Stop levelling the playing field in HE – it’s time to redesign the stadium

World Cup stadiums are often celebrated as neutral spaces of competition. But like higher education systems, they are carefully designed environments that determine who can participate, and how.

Universities often describe accommodations as a way to “level the playing field” for disabled students (identity-first language intentional). It is a convenient metaphor. If some students encounter barriers, we do our best to remove them so that disabled students have the same shot at success as their peers.

Accommodations remain essential, and for many disabled students they make participation possible. But what if the metaphor limits how we think about inclusion in higher education?

Metaphors do more than simplify complex ideas; they shape how we understand problems and, therefore, the solutions we pursue. If we imagine higher education as a playing field, our attention naturally turns to smoothing uneven ground while assuming the field itself is fundamentally fair. We ask how disabled students can adapt. We rarely stop to ask who designed these environments, or for whom. 

Perhaps the problem is not the field. Perhaps it is the stadium.

A stadium is much more than the grass beneath our feet. It includes the entrances, seating, changing rooms, lighting, scoreboards, rules of the game and assumptions about who belongs there in the first place. Every element reflects design decisions.

Healthcare education resembles a stadium far more than it does a playing field. Admissions processes determine who enters. Technical standards shape who is considered capable of becoming a healthcare professional. Assessment practices define what counts as competence. Clinical placements reward particular ways of working. Institutional cultures influence who feels they belong.

None of these systems emerged naturally. They were designed around historically dominant assumptions about the “ideal” learner and practitioner. 

Disability scholar Lennard Davis argues that “normal” is not a biological fact but a historical and social construction. Educational institutions were built around assumptions about the “normal” body and mind, and those assumptions became embedded in ideas of competence, professionalism and educational excellence. If normality is socially constructed, then educational systems built around it are not neutral, they are designed. But what is designed can be redesigned.

This shift in perspective changes how we think about accessibility in higher education. The question is no longer simply “How do we support disabled students?” It becomes “How do we design programmes that expect human diversity from the outset?”

A useful place to begin is to review the systems that define competence. Whenever programmes review admissions criteria, technical standards or assessments, four questions can help shift the conversation from accommodation to design:

• What are we trying to achieve?
• Does this requirement measure that outcome or merely reflect tradition?
• Who might be unintentionally excluded?
• Who needs to be involved in redesigning this process?

Assessment is an obvious place to start. Does every student need to complete the same timed written examination, or could they demonstrate clinical reasoning through multiple formats without compromising academic standards? Where flexibility preserves learning outcomes, it should be viewed as good educational design rather than an individual concession.

• Spotlight guide: Make learning accessible to all in higher education
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Clinical education also deserves scrutiny. Placement models often assume one correct way to organise working hours, communicate with colleagues or perform clinical tasks. Yet healthcare is increasingly collaborative, technology-enabled and adaptable. Educational environments should prepare students for this reality rather than reproduce historical practices that may unnecessarily exclude talented future clinicians.

Universal design for learning encourages educators to anticipate learner variability from the outset instead of relying on individual accommodations once barriers arise. Extending this principle to programme policies, assessment strategies and clinical education shifts accessibility from a reactive service to a core design principle.

Perhaps the most important redesign strategy is to involve disabled people in shaping the system itself. Too often, disabled students are viewed primarily as recipients of accessibility services or consulted only after barriers become apparent. Universities should instead involve disabled students, clinicians and academics as partners in reviewing curricula, designing assessments and reconsidering technical standards. Their lived experience provides expertise that complements professional knowledge and identifies barriers that others may overlook.

Recent scholarship describes this as a “haunted curriculum”: educational practices that continue to carry historical assumptions about who belongs in the professions, even when those assumptions no longer serve contemporary healthcare. Recognising this legacy is not about assigning blame. It is about recognising that institutional assumptions often outlive the historical contexts that created them.

Redesigning the stadium is about improving healthcare itself. Disabled learners carry forms of clinical insight that cannot be taught through textbooks or simulations: they have navigated fragmented systems, anticipated inaccessible environments and understood first-hand how institutions either include or exclude the people they are meant to serve. As clinicians, these experiences translate into stronger patient advocacy, sharper systems thinking and a more grounded understanding of what exclusion means from the inside. A healthcare workforce that includes disabled professionals is better equipped to reflect and respond to the diverse communities it serves. When educational systems require disabled learners to continually adapt to environments they had no role in creating, we risk losing precisely the perspectives healthcare needs most.

The playing field metaphor has helped universities recognise that some learners face barriers others do not. But perhaps the next question is now, “Who designed the stadium and who was missing from the blueprint?”

Daphne Pereira is the academic coordinator of clinical education at Dalhousie University in Canada. 

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