Discussion

Key results

Facilitators for inclusion in clinical dental education

Facilitators affecting the inclusion of students with hearing disabilities emerged across pedagogical, technological, communicative, relational, and sociocultural dimensions. Participants described multiple pedagogical adaptations that supported participation in preclinical and clinical learning environments, including early access to lectures and study materials, flexible assessments, extended clinical time, and visual teaching resources such as images, videos, and color-coded notes. Reduced student-to-instructor ratios and coordination between faculty members and interpreters also improved accessibility. Alternative communication strategies played a central role in supporting participation and comprehension. These strategies included lip reading, written communication, visual supports, Chilean Sign Language, and the use of transparent masks when possible. Faculty members described adapting their communication styles by maintaining visual contact, repeating instructions, and incorporating visual explanations to improve understanding. The collaborative development of dental terminology in Chilean Sign Language by students and interpreters also emerged as an important strategy for supporting clinical learning.

Technological resources represented another important facilitator. Participants described the use of real-time transcription tools, microphones with automatic captioning, tablets, digital applications, and social media platforms to support communication, learning, and autonomy in academic and clinical settings. Flexible assessment practices also facilitated inclusion, including additional time during examinations, modifications to evaluation formats, clarification of instructions in Chilean Sign Language with interpreter support, and grading approaches that prioritized conceptual understanding over grammatical accuracy in written Spanish.

Relational support emerged as a critical component of inclusion. Faculty characteristics such as empathy, patience, flexibility, and willingness to adapt teaching practices were highly valued by students. Participants described inclusive educators as professionals who provided emotional support, repeated explanations when needed, and actively sought accessible ways to communicate clinical content. Support networks involving peers, family members, partners, tutors, and institutional staff also contributed substantially to students’ academic continuity and well-being. Emotional support, academic assistance, and collaborative learning practices were frequently described as essential for navigating clinical education. The Chilean Sign Language interpreter occupied a particularly important role in both educational and clinical settings. Beyond interpretation, interpreters acted as communicative and pedagogical mediators, facilitating understanding among students, faculty members, peers, and patients. Their role also extended to tutoring and study support.

Participants also emphasized the importance of recognizing students with hearing disabilities as capable and autonomous individuals in clinical education. Faculty members and interpreters highlighted students’ responsibility, perseverance, adaptability, and commitment to professional training. The findings also reflected recognition of the broader social value of inclusive dental care, particularly the importance of training professionals who can communicate directly with Deaf patients in Chilean Sign Language and contribute to more accessible healthcare environments.

Barriers to inclusion in clinical dental education

Participants identified multiple barriers affecting inclusion in clinical dental education across structural, institutional, communicative, and attitudinal dimensions. Structural challenges included noise, limited physical space, inadequate lighting, and the complexity of interactions in clinical environments, all of which created difficulties for communication and learning. Participants also described the need for larger clinical cubicles, visual alert systems, and environmental adaptations to improve accessibility. Institutional barriers were frequently described as reactive rather than proactive. Participants reported insufficient planning time for inclusive strategies, lack of institutional coordination, and limited integration between faculty and inclusion support services. Inclusive practices often depended on individual initiatives rather than being systematically embedded in clinical education structures.

Communication difficulties represented one of the most significant barriers identified in the study. Participants described challenges in interactions with patients, peers, and faculty members, particularly in fast-paced and communication-intensive clinical environments. Difficulties related to academic literacy were also reported, including comprehension of lengthy texts, written examinations, and academic writing in Spanish, which was described as a second language for Deaf participants. Social interactions during clinical training also presented challenges. Participants described tensions related to coordination with clinical partners, requests for peer support, and concerns regarding fairness in the distribution of clinical work. Experiences of social isolation and discomfort when seeking assistance outside close social circles were also reported.

Faculty members frequently described feeling insufficiently prepared to teach students with hearing disabilities in clinical settings. Although participants expressed interest in learning inclusive strategies and Chilean Sign Language, they also reported uncertainty and anxiety regarding inclusive teaching practices. Participants additionally described experiences of prejudice, misconceptions, and discriminatory attitudes toward individuals with hearing disabilities. These included assumptions regarding reduced efficiency, concerns about clinical errors, exclusion from group feedback processes, and communication practices that relied heavily on inaccessible auditory cues. Some participants also reported concerns regarding discrimination from patients and peers in clinical environments.

Interpretation

The findings suggest that inclusion in clinical dental education for students with hearing disabilities is shaped by the interaction between facilitating mechanisms and persistent systemic barriers. Pedagogical adaptations, assistive technologies, alternative communication strategies, and relational support promoted participation and accessibility in communication-intensive clinical environments.

However, structural, institutional, communicative, and attitudinal barriers continued to limit inclusion. Noise, spatial constraints, and complex real-time interactions created significant challenges, consistent with previous research on clinical education settings [8]. Institutional responses were often reactive, reflecting limited anticipatory planning and insufficient faculty preparation in inclusive education and sign language.

These findings support literature suggesting that barriers are embedded within educational systems rather than inherent to students themselves [2]. They also align with studies showing that Deaf and hard-of-hearing students frequently rely on individual coping strategies to compensate for insufficient accessibility measures [4].

Comparison with previous studies

The findings of this study are consistent with previous research showing that inclusion in higher education is shaped by the interaction between structural, pedagogical, and relational factors. Similar to prior studies, the barriers identified in this research were associated with communication difficulties, insufficient institutional planning, inaccessible learning environments, and limited faculty preparation in inclusive education [2,8]. The importance of technological resources, communication adaptations, and support networks as facilitators was also consistent with previous literature.

In agreement with studies focusing on Deaf and hard-of-hearing students, participants in this study described the need to develop individual coping and adaptation strategies in response to insufficient accessibility measures [4]. Likewise, the communication-intensive nature of clinical education appeared to intensify barriers related to noise, overlapping interactions, and real-time communication demands, as previously described in clinical training settings [8].

A notable contribution of the present study is its specific focus on clinical dental education, an area that remains relatively underexplored in the literature. Unlike broader studies on disability in higher education, these findings highlight how communication barriers, clinical workflows, and patient interactions uniquely shape inclusion in dental training environments.

Limitations

Small sample size and single-site design limit the generalizability of this study. The lack of quotations reduces narrative depth.

Generalizability

The findings of this study have several implications for higher education institutions, particularly those involved in clinical training. First, they highlight the need to strengthen faculty development in inclusive pedagogical practices, especially in communication-intensive environments. Second, they underscore the importance of ensuring that accessibility measures are not only available but also consistently implemented across different courses and clinical settings.

Additionally, the results suggest that institutions should adopt a more proactive approach to inclusion, integrating accessibility into the design of clinical teaching rather than relying on reactive accommodations. This includes anticipating communication barriers, adapting teaching strategies, and fostering collaborative practices between students, faculty, and support services.

Suggestions

Future research should explore inclusion in clinical education across multiple institutions and healthcare disciplines. Higher education institutions should strengthen proactive accessibility planning and faculty training in inclusive practices within clinical teaching environments.

Conclusion

This study demonstrates that inclusion in clinical education for students with hearing disabilities is a multidimensional and dynamic process shaped by the interaction between structural conditions, pedagogical practices, and individual agency. Although students develop adaptive strategies to navigate barriers, these strategies often compensate for systemic limitations rather than reflect fully inclusive environments.

The findings highlight the need to move beyond accommodation-based models toward more integrated and anticipatory approaches that embed accessibility within the core design of clinical education. By doing so, higher education institutions can better support not only access but also meaningful participation and belonging for students with disabilities.