences in performance on certain stations (P\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;0.01) \u003csup\u003e\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u003c/sup\u003e. However, another study found no significant effect of dyslexia on examination performance across all assessment types, including OSCE \u003csup\u003e\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eStaff perceptions of teaching and supporting neurodivergent students\u003c/h2\u003e\u003cp\u003eTwo studies surveyed staff perceptions of teaching students with ADHD \u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e\u003c/sup\u003e (n\u0026thinsp;=\u0026thinsp;2) or neurodevelopmental disorders \u003csup\u003e\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e\u003c/sup\u003e. Both identified limited understanding about these conditions and identified a desire for further training.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e To identify key themes and gaps in the existing literature on undergraduate medical education for neurodivergent students, this review has discussed 15 relevant studies. These studies investigated student experiences, staff perceptions, and assessment. We initially discuss studies on assessment; these positivist works quantify the impact on assessment for students who are neurodivergent, however these studies are not able to capture their broader lived experience which extends beyond that of assessment and academic achievement. We therefore then discuss the included interpretivist qualitative studies, which, when combined with positivist data, provide a more well-rounded view that can illustrate the experiences of these students and provide implications for practice.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAccommodations can remediate for issues with written assessment, but work is needed to further investigate assessment practices themselves\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThree single-center studies found no significant difference in written exam performance between students with dyslexia or SpLDs and those without, when accommodations are provided \u003csup\u003e\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e,\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e,\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e\u003c/sup\u003e. The role and power of assessment accommodations in supporting neurodivergent students is important, as it has been widely recognized that differential attainment is a challenge faced by disabled medical students, including those with cognitive or learning disabilities \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e\u003c/sup\u003e. The studies in this review indicate that proper provision of accommodations may be a crucial step towards remediation. However, these studies did not compare different SpLDs, and this review found no studies regarding assessment for students with Autism, ADHD or dyspraxia, meaning we cannot determine if different diagnoses affect assessment performance and the role of accommodations differently. Additionally, assessment practices vary between medical degrees \u003csup\u003e\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e\u003c/sup\u003e, meaning studies performed within the context of individual institutions are required.\u003c/p\u003e\u003cp\u003eTwo studies found differing results regarding OSCE performance \u003csup\u003e\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e,\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e\u003c/sup\u003e, demonstrating a need for further research, particularly as accommodations are less frequently offered for clinical assessments \u003csup\u003e\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e\u003c/sup\u003e. Neurodivergent students report that lack of adjustments for clinical assessments results in anxiety, in turn causing students to rush and make mistakes \u003csup\u003e\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e\u003c/sup\u003e, however some educators argue against accommodations as performing clinical tasks under pressure is essential for practicing clinicians \u003csup\u003e\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e\u003c/sup\u003e. Such arguments speak to the wider structural and cultural barriers facing neurodivergent medical students. Previous work regarding the experiences of disabled students has identified a \u0026lsquo;capability imperative\u0026rsquo; within medical education \u003csup\u003e\u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e\u003c/sup\u003e, whereby a historic culture of \u0026lsquo;\u003cem\u003ecompulsory hyper-ablebodiedness and mindedness\u0026rsquo;\u003c/em\u003e has created assessment standards that may themselves be inherently ableist. A simplistic view of providing accommodations to allow neurodivergent students to meet existing standards or perform under existing assessment approaches does not acknowledge the systemic exclusion that underpins these practices. None of the studies regarding assessment identified in this review sought to consider the inclusivity of assessment practices themselves, making this an important future area to explore.\u003c/p\u003e\u003cp\u003e\u003cb\u003eNeurodivergent students face barriers in medical education beyond assessment, and there is paucity in the literature regarding appropriate teaching modalities\u003c/b\u003e\u003c/p\u003e\u003cp\u003eStudies on neurodivergent student experiences highlight challenges beyond assessment. Barriers to disclosure, including stigma, low self-esteem, poor reactions from staff or lack of understanding from peers \u003csup\u003e\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e,\u003cspan additionalcitationids=\"CR73\" citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e,\u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e\u003c/sup\u003e are common and seen amongst other healthcare students \u003csup\u003e\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e,\u003cspan additionalcitationids=\"CR85 CR86\" citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e\u003c/sup\u003e. Educators often lack understanding of neurodivergence \u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e,\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e,\u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e,\u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e\u003c/sup\u003e, and some express concerns about non-disclosure as a patient safety issue \u003csup\u003e\u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e\u003c/sup\u003e (despite limited evidence \u003csup\u003e\u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e\u003c/sup\u003e), or fear neurodivergent students may struggle to communicate with patients \u003csup\u003e\u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e\u003c/sup\u003e. However, neurodivergent students are often hyper-vigilant, double-checking and taking extra time for clinical tasks \u003csup\u003e\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e,\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e,\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e,\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e,\u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e,\u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e\u003c/sup\u003e, and autistic doctors report finding patient interactions straightforward, due to clear behavioral expectations and guidelines \u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e,\u003cspan additionalcitationids=\"CR73\" citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e\u003c/sup\u003e. Neurodivergent students suggest interpersonal relations with teachers and peers are more challenging \u003csup\u003e\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e,\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e,\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e\u003c/sup\u003e. Some argue this results from \u0026lsquo;weaponized professionalism\u0026rsquo;\u003csup\u003e65\u003c/sup\u003e, whereby those deviating from the construct of an \u0026lsquo;ideal\u0026rsquo; medical professional (grounded in \u0026lsquo;\u003cem\u003ewhite, cis-gendered, heteronormative, able-bodied\u003c/em\u003e [and neurotypical] \u003cem\u003emale experience\u0026rsquo;\u003c/em\u003e) are viewed as unprofessional, regardless of whether their behavior actually affects their ability to practice medicine \u003csup\u003e\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e,\u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eCurrent teaching approaches, such as lectures, present barriers for neurodivergent students \u003csup\u003e\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e,\u003cspan additionalcitationids=\"CR74\" citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u003c/sup\u003e. Drawbacks of lectures are known \u003csup\u003e\u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e94\u003c/span\u003e\u003c/sup\u003e, but these may be more significant for students who are neurodivergent. This review did not identify any empirical research investigating the most appropriate teaching modalities for neurodivergent students (existing articles are limited to opinion/commentary \u003csup\u003e\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e,\u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e,\u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e\u003c/sup\u003e or generic guidance \u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e), nor any exploring specific curriculum elements (included studies only investigated medical education in general). Many neurodivergent students utilize alternative learning approaches \u003csup\u003e\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e,\u003cspan additionalcitationids=\"CR72\" citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e\u003c/sup\u003e and therefore appreciated flexible teaching approaches adopted during the COVID-19 pandemic (such as online or pre-recorded sessions) \u003csup\u003e\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eCommonly, barriers identified were known issues for many learners but were identified as more likely to be important for the neurodivergent \u003csup\u003e\u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e\u003c/sup\u003e. Competitive medical school cultures \u003csup\u003e\u003cspan citationid=\"CR98\" class=\"CitationRef\"\u003e98\u003c/span\u003e\u003c/sup\u003e, coupled with the \u0026lsquo;\u003cem\u003einvincibility myth\u0026rsquo;\u003c/em\u003e, of doctors as being \u0026lsquo;superhuman\u0026rsquo; and discouraged from disclosing difficulties \u003csup\u003e\u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e\u003c/sup\u003e, are known challenges for all medical students. These may exacerbate difficulties faced by neurodivergent students, by discouraging disclosure of what may be perceived as \u0026lsquo;weaknesses\u0026rsquo;, leading to perfectionism and over-compensation \u003csup\u003e\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e,\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e,\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e,\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e\u003c/sup\u003e. None of the included studies explicitly investigated the potential intersectionality between neurodivergent student experiences and that of other minoritized groups \u003csup\u003e\u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e100\u003c/span\u003e,\u003cspan citationid=\"CR101\" class=\"CitationRef\"\u003e101\u003c/span\u003e\u003c/sup\u003e, an area certainly in need of further work within medical education. Supportive strategies that are likely to benefit all students are therefore crucial, an idea underpinning Universal Design for Learning (UDL) \u003csup\u003e\u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e102\u003c/span\u003e\u003c/sup\u003e, a popular concept \u003csup\u003e\u003cspan additionalcitationids=\"CR104\" citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e105\u003c/span\u003e\u003c/sup\u003e despite limited evidence \u003csup\u003e\u003cspan citationid=\"CR106\" class=\"CitationRef\"\u003e106\u003c/span\u003e\u003c/sup\u003e, wherein teaching is delivered using approaches that are accessible to all students and can therefore benefit a wider population. In order to implement UDL, more robust evidence underpinning the approach is required, as well as better understanding regarding suitable approaches for neurodivergent students, who are often \u0026lsquo;hidden\u0026rsquo; (undiagnosed or undisclosed). This is a notable literature gap, as educators have expressed a desire for better training in supporting these students \u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e,\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e,\u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e107\u003c/span\u003e\u003c/sup\u003e. Changes may be needed on a systemic and policy level, but many educators would benefit from pragmatic and actionable guidance on how to adapt their day-to-day teaching, which could benefit all students \u003csup\u003e\u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e108\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eExisting literature focuses on a small number of conditions with limited application of the neurodiversity paradigm\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMost included studies concerned dyslexia or SpLDs in general; there is limited empirical research regarding undergraduate medical education for other SpLDs, ADHD, or Autism. This review identified many common experiences across diagnoses, which could simplify development of supportive teaching strategies, but lack of studies on conditions beyond dyslexia and SpLDs weaken this conclusion. Compounding this gap is the lack of studies employing the neurodiversity paradigm. Most studies focus on a single condition, and this single-condition focus restricts opportunities to identify shared experiences across neurodivergences, hindering the development of educational interventions with wider applicability. The neurodiversity paradigm also encourages inclusion of neurodivergent people within research designs \u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e, yet only eight included studies openly acknowledged involving neurodivergent contributors. Author reflexivity \u003csup\u003e\u003cspan citationid=\"CR109\" class=\"CitationRef\"\u003e109\u003c/span\u003e\u003c/sup\u003e and consideration of the research team is essential, particularly due to known communication differences between neurotypical and neurodivergent people (the \u0026lsquo;\u003cem\u003edouble empathy\u0026rsquo;\u003c/em\u003e problem \u003csup\u003e\u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e110\u003c/span\u003e\u003c/sup\u003e). Neurotypical researchers should explicitly reflect on their position, so readers can consider this influence on study design and data interpretations, and so researchers can take steps to challenge their own perspectives. Researchers should also take steps to create research environments that can support empowerment of neurodivergent participants. Co-production methodologies \u003csup\u003e\u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e111\u003c/span\u003e,\u003cspan citationid=\"CR112\" class=\"CitationRef\"\u003e112\u003c/span\u003e\u003c/sup\u003e may be one way to achieve this. The medical education community cannot expect the burden of this work to solely befall neurodivergent researchers, and neurotypical educators have a responsibility to use our privilege to enact change by elevating neurodivergent voices and removing disabling barriers.\u003c/p\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThe majority of authors of this review are neurotypical, which may influence the development of search terms and interpretation of studies. As discussed, the work to improve inclusivity of medical education for neurodivergent students should not solely fall on neurodivergent researchers, but authors should be explicit about their own experiences. Neurotypical authors made efforts to improve their awareness of neurodivergent experiences through familiarization with neurodivergent-authored texts and discussion with neurodivergent colleagues, but we acknowledge this is not equivalent to lived experience. The search aimed to include a range of terms used to describe neurodivergence. However, the nature of a search strategy requires a finite list of terms, which may not be in keeping with the broad definition of neurodiversity, and relevant studies may have used terms not included in the search. A \u0026lsquo;NOT\u0026rsquo; operator was required to produce manageable search results, and pragmatic factors reduced capacity for full independent screening of identified articles, heightening the risk of excluding potentially relevant studies. Backwards citation searching was employed to help mitigate this. The databases searched also skew heavily to the West, so alongside limitations introduced by only including studies in English, it is likely these findings are most suited to application in a Western context.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThere is a notable lack of empirical studies investigating educational practice for undergraduate neurodivergent students in medical education, with only 15 studies identified in this review. Although the barriers facing neurodivergent students are clear, there is limited research regarding how educators can best tackle these and improve support for this student group. Existing evidence suggests stigma and poor understanding by staff are present, meaning better training and awareness should be prioritized. Educators can adapt their practice, for example by relying less on traditional, didactic lectures, and being mindful of communication differences that may exist between neurodivergent students and staff, particularly during smaller group sessions. Consideration of UDL principles within teaching may be useful, although further work on this concept is necessary. These adaptations are likely to benefit all students, but will provide significant impact on enhancing inclusivity for the neurodivergent, which is vital to ensure our physician workforce is as diverse as the patient populations it serves. Future studies should further explore the learning experiences of students who are neurodivergent, for a range of conditions and for specific areas of the medical curriculum, to more clearly define their strengths and challenges, with the aim of developing clear, pragmatic, and evidence-based guidance for educators. Furthermore, research regarding assessment should extend to a variety of diagnoses beyond dyslexia and SpLDs, and interrogate our assessment approaches and standards themselves, not only the role of accommodations. In particular, assessment approaches and accommodations for practical clinical examinations should be further investigated. Explicit utilization of the neurodiversity paradigm is likely to be helpful in developing inclusive research practice, for example through use of co-production methods that can act to amplify neurodivergent voices. The limited evidence identified in this review indicates that medical education is only just waking up to the inherent and structural disabling barriers that exist for neurodivergent students, and it is vital that educators begin to consider how we might adapt our practice to celebrate and enhance the strengths that this group bring to the medical profession.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eHigher Education Institutions (HEIs)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSpecific Learning Difficulty (SpLD)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAttention-Deficit Hyperactivity Disorder (ADHD)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePreferred Reporting Items for Systematic Reviews and Meta Analyses for Scoping Reviews (PRISMA-ScR)\u003c/p\u003e\n\u003cp\u003eOpen Science Framework (OSF)\u003c/p\u003e\n\u003cp\u003eObjective Structured Clinical Examinations (OSCEs)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUniversal Design for Learning (UDL)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003eClinical Trial Number\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eEJG developed the protocol. IDK and GHSV supported protocol development. EJG and IDK carried out screening and data extraction. MB supported development of qualitative themes and provided guidance on correct terminology. All authors contributed to manuscript writing, and all authors read and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eThe authors wish to thank Linda Errington, Medical Sciences Librarian at the Walton Library, Faculty of Medical Sciences, Newcastle University, for her support in developing the search strategy.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article and its supplementary information files\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAdvance HE. October,. Equality in higher education: statistical reports 2021. Advance HE. Updated 28 October 2021. 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Clin Teach. 2024;21(6). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/tct.13804\u003c/span\u003e\u003cspan address=\"10.1111/tct.13804\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Neurodiversity, Undergraduate, Medical Schools, Medical Students, Teaching, Education","lastPublishedDoi":"10.21203/rs.3.rs-7415903/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7415903/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eRecognition of the importance of the neurodiversity paradigm is growing within medical education, as is understanding of how current practices may create barriers for neurodivergent students. This review aims to explore existing empirical research regarding undergraduate medical education for neurodivergent students, in order to provide practical considerations for educators and inform planning of future research.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003e Following frameworks outlined by Arksey and O\u0026rsquo;Malley and the PRISMA Extension for Scoping Reviews, six electronic databases were searched in April 2024 for empirical studies relating to neurodiversity within undergraduate medical education. Quantitative synthesis of article characteristics and a thematic analysis of qualitative studies on student experience were conducted.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eFifteen (n\u0026thinsp;=\u0026thinsp;15) studies were identified, relating to student experience, assessment, or staff perceptions. Most focused on dyslexia or specific learning disabilities, with few explicitly implementing the neurodiversity paradigm. Studies of student experience frequently identified discrimination and stigma, and studies of staff perceptions highlighted inadequate training. Barriers to neurodivergent student education were linked to certain teaching modalities and learning environments. Several perceived strengths of neurodivergence were also noted. Studies on assessment focused on the role of accommodations, with an emphasis on written rather than clinical examinations.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThis review highlights a lack of empirical studies on neurodiversity within undergraduate medical education, limiting the development of pragmatic guidance. Some adaptations are suggested, but studies are limited to discussing medical education in general with few implementing the neurodiversity paradigm. Future research should explore a greater range of neurodivergent conditions, interrogate assessment practices including clinical examinations, and provide further evidence for inclusive teaching approaches. Explicit utilization of the neurodiversity paradigm is crucial, to amplify neurodivergent voices and better understand existing barriers. This work will have implications for medical educators seeking to understand neurodivergence, with a view to implementing adaptations for neurodivergent students in their educational practice.\u003c/p\u003e","manuscriptTitle":"Undergraduate medical education for neurodivergent students: A scoping review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-10 20:13:13","doi":"10.21203/rs.3.rs-7415903/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-05T07:24:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-31T14:49:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"179841310468847963387461603371784064915","date":"2025-10-20T09:39:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"107012593191905274273008610567590062098","date":"2025-10-01T12:27:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-01T10:03:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"84891397689761195301092847305332429684","date":"2025-09-29T17:22:22+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-28T23:47:41+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-26T13:17:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-24T05:37:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-24T05:36:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-08-20T09:33:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4049bcdc-30cc-47f7-ad36-aee2c0d9c43f","owner":[],"postedDate":"October 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-15T16:11:32+00:00","versionOfRecord":{"articleIdentity":"rs-7415903","link":"https://doi.org/10.1186/s12909-025-08447-2","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-12-13 15:58:32","publishedOnDateReadable":"December 13th, 2025"},"versionCreatedAt":"2025-10-10 20:13:13","video":"","vorDoi":"10.1186/s12909-025-08447-2","vorDoiUrl":"https://doi.org/10.1186/s12909-025-08447-2","workflowStages":[]},"version":"v1","identity":"rs-7415903","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7415903","identity":"rs-7415903","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}