The impact of disability competency frameworks in guiding curriculum development in healthcare education: a scoping review
TL;DR
No single framework emerged as superior; the commitment to intentional, structured disability education, regardless of framework, was associated with improvements across disciplines and contexts.
Abstract
More than one billion people worldwide, and more than one in four US adults, have a disability, yet continue to face barriers to equitable healthcare. Evidence links these disparities to inadequate professional preparation: limited disability-focused content, persistent ableist attitudes, and the absence of structured competency frameworks. This scoping review mapped how current disability competency frameworks guide curriculum development in healthcare education, identifying frameworks, instructional approaches, and outcomes across disciplines and contexts. A scoping review was conducted in accordance with PRISMA-ScR guidelines. Databases searched, in collaboration with a health sciences librarian, included Medline, CINAHL, Embase, and Scopus. Studies were eligible if they were peer-reviewed, published from 2010 onward, available in English, and used an identifiable framework, competency set, model, theory, or professional standard to guide disability-focused education within a formal healthcare education program. Three independent reviewers conducted screening in Covidence. Forty-seven studies met inclusion criteria, representing 12 countries. Learner populations included medical, nursing, dental, pharmacy, physical and occupational therapy, and social work, with medical students the most frequently studied population. Four framework categories were identified: formal competency frameworks from accrediting bodies or national health authorities; educational theory frameworks drawn from the learning sciences; disability rights and justice frameworks; and practice-specific or hybrid frameworks. A diverse range of named frameworks, theories, competency sets, and professional standards was identified, with relatively few recurring across multiple studies. Instructional approaches ranged from simulation and experiential learning to arts-based methods, virtual platforms, and interprofessional education. Nearly all included studies reported at least one positive learner outcome; most reported statistically significant improvements in self-reported attitudes, knowledge, and confidence, while few assessed clinical behavior or patient experience. Studies incorporating people with disabilities as educators or co-designers and those using experiential approaches reported some of the strongest and most durable outcomes. No single framework emerged as superior; the commitment to intentional, structured disability education, regardless of framework, was associated with improvements across disciplines and contexts. Significant gaps remain in geographic representation, disciplinary coverage, evaluation rigor, and the durability of measured outcomes. The findings support calls for mandatory disability competency requirements, longitudinal curriculum design, and authentic partnership with disability communities in program delivery.