Navigating neurodivergence: A scoping review to guide health professions educators

Abstract

Introduction

To create inclusive learning environments where neurodivergent students can learn and thrive, educators must appreciate their unique perspectives and experiences. This is particularly crucial in health professions courses, where students may face additional pressures as they undertake placements in clinical environments where neurodivergence is misrepresented or misunderstood. A comprehensive review of the existing literature is necessary to identify the available data to guide educators and pinpoint areas that warrant further exploration.

Methods

Scoping review methodology, informed by the Joanna Briggs Institute approach, was used to guide a search of four electronic databases (MEDLINE, CINHAL, ERIC and PsycINFO), considering sources of primary data and analysis published up to June 2024. The retrieved literature was screened based on the inclusion criteria. Bibliographic data was extracted, and the included papers (n = 69) were reviewed and the themes charted using a framework approach.

Results

Analysis of the included literature indicated some clear trends over time, with earlier papers predominantly focussing on dyslexia or framing neurodiverg as a form of disability. More recently there has been an increase in the number of papers specifically exploring the experiences of students identifying as neurodivergent, or the perspectives of educators. Narratives evident in the literature centred around relationships between a neurodivergent identity and a developing professional identity, challenges around disclosure, seeking effective accommodations in a stigmatising environment and the impact of educator perspectives.

Discussion

Although the framing of neurodivergence has changed over time, a consistent finding is that neurodivergent students in health professions programmes are expected to conform to learning environments that exclude them and do not support their learning. Further evidence is required to inform recommendations for educators on how to provide safer learning environments which enable neurodivergent students to thrive.

Short abstract

Despite growing awareness of neurodivergence, neurodivergent students still struggle. This review summarizes 69 studies that highlight challenges arising from rigid course requirements, accessing accommodations, and educator attitudes.

1. INTRODUCTION

Health care educators aspire to prepare graduates to serve a diverse population. To do this well, we must understand the diverse ways of thinking and being within our student cohorts, a phenomenon which can be conceptualised as neurodiversity. ¹ As understanding of neurodiversity has evolved, so too has the university sector's awareness of the presence of neurodivergent students in higher education, ² , ³ , ⁴ with estimates ranging between 5% and 30%. ⁵ Current conceptualisations of neurodivergence frame this as an umbrella phenomenon which describes when an individual's mind and brain function in a way that differs from normative societal expectations. ⁶ , ⁷ Neurodivergence encompasses autism, Attention Deficit Hyperactivity Disorder (ADHD), dyslexia and other learning and cognitive differences. ⁸ As with all other student groups, educators need to be equipped to understand both the strengths of neurodivergent students and the challenges this group may experience through their studies. ²

Health professions programmes present distinctive challenges and opportunities for neurodivergent students. Often centred around competency‐focused education, and involving extensive exposure to clinical environments, ⁹ health care courses commonly expect students to adhere to professional standards and actively engage in clinical care. ¹⁰ Health care workplaces and training environments are also spaces where ablism at the individual and institutional levels is common, which negatively impacts the health, well‐being and career sustainability of health care professionals. ¹¹

Data regarding the proportion of health care students and practitioners who identify as neurodivergent is sparse as yet. However, troubling reports identify a workplace culture of stigma, internalised ableism and subsequent barriers to disclosure of neurodivergent status in health professional settings. ¹² Barriers to disclosure can also result in arduous efforts to compensate for identity‐related stigma and hide or “mask” neurodivergent characteristics. ¹³ As masking strategies can negatively impact mental health, ¹³ these experiences may therefore account for the high rates of mental health concerns cited among autistic doctors, ¹² and increased risk of burnout reported in medical students with disabilities, including those with autism or ADHD. ¹⁴ This suggests the negative experiences of neurodivergent individuals as they navigate training and professional practice may contribute to the high rates of burnout in health professionals. ¹⁵ It also points to the lack of psychological safety in clinical environments, and the need to identify factors that may promote authenticity, and facilitate disclosure and success in health professional workplaces. ¹²

The authors recognise the complex relationship between understandings of neurodiversity and disability, at both individual and structural levels, ¹⁶ however, it is helpful to draw from critical disability theory to understand the systems in which neurodivergent students experience learning and seek to disrupt structures which perpetuate inequity. ¹⁷ , ¹⁸ It is therefore important to examine both the evidence available to support educators to further neuroinclusive health professions education and also the extent to which the methods of data collection and interpretation are neuroaffirming. ¹⁹

To date, research exploring the experiences of neurodivergent students in health professions education has been limited and fragmented. Existing research generally focuses on specific disciplines or forms of neurodivergence, providing some insight but not a comprehensive overview. A holistic synthesis of current research is needed to identify common themes in the experiences of neurodivergent health professions students to better inform educator practices. The following research question was therefore posed: how is neurodiversity conceptualised within health professions education literature historically and currently? We also explore how the evolving understanding of neurodiversity and the increasing adoption of neuro‐affirming approaches influence how students' needs are perceived and addressed, to identify future research opportunities and education practices. This scoping review therefore aims to:

1. Examine the evolving narrative around neurodivergence in health professions education literature.

2. Establish what is in the literature to guide educators currently, and where the gaps are for further research.

2. METHODS

A scoping review was selected to enable a systematic and comprehensive exploration of the literature relating to neurodivergent health professions students' learning experiences. The method for this review was informed by the Joanna Briggs Institute Manual for Evidence Synthesis. ²⁰ The protocol for the search was initially developed in November 2023 and amended in August 2024, and is registered with Open Science Framework.

(https://doi.org/10.17605/OSF.IO/G2KTS).

2.1. Search strategy

The search strategy was developed in consultation with a health research‐trained University librarian and aimed to identify relevant peer‐reviewed studies published in English. No limits on publication timeframes were included to capture the evolution of research in this area. Using the research question as a guide, keywords were developed for the concepts of ‘neurodiversity/neurodivergence’, ‘learner experience’ and ‘health professions students’. These were preliminarily applied to Medline and CINAHL leading to further refinement of keywords, index terms and Boolean searching techniques. Individual search strings were then developed and applied to Medline, ERIC, CINAHL and PsycINFO (see Table S1). The search was undertaken in November 2023, and again in June 2024 to capture any new publications. Hand‐searching of journals was not undertaken.

2.2. Sources of evidence, screening and selection

Search results were imported into Covidence systematic review software (Health Innovation, Melbourne, Australia, available at www.covidence.org) to manage and organise the screening process. After duplicates were removed, six reviewers screened titles and abstracts then full text of identified publications for potentially relevant articles. To ensure consensus on how eligibility criteria were applied during screening, 10% of articles were screened by the entire review team at both the title/abstract stage and full text stage. The remaining 90% of texts were double‐screened at the title/abstract and full text stage, with any mismatched reviews triple‐screened to reach a consensus. Inclusion criteria required that studies explore the experiences of health professions students who identify as neurodivergent. This included the learning and placement experiences of neurodivergent health professions students as well as staff experiences of teaching or supporting neurodivergent students in health professions. Research which either focussed on neurodivergent students or included neurodivergent students in addition to students with other disabilities was included. Exclusion criteria included papers with participants solely in post‐licensure health workplace settings, along with evidence sources that had not been peer‐reviewed, or that did not include primary data collection.

2.3. Data extraction and analysis

Data extraction was based on the iterative development of a framework to record key information. This involved the researchers familiarising themselves with the papers and then using a combination of a priori and emergent topics from the papers to develop a framework structure (charting form) for analysis. ²¹ Two team members trialled the framework structure on 10 papers to ensure all relevant data was extracted and modified the framework following discussion with the wider research team. Data from each paper was then mapped to the framework, and then interpreted and contextualised to the literature by the research team. The final framework included bibliographic information, study characteristics and mapping of key findings from each study to themes and subthemes (see Table S2).

2.4. Researcher positionality

All researchers are university educators and/or researchers holding a range of roles (including design and delivery of courses, and leadership positions) across various health professions programmes (Medicine, Psychology, Occupational Therapy, Interprofessional Collaboration and Education). Some have worked as health professionals. The research team includes neurodivergent individuals and family members of neurodivergent people. The research team have taken a neuroaffirming stance in this work, drawing on both social and human rights models of disability ²² as well as the neurodiversity movement ²³ and critical disability theory ²⁴ , ²⁵ to inform their interpretation of the reviewed literature.

3. RESULTS

3.1. Selection of sources of evidence

Figure 1 summarises the screening process. A total of 69 articles were included for data extraction and analysis. Table S3 shows the extracted data from these papers.

FIGURE 1.

Outline of the screening process. [Color figure can be viewed at wileyonlinelibrary.com]

3.2. Characteristics of sources of evidence

Table 1 summarises the included articles. The papers were published across 40 journals with the majority published since 2006. Half of the papers were based in the United Kingdom (UK), with many from the United States of America (USA). Most papers were qualitative in nature, exploring the perspective of students rather than educators. Most of the articles focused on either nursing/midwifery or medical students, particularly in the clinical or placement context.

TABLE 1.

Summary of included articles.

		N (%)
Year of publication	Pre 1995	1 (1)
	1995–2000	5 (7)
	2001–2005	2 (3)
	2006–2010	14 (20)
	2011–2015	17 (25)
	2016–2020	15 (22)
	2021–2024	15 (22)
Journal	Disability & Society	6 (9)
	Nurse Education in Practice	6 (9)
	Nursing Standard	6 (9)
	Advances in Health Sciences Education	4 (6)
	Medical Teacher	4 (6)
	Other journals	35 (49)
Region	UK	34 (49)
	USA	14 (20)
	Canada	5 (7)
	Australia	4 (6)
	Other	12 (18)
Study Design	Qualitative	45 (66)
	Quantitative	12 (17)
	Mixed	12 (17)
Health Professions	Nursing/midwifery	29 (43)
	Medicine	20 (30)
	Occupational Therapy	2 (3)
	Physiotherapy	2 (3)
	Dentistry	2 (3)
	Medical imaging	1 (1)
	Social work	1 (1)
	Multiple	12 (19)
Participants	Students	47 (68)
	Educators/health services	13 (19)
	Both	9 (13
Learning environment	Clinical/placement	36 (52)
	Campus	19 (28)
	Not specified	14 (20)
Focus	Neurodiversity as a subtype of disability	30 (43)
	Specific learning difference	32 (46)
	Other neurodivergence	7 (11)

3.3. Synthesis of results

3.3.1. Publication trends over time

Figure 2 shows the pattern of publications over time. Only one paper aligned with our search criteria before 1995; after this point, the number of relevant papers published each year increased steadily. Earlier papers primarily focused on dyslexia or other specific learning differences (predominantly in nursing, solid line in Figure 2). The number of papers considering forms of neurodivergence as a type of disability (dashed line in Figure 2) increased steadily until the period 2011–2015. These papers generally included data from students with a diagnosis of autism, ADHD or dyslexia along with students with a range of other forms of disability. After this period there was significant growth in the number of papers focusing on autism, ADHD or other neurodivergence (dotted line in Figure 2).

FIGURE 2.

Patterns of publication over time within the three major categories observed; specific learning differences (including dyslexia), neurodivergence as a sub‐type of disability and other neurodivergence (including autism, ADHD). [Color figure can be viewed at wileyonlinelibrary.com]

Four major overarching themes were identified in the included papers, as described in Table 2.

TABLE 2.

Summary of themes identified.

Theme	Summary	Example references
Identities	Students experienced tensions between their neurodivergent identity and their identity as a health care professional. Neurodivergent traits were often perceived as incompatible with professional expectations, leading to masking behaviours which negatively impacted learner well‐being and professional identity development.	15 , 16 , 18 , 24 , 26 , 27 , 28
Disclosure	Students who disclosed their neurodivergence experienced disbelief, judgement and hostility from educators and peers. However, disclosure was often necessary in order to access support.	16 , 22 , 24 , 26 , 28
Accommodations and supports	Formal adjustments were often generic, typically consisting of additional time for assessment tasks. Personalised accommodations to support learning in the clinical environment were lacking.	15 , 24 , 29 , 30 , 31
Framing of neurodivergence	Most studies defined neurodivergence using a medical model of disability. Although some studies identified strengths of neurodivergent learners, the focus tended to be on deficits within the individual student and their need for accommodations.	32 , 33 , 34 , 35

3.3.2. Identities

Two forms of identity were frequently described in the included papers, often found in tension with one another: neurodivergent identities, and professional identities. Among the studies that described broader experiences of identity construction, students' sense of self was framed as being continually shaped by the learners themselves and by those they interact with (including staff, supervisors and patients). ³⁶ , ³⁷

Earlier papers often framed identifying as dyslexic as a negative experience; as something to be avoided or overcome. ²⁶ , ²⁷ , ²⁸ , ³⁸ , ³⁹ , ⁴⁰ As the broader social narrative shifted towards the neurodiversity paradigm in more recent years, papers increasingly described students positively identifying and navigating disclosure.

Several papers highlighted that students identifying as neurodivergent can bring opportunities for insight and development of self‐regulated learning skills. ⁴¹ , ⁴² , ⁴³ In the context of course requirements and study management this was described as part of the development of professionalism skills, with students framing self‐management as part of their duty to their patients. ²⁹ , ⁴¹ In many papers, students related that affirming a neurodivergent identity may bring a sense of being part of a community, particularly where (professional) role models are visible. ³⁰ , ³⁶ , ⁴² This correlates with evidence suggesting that holding a well‐developed sense of a neurodivergent identity can be protective against the risk of burnout. ¹²

However, many of the papers reviewed – including those based on both student and educator narratives – highlighted that tension arises when a neurodivergent identity is not seen as compatible with a health professional identity. This perceived incompatibility was commonly linked to questions of competence and patient safety, ²⁷ , ³² , ³⁶ , ³⁷ but also to personal characteristics of neurodivergent students which were seen as inherently unprofessional (e.g. preferring not to make eye contact, fidgeting during teaching sessions). ³¹ , ⁴² These papers also cited learners' perceptions of their neurodivergent identities conflicting with the dominant archetype of the ideal student/professional ⁴⁰ , ⁴⁴ , ⁴⁵ ; the ‘capability imperative’ for health professionals to be selfless, hyper‐able‐bodied (and ‐minded) and eternally competent. ⁴⁶ Students in these studies reported that professionalism ⁴² , ⁴⁴ or fitness to practice ³⁹ , ⁴⁴ processes could be ‘weaponised’ as exclusionary measures.

Other studies pointed to the impact of unsafe environments, and the subsequent need to engage in masking or camouflaging (concealing neurodivergent traits to conform to neurotypical norms ⁴⁷ ) to better fit the professional identity archetype. ⁴² , ⁴⁴ , ⁴⁵ Although earlier publications may not have framed this process using the same language, they describe similar concepts of minimising aspects of one's identity or hiding challenges. ²⁶ , ²⁸ , ³⁶ , ³⁷ , ³⁹ The process of masking came at a significant cost to students' energy available for study and poses significant challenges to self‐identity. Working in an environment which requires masking was at odds with the concept of neurodivergent identity being inseparable from the individual. ⁴⁴

3.3.3. Disclosure

Similar tensions were described around disclosure. In some papers, students identified that the risks of disclosure related to the perceived incompatibility of professional identity and a neurodivergent identity – generally relating to the perceptions of educators but sometimes also peers. ⁴⁰ , ⁴² Responses to students' disclosure include disbelief or discounting of student experiences, ⁴⁰ , ⁴⁴ judgements around capability, ³⁷ and sometimes outright hostility. ⁴²

In many of the included papers, educators felt that students held the responsibility for disclosing neurodiversity or disability in order to access adjustments. Without disclosure, educators felt that they were not able to provide support to students. ³² , ³³ , ³⁴ , ³⁵ In some studies, disclosure was framed as a requisite of professional behaviour, or ‘concealment’ was equated to a lack of trustworthiness. ²⁹ , ³³ In others, students noted that it is often difficult to obtain the formal diagnosis required to access supports, adding to the pressure they experienced. ²⁹ , ⁴²

The included papers highlighted that disclosure as a student was not experienced as a single isolated event. This was not always clear to students commencing their courses, who sometimes expressed frustration that disclosure to university disability services did not result in access to support in an ongoing manner. ³⁶ Disclosure was required on many occasions, with different staff and in different environments, and each may be met with a different response. The risks of disclosure were also higher in competitive, high‐pressure or time‐limited environments, which were most often encountered during clinical placement. ⁴²

3.3.4. Accommodations and supports

Overall, there was evidence in the included papers suggesting that formal reasonable adjustments can have a positive impact on academic outcomes, enabling neurodivergent students to attain comparable academic outcomes and similar levels of success in their degrees as neurotypical peers. ⁴⁸ , ⁴⁹ However, these positive effects were largely contingent on the provision of appropriate and personalised accommodations or adjustments. ⁵⁰

Some studies pointed to a discrepancy in the perceptions of educators and students. Educators described providing accommodations for neurodivergent learners, which mostly included extra time for assessments or exams. ⁴⁸ , ⁴⁹ However, students felt that while educators espoused their support for inclusivity and the provision of reasonable adjustments, to have the most benefit they needed to be relevant to neurodivergent‐specific learning needs (as distinct from assessment), and tailored to both the course and the clinical learning environment. ³⁶ , ⁴² , ⁵¹ There was also evidence of disability support staff having limited familiarity with clinical work, with some studies reporting that the adjustments provided were not always appropriate. ²⁷ Together, the included studies described the need for collaborative relationships between educators and students to identify accommodations that were an appropriate fit for both the individual and the learning context. ⁵⁰ , ⁵²

These relationships were contingent on cultures which enable disclosure. A clear pattern was observed across studies, where students and educators experienced clinical environments as more challenging, and as spaces where stigma or ablism was more evident. ²⁷ , ²⁹ , ³⁶ , ³⁷ , ³⁸ , ³⁹ , ⁴¹ , ⁴⁵ This may be because clinical spaces are sites in which the archetypes of the ideal health professional are most clearly embodied, in addition to the time and resource pressures associated with balancing education and patient care. ³⁷ Students found that disclosure in clinical environments did not always result in the availability or effectiveness of adjustments, but instead led to restricted access to learning activities (e.g. patient contact), ³⁹ , ⁵³ further emphasising the risks of disclosure and reducing access to learning opportunities. Within these papers, students who experienced stigma or who did not disclose for fear of stigma did not seek accommodations or feel confident to advocate for their needs. ⁵¹ , ⁵⁴ , ⁵⁵ Conversely, students were more likely to have had positive experiences when colleagues and supervisors had received training on neurodiversity, ⁴⁵ or in environments where they felt safe to embrace their neurodivergent identities. ³⁶

Effective provision of accommodations was also contingent on educator knowledge. In several papers, training was identified as a requirement to enhance educator awareness and skills to better support learning, engagement and clinical practice for their students. ³¹ , ³⁴ , ³⁵ Some educators described feeling restricted in their role or lacking clear guidelines and policies. Others described providing informal and more personalised supports that extended beyond formal adjustments, ⁴² , ⁵¹ which were influenced by the knowledge and perspectives of each unique educator and therefore less consistent or regulated. ⁴² This was particularly evident in instances where a student had not sought formal adjustments, yet individual educators were aware of their unique needs. ³³ Educators also had low self‐reported knowledge of the pedagogical basis for accommodations helpful in supporting neurodivergent learners, ³¹ and this was compounded by students being unclear about what accommodations were available.

3.3.5. Framing of neurodivergence

Most studies framed neurodivergence using a medical model, understanding neurodivergence as disability and defining disability as an individual problem compromising effective participation. ¹⁷ A number of studies defined neurodivergence using the formal diagnostic criteria outlined in the DSM‐5. ⁵⁰ , ⁵² , ⁵⁶ This approach is consistent with the dominant view within higher education, ⁵⁷ and reflects the focus of many of the included studies on compliance with university requirements to provide reasonable accommodations.

A smaller proportion of included studies identified specific strengths that neurodivergent learners bring as future health professionals or identified strategies that neurodivergent learners developed during their studies to support their own learning. ²⁸ , ³¹ , ³² , ³⁵ , ³⁸ , ³⁹ , ⁴¹ , ⁴³ , ⁵⁴ , ⁵⁸ , ⁵⁹ , ⁶⁰ , ⁶¹ , ⁶² Of note, identification of neurodivergent strengths did not necessarily reflect a neuroaffirming framing of the work. For example, despite enumerating strengths associated with dyslexia, an earlier (2006) article reporting on a nursing programme suggested that there may be merit in including dyslexia screening as part of the admission process. The premise for this was a concern that prospective students with ‘severe’ forms of the condition may present a ‘potential threat to public safety’. ³⁹

The narratives around neurodiversity in included studies were predominantly focused on deficits located in the individual, and the responsibility of educators to mitigate the impact of these deficits to support the learner. ²⁷ , ³¹ , ³⁹ , ⁴⁸ Few studies explicitly or implicitly took a social or relational framing approach, ¹⁷ which would allow for a contextualised understanding of learner experiences as being constructed by interactions between the individual, their needs and capabilities, and their physical, social and structural environments. ³⁸ , ⁴² , ⁴⁴ , ⁶³ , ⁶⁴

The increasing number of papers examining neurodivergence as distinct from disability more generally may facilitate a more nuanced understanding of the student experience, given the considerable variability in the ways that neurodivergent students relate to concepts of disability identity. ⁶⁵ , ⁶⁶ However, as several studies described the health professions environment as one where disability is viewed as a stigmatised identity, this relationship may be even more fraught for these learners. ²⁷ , ³² , ³⁶ , ³⁷ , ⁴³ , ⁴⁴ Only a small number of the most recently published papers were framed with a neuroaffirming perspective or took a human rights approach, ⁵⁴ , ⁶⁷ which like the social model of disability challenges assumptions about the dominant norms of the educational system. ²²

3.3.6. Intersection between key themes

Intersections were also apparent between each of the key themes. Consideration of these intersections provides a nuanced understanding of emerging perspectives, lived experiences and unmet needs of neurodivergent health professions students. The prevailing models used to frame disability and neurodiversity significantly influence both educators' practices (including provision of accommodations) and neurodivergent students' sense of identity and decisions about disclosure.

A medical model of neurodivergence can prompt educators to view accommodations as burdensome mechanisms that compensate for individual student deficits and uphold professional identity standards based on neurotypical norms. ²⁸ , ³⁸ , ⁵⁰ , ⁶⁸ , ⁶⁹ The high‐pressure demands of clinical work can compound the perceived risks associated with disclosing neurodivergence, and these perceptions from educators. Reliance on diagnostic labels may also disregard the co‐existence of multiple forms of neurodivergence which also hinder the development of inclusive curricula and support. Students experiencing these exclusionary standards, negative outcomes of disclosure or poor experiences when seeking accommodations may experience greater levels of identity dissonance and increased risk of distress. ²⁷ , ⁴⁰

Conversely, educators working from a neurodiversity‐affirming perspective can create inclusive professional identity standards, accessible and tailored accommodations and respond to disclosures constructively and compassionately. ²⁸ , ⁷⁰ , ⁷¹ The complex and dynamic relationship between the themes described in this review illustrates the way the models of disability and neurodiversity in use have a profound impact on how neurodivergent students construct their identities and how educators perceive and interact with them, creating a dynamic interplay. However, gaining a greater understanding of this complexity through addressing key research gaps offers many opportunities for positive interventions.

4. DISCUSSION

This scoping review documented an evolving body of data regarding the experiences of neurodivergent health professions students and the educators who work with them. The narrative built around this data has evolved over time, informed by changing practice in health professions education, social discourse around neurodiversity, diagnostic patterns and sociological frameworks such as critical disability studies.

Relevant papers only emerged after 1995, likely reflecting the growing interest in disability inclusion in higher education around this period, driven by the 1994 UNESCO Salamanca Statement, ⁷² and international enactment of legislation governing disability rights in higher education. The focus on dyslexia or other specific learning differences just after this period possibly reflects the limited recognition at the time of autism, ADHD and other forms of neurodivergence in adults, particularly in women. ⁷³ The decline in papers focusing on specific learning differences in the last 5–10 years may reflect the increasing recognition of co‐occurrence of this phenomenon with other forms of neurodivergence, ⁷⁴ as well as recognition of common patterns of overlap between diagnoses and identities within the neurodivergent “umbrella”. ⁷⁵ , ⁷⁶ , ⁷⁷ However, it is also possible that this is correlated with the shift to increasing use of technology in learning post‐2020, which may have changed the experience of dyslexic learners. ⁷⁸ The later shift from papers considering forms of neurodivergence as a type of disability to focusing specifically on autism, ADHD or other neurodivergence may also represent a change in researchers' and educators understanding of neurodiversity as being a phenomenon requiring attention in its own right. ⁵

An emerging pattern in both the papers reviewed and the broader higher education literature is the shift in focus outward from the deficits experienced by the neurodivergent individual to the challenges they encounter as a learner. The earlier narrow focus aligns with a pathologisation of neurodivergence which underpins experiences of stigma and marginalisation. ⁴⁷ However, more recent papers reflect the increasing representation of neurodiversity paradigms in broader social discourse. They also align with emerging trends within neurodiversity scholarship, and how accommodating environments and enablers of neurodivergent flourishing are increasingly prioritised over conventional models of impairment mediation. ¹⁶ , ⁷⁹ While the intent of many of the early papers reviewed could be seen as benevolent, from a critical disability theory standpoint we can see such an approach as further reinforcing the medical model of disability. ¹⁷ In the higher education context this view requires neurodivergent students to identify themselves as such and to change their actions and behaviours, ⁵ in contrast to approaches questioning the implicit assumptions built into ableist educational systems, as called for by a critical disability theory framework. ⁸⁰

The shift to a neuroaffirming approach in higher education calls on educators and higher education institutions to shift their focus from the individual to the learning environment, and critically evaluate how stigma, language and learning environments and systems may be impeding neurodivergent students' learning. ⁵ , ⁸¹ A recurring theme in the literature is the tension between the expectation that students disclose their neurodivergence to access supports, and the many accounts of poor experiences when they do disclose. ⁴² , ⁴⁴ , ⁵⁴ , ⁶¹ Tensions were often compounded by cultures of stigma that created barriers to disclosure, psychological safety and subsequent masking of neurodivergent characteristics. ²⁷ , ⁴⁰ , ⁴⁴ These factors compromised learners' autonomy and agency in educational environments, which hindered their capacity to engage with their learning and achieve success. ⁷⁰ This underscores a systemic issue within higher education that burdens disabled students with the need to establish credibility, legitimacy and self‐advocacy in addition to negotiating their studies. ⁶³ , ⁸²

The reviewed literature suggests that there is commonly a limited repertoire of formal adjustments provided, without tailoring to the individual or the clinical environment. Narratives from educators suggests that they are not clear on what accommodations might be helpful for neurodivergent students, and students are unclear on what they could reasonably request. There is a significant opportunity for further research identifying what adjustments and accommodations are effective, particularly in the clinical environment, and how to provide these in a systemic and sustainable manner. Importantly, further research could examine approaches to clinical teaching and assessments based on universal design for learning, therefore reducing the need for individual accommodations. ⁸³

Situating our interest in the clinical environment, the data here reviewed points to particular social and contextual factors of relevance to the neurodivergent student experience. Many papers described pragmatic issues relating to educator workloads and the need to balance patient care tasks with learner support. However, more pervasive and perhaps less clearly identified are the highly embodied archetypes of hyperable‐bodied and ‐minded health care professionals. ⁸⁴ While many papers pointed to a tension between a neurodivergent identity and the ideal of a health professional identity, there was limited exploration of what drives this phenomenon and how educators can intervene to craft environments where students can navigate these intersections safely as they progress through their studies. A key gap in the literature to help educators understand students' experiences is the exploration of interfaces between experiences of stigma, contested and marginalised identities, ⁴⁷ masking behaviours, ⁸⁵ and the extent to which neurodivergent students feel they belong as health care professionals. ⁸⁶ , ⁸⁷ Future research in this area can explore the role of power structures within health professions education and the mechanisms by which students who do not fit the archetype of the ideal health professional are afforded less power and agency and therefore are at greater risk of identity dissonance. ⁸⁷ , ⁸⁸

There were also only passing references to the impacts of curriculum relating to neurodiversity on the neurodivergent student experience, particularly where key concepts are taught in a non‐inclusive manner. Few papers provide educators information on how to ensure that health professions students are taught about current concepts of neurodiversity in a neuroaffirming manner, or how to support neurodivergent students when they are exposed to unsafe discussions (for example, around screening, prevention or cure for neurodivergence). These instances are when students might experience further dissonance between their neurodivergent identity and their health professional identity, as has been described in students with disability more broadly. ⁸⁹ , ⁹⁰

4.1. Summary of key gaps in the literature

• Research informed by the neurodiversity paradigm and critical disability theory: Research that does not sufficiently address the broader social and political context of neurodiversity and disability, or takes into account intersectionality, runs the risk of failing to disrupt systems which are unjust, or causing further harm to neurodivergent learners. ¹⁸ , ⁸⁰ In line with this approach, future research can appropriately focus on steps educators can take to enable and empower neurodivergent students, in addition to reforms to educational practice that promote true inclusion and systemic change.

• Further exploration of the changing definition of professionalism: Professionalism is a core aspect of most health professions programmes. It is therefore critical that further research explore the intersections between explicit and implicit professionalism expectations and neurodivergent student identities.

• Further exploration of neuroaffirming approaches to teaching health professions students about neurodiversity: New approaches are required in order to provide safety to neurodivergent students, and to engender neuroaffirming practice in future health professionals.

• Transdiagnostic approach to research: Given the common co‐occurrence of multiple forms of neurodivergence, there is value in further research describing the experiences of neurodivergent health professions students which is not limited by diagnostic boundaries.

• Cross‐disciplinary approach to research: Many of the structural and cultural challenges associated with health professions programmes are common across disciplinary and professional boundaries, in particular relating to the clinical environment. There is therefore value in research which explores aspects of clinical learning and placement further.

4.2. Limitations

The following limitations to this study should be noted. Firstly, although a wide range of terms were included in our search, due to changing trends in the language used to describe neurodivergence, it is possible that relevant studies were omitted from our search. Secondly, as our search was limited to publications written in English, our findings primarily reflect the experiences and perspectives of English‐speaking countries and institutions.

5. CONCLUSION

In seeking to explore the evolution of literature regarding neurodiversity in health professions education, this review identified a progressive shift from papers examining predominantly dyslexia, towards a broader understanding of neurodivergence, and a more commonly neuroaffirming perspective. However, despite the diversity of health professions programmes examined and the time span of the included literature, some common themes emerged.

We identified that neurodivergent students experience a unique tension between their neurodivergent and professional identities. This tension was often associated with themes of masking and challenges relating to disclosure of neurodivergence in unsafe learning environments. These challenges were often more apparent in clinical settings. However, while the existing literature provides some insights into the neurodivergent student experience, there are several opportunities for further exploration identified by this scoping review which could further support educators to provide safe, inclusive learning environments for neurodivergent health professions students.

Importantly, the student voices in the literature reviewed call us to reframe both research and educator practice away from a deficit perspective to a more nuanced approach; adopting an understanding that recognises the plurality and contextualised nature of the neurodivergent experience. In short, neurodivergent students have distinct capabilities and can thrive given appropriate social, physical and structural environments, and educators and students will benefit from recognising, celebrating and supporting this complexity.

AUTHOR CONTRIBUTIONS

All authors made substantial contributions to the conception and design of the work; or the screening, review and analysis of included literature, and the drafting, review and revision of the manuscript. All authors have approved the submitted manuscript and agree to be accountable for all aspects of the work.

ACKNOWLEDGEMENTS

The researchers would like to acknowledge the contributions of Emma Stevens to the initial concept for this work.

CONFLICT OF INTEREST STATEMENT

The authors have no direct or indirect financial ties or consultancies with the developers of any software or applications used in this research, or any party that could benefit from the publication of these findings. The authors declare no other conflicts of interest. https://doi.org/10.17605/OSF.IO/G2KTS.

ETHICS STATEMENT

This research utilized publicly available data from published sources. As the study did not involve direct interaction with human subjects or the collection of private identifiable information, formal ethics approval was not sought.

Supporting information

Table S1: Full search strings.

Table S2: Publications included for analysis.

Table S3: Framework for analysis.

Gray L, McNeill B, Pecora L, et al. Navigating neurodivergence: A scoping review to guide health professions educators. Med Educ. 2025;59(10):1037‐1048. doi: 10.1111/medu.15676

DATA AVAILABILITY STATEMENT

The data that supports the findings of this study are available in the supplementary material of this article.