A survey of internal and family medicine residents: Assessment of disability-specific education and knowledge

Obstetrics and Gynecology Resident Comfort in Caring for Pregnant People with Physical Disabilities

Pregnant people with disabilities face higher complication rates, yet few guidelines exist on caring for this population. This study evaluates obstetrics and gynecology (OBGYN) residents' comfort in caring for pregnant people with physical disabilities.A 19-question e-survey was developed and piloted for content and face validation. Likert scale was used to assess comfort in caring for pregnant patients with physical disabilities. The e-survey was sent to U.S. OBGYN residents via CREOG-coordinator listserv, a listserv to all U.S. OBGYN residency coordinators, in February 2024, with three reminder emails. Descriptive statistics were used to analyze the data, and variables with clinical and statistical significance were considered for adjustment in regression models.Eighty-eight residents completed the survey. The mean age was 29 years; 88% identified as female. All ACOG regions were represented. Eight and 44% reported formal education on disability care in residency and medical school, respectively. Seventy-three percent felt uncomfortable positioning disabled patients for a pelvic examination, 59% felt uncomfortable discussing sexual health practices, and 89% felt uncomfortable making recommendations regarding the mode of delivery. Those without education in residency were 91% less likely to be comfortable making recommendations regarding the mode of delivery (absolute risk reduction [aRR]: 0.09; 95% confidence interval [CI]: 0.01 and 0.59). Only 30% were comfortable discussing lactation/breastfeeding with patients with physical disabilities; residents without personal experience including caring for family members or friends or other caretaking experiences were 66% less likely to be comfortable (aRR: 0.34; 95% CI: 0.12 and 0.99). A total of 92.5% of residents wanted more education in this space. Of those 83, 71, and 82% desired didactics, patient panels, and simulations, respectively.Among responding residents, comfort in caring for pregnant people with physical disabilities is low. Additional training is necessary to adequately care for this population. · OBGYN resident comfort with disability care is low.. · Few residents receive formal disability training.. · Formal education improves disability care comfort..

Cross-sectional analysis of disability education in American Medical Schools

Greater than 25% of the American population has a disability. The demand for disability-informed physicians underscores the need to better prepare physicians to care for patients with disabilities. This study presents findings from three Qualtrics survey studies that investigated (1) medical students' exposure to patients with disabilities while on clinical rotations at Western University of Health Sciences, (2) students' perceived preparedness to care for patients with disabilities nationwide, and (3) the effectiveness of Special Olympics online modules to teach students about caring for patients with disabilities. Descriptive analysis from these studies together indicated that medical students did not feel prepared to care for patients with disabilities. To remedy this, Special Olympics online modules for healthcare professionals were found to effectively enhance student physician training. These findings highlight a critical need for improved medical training to prepare the next generation of physicians to care for patients with disabilities, while outlining a possible educational tool that could be incorporated into medical school curriculum.

Dismantling Ableism in Undergraduate Medical Education: Promising Practices in Disability-Conscious Training

The healthcare workforce in the United States does not provide the same standard of care for people with disabilities as for nondisabled people. Many academic medical institutions do not routinely offer disability-conscious medical training, and many clinicians and medical educators feel ill-equipped to incorporate anti-ableist learning goals into their curricula. Drawing on a critical review of the literature and interviews with medical educators, representatives of professional organizations, and disability advocates, this article presents promising practices for disability-conscious undergraduate medical education. Disability-conscious education, which is grounded in the insights of disability studies and disability rights and justice frameworks, is distinguished from disability-specific education, which may not extend beyond biomedical models of disability. First, we define current approaches to teaching about disability, highlighting limitations and opportunities for further development. We then identify and analyze approaches to teaching about disability that support the development of disability consciousness among learners. With attention to both curricular format and theoretical frameworks, we offer concrete approaches that medical schools can take to equip students with the knowledge, attitudes, skills, and practices they need to provide equitable care for patients with disabilities.

Priority setting for multicenter research among adults with cerebral palsy: a qualitative study

PURPOSE

Identify priorities for adult cerebral palsy (CP) research by engaging individuals with lived experience, clinical investigators, and community leaders.

MATERIALS AND METHODS

Qualitative descriptive study using iterative focus groups, followed by inductive thematic analysis. Participants included adults with CP and caregivers, clinical investigators, and community leaders in the CP and disability spaces. We explored research priorities among three research areas identified a priori- bone health, kidney health, and preventive care.

RESULTS

We conducted four focus groups (20 participants with lived experience; 10 clinical investigators; 9 community leaders). Most participants felt all topic areas were very important, though preventive care emerged as the top priority. We identified three overarching themes that cut across the various research areas discussed: patient and provider knowledge gaps; a precision medicine approach for adult CP care; and the need to address ableism.

CONCLUSIONS

Adults with CP face unique healthcare needs and risks as they age, and the evidence base to guide their care lags significantly behind. Our study identified preventive care as the top research priority for the adult CP research agenda. Next steps in this line of research should focus on interventions to facilitate primary and preventive care interactions for adults with CP.

Reducing barriers through education: A scoping review calling for structured disability curricula in surgical training programs

BACKGROUND

Patients with disabilities face widespread barriers to accessing surgical care given inaccessible health systems, resulting in poor clinical outcomes and perpetuation of health inequities. One barrier is the lack of education, and therefore awareness, among trainees/providers, of the need for reasonable accommodations for surgical patients with disabilities.

METHODS

We conducted a scoping review of the literature on the current state of disabilities curricula in medical education and graduate residency curriculum.

RESULTS

While the literature does demonstrate a causal link between reasonable accommodation training and positive patient-provider relationships and improved clinical outcomes, in practice, disability-focused curricula are rare and often limited in time and to awareness-based didactic courses in medical education and surgical training.

CONCLUSIONS

The absence of structured curricula to educate on anti-ableism and care for patients with disabilities promotes a system of structural "ableism." Expanding disability curricula for medical students and trainees may be an opportunity to intervene and promote better surgical care for all patients.

A Survey on Disabilities and Disability Awareness in General Surgery Residents in the United States

INTRODUCTION

Disabilities affect a substantial portion of the US population, with mental health conditions being predominant. Despite the acknowledged challenges, there is a lack of data on disability prevalence among general surgery residents. This study aimed to compare the prevalence of disabilities in general surgery residents to the national benchmark, investigate the factors that prevent surgery residents from disclosing their disabilities, and assess the presence of a disability policy in a residency program.

METHODS

A descriptive cross-sectional cohort study surveyed 198 general surgery residents from 323 programs using a 33-question conditional survey. The survey, distributed via mass email, covered demographics, disability status, disclosure practices, accommodation use, and awareness of disability policies and training.

RESULTS

Among respondents, 30.3% reported having a disability, higher than the national average. Although 83.9% of respondents reported that their disability has some impact on their ability to work, 62.9% of residents with a disability have not informed their program directors or administration. Moreover, many residents experienced negative outcomes due to their disabilities. Fear of discrimination and lack of transparency, among other factors, were major barriers to disclosure. Only 16.2% received disability training, and 75.3% were unaware of their program's disability policy or if one existed.

CONCLUSIONS

This study reveals significant gaps in disability policy and training within general surgery residency programs in the United States. Despite about 1 in 3 surgical residents reporting a disability, disability support seems lacking, impacting the health of residents and the care provided to patients. Furthermore, many residency programs do not comply with requirements and recommendations regarding disability policy from graduate education organizations. Enhancing transparency, providing robust support systems, and integrating disability awareness into training are crucial steps to improve resident experiences and promote inclusivity in surgical training programs.

How are medical students learning to care for patients with intellectual disabilities? A scoping review

BACKGROUND

Individuals with intellectual disabilities experience barriers to quality healthcare. To reduce this disparity, equipping medical trainees with the knowledge and skills required for treating this patient population is critical. Our aim is to describe the breadth of instructional interventions and identify gaps in intellectual disability medical education curricula.

METHOD

Using scoping review methods, the intellectual disability programmes described in 27 articles were evaluated and their coverage of the six core competencies on disability for health care education was examined.

RESULTS

The most frequently represented core competencies were disability conceptual frameworks, professionalism and communication, and clinical assessment, which were, in most programmes, fulfilled by activities involving individuals with intellectual disabilities. Uneven competency coverage warrants consideration.

CONCLUSIONS

Considerable variabilities exist in medical school curricula on intellectual disabilities. Using core competencies on disability for health care education for curricular design and evaluation would provide a coherent training experience in this important area.

Twelve tips for including disability education in undergraduate medical education

Disability is a large and growing minority population worldwide. People with disabilities continue to experience health and healthcare disparities. Despite multiple calls to action to provide disability education within undergraduate medical education as a strategy to mitigate ongoing inequities, robust disability education is not routinely provided across medical schools. This article provides twelve tips that any medical school faculty can utilize to integrate meaningful disability education within existing core medical education.

Disability-Specific Education in US Internal Medicine Primary Care Residency Programs: A Survey of Program Directors

Phenomenon: The dearth of disability-specific education in United States medical schools and residency programs has perpetuated health care inequities experienced by people with disabilities. In this study, we surveyed internal medicine primary care residency program directors about the disability-specific education they offer their learners, their attitudes toward physicians' preparedness to care for people with disabilities, and their perceived challenges to offering more robust disability-specific education. Approach: We developed an on-line survey and forwarded it in 3 weekly emails during October of 2022 to 104 primary care residency program directors. We collected basic information about the residency programs and queried whether they were providing disability-specific education to their residents, which topics were being covered, and perceived barriers to offering additional disability-focused curricula. Data analyses included descriptive statistics, chi-squared, and independent samples t-tests. Findings: Forty-seven program directors responded (response rate 45.2%). The largest plurality of programs was in the Northeast, their average number of primary care residents was 15.6, most (67.4%) hosted primary care clinics in hospitals or academic centers, and 55.6% had affiliated divisions or departments of rehabilitation medicine. The majority of respondents felt that both internists and their own residents (88.3% and 77.8%, respectively) are inadequately educated in the care of people with disabilities, yet only 13 (28.9%) offered disability-focused curricula, and they tended to be narrow in scope. Only 8 of those 13 respondents (61.5%) reported that their disability curricula were required, rather than optional. Participants listed a number of barriers to implementing disability-focused education including a lack of advocacy for such work (65.2%), lack of time in the curriculum (63.0%), lack of expectation by educational governing boards that physicians understand disability-specific care considerations (60.9%), and lack of affiliated expertise in the care of people with disabilities (52.2%). Insights: While the program directors training future primary care physicians largely understand that physicians are inadequately prepared to offer equitable health care to individuals with disabilities, few of them are offering disability-specific education to their residents and most see significant barriers to doing so.

The Dearth of Disability Medical Education and a Partial Solution

Issue: While over one-quarter of adult Americans have a disability, there is a paucity of disability-specific curricula in American medical schools and residency programs. Potential consequences of this educational dearth include persistent inaccessibility of health care facilities and delivery of inequitable health care to individuals with disabilities. Evidence: Several working groups have proposed disability-specific competencies for health professions education and means by which to integrate them into existing curricula. A limited number of medical schools and residency programs have formally introduced disability-specific materials into their curricula. To our knowledge, however, there are no generalist (internal medicine or family medicine) residency programs that offer specialized training in the clinical care of people with disabilities. Implications: Offering generalist physicians the opportunity to acquire the clinical and cognitive skills required to provide thorough and equitable health care to people with disabilities is critically important. There are too few physiatrists to see to their care needs. In this manuscript, we present a novel concentration in an Internal Medicine residency program in the care of individuals with a variety of disabilities. Our hope is that this work will initiate discussions among educational leaders about how to address the lack of graduate medical education-level training in disability care. We also hope it will afford program directors the opportunity to implement similar concentrations and tracks and will eventually produce a generation of generalists who are well-equipped to help care for people with disabilities.

Education Research: Predictors of Resident Physician Comfort With Individuals With Intellectual and Developmental Disabilities: A Cross-sectional Study

Background and Objectives

Individuals with intellectual and/or developmental disabilities (IDD) experience worse health outcomes compared with peers without a disability partly due to difficulties accessing age-appropriate health care. Provider discomfort with interacting and caring for individuals with IDD is a primary barrier to accessing care. The objectives of this study were to describe resident physicians' education, experiences, and comfort levels regarding individuals with IDD and to identify predictors of higher comfort levels with this patient population.

Methods

In this cross-sectional study, we surveyed medical trainees in 7 residency programs in Boston, Massachusetts on their education, experiences, and comfort levels regarding individuals with IDD. The comfort level was assessed directly on a 6-point Likert scale. The relationship between comfort regarding people with IDD and several candidate explanatory variables was explored with Spearman and partial Spearman correlations (r s).

Results

The estimated survey response rate was 49%. Of 423 resident physicians included in the study, 96% reported they had treated a patient with IDD, while only 25% reported having formal education on caring for this population. On a scale of 1-6, with higher numbers corresponding to greater comfort, the mean comfort level treating individuals with IDD was 3.73 (CI 3.61-3.85). In bivariant analyses, the amount of prior experience with people with IDD had a moderate, positive correlation with increased comfort levels treating individuals with IDD (r s = 0.42, p < 0.01). The following characteristics had a weak, positive correlation with increased comfort levels: training in a pediatric-focused residency specialty (r s = 0.18, p < 0.01), number of hours of formal education on caring for people with IDD (r s = 0.15, p < 0.01), and age (r s = 0.12, p = 0.03). Only the amount of prior experience with this patient population remained positively correlated with higher comfort levels when the other variables were controlled for (r s = 0.38, p < 0.01).

Discussion

Prior experience with individuals with IDD predicted higher comfort levels with this population. This study supports the need for increased opportunities for medical trainees to engage with people with IDD to improve resident physicians' comfort caring for this patient population.

Racial and Ethnic Inequities in Use of Preventive Services Among Privately Insured Adults With a Pediatric-Onset Disability

PURPOSE

Cerebral palsy (CP) and spina bifida (SB) are pediatric-onset disabilities. Adults living with CP/SB are in a greater need of preventive care than the general population due to their increased risk for chronic diseases. Our objective was to compare White/Black and White/Hispanic inequities in the use of preventive services.

METHODS

Using 2007-2017 private claims data, we identified a total of 11,635 adults with CP/BS. Of these, 8,935 were White, 1,457 Black, and 1,243 Hispanic. We matched health-related variables (age, sex, comorbid conditions) between White adults and those in each minority subpopulation. Generalized estimating equations were used and all models were adjusted for age, sex, comorbidities, income, education, and US Census divisions. Outcomes of interest were: (1) any office visit; (2) any physical/occupational therapy; (3) wellness visit; (4) bone density screening; (5) cholesterol screening; and (6) diabetes screening.

RESULTS

The rate of recommended services for all subpopulations of adults with CP/SB was low. Compared with White adults, Hispanic adults had lower odds of wellness visits (odds ratio [OR] = 0.71, 95% CI, 0.53-0.96) but higher odds of diabetes screening (OR = 1.48, 95% CI, 1.13-1.93). Compared with White adults, Black adults had lower odds of wellness visits (OR = 0.50, 95% CI, 0.24-1.00) and bone density screening (OR = 0.54, 95% CI, 0.31-0.95).

CONCLUSIONS

Preventive service use among adults with CP/SB was low. Large White-minority disparities in wellness visits were observed. Interventions to address physical accessibility, adoption of telehealth, and increased clinician education may mitigate these disparities, particularly if initiatives target minority populations.

Evaluation of the Association of Academic Physiatrists Medical Student Summer Clinical Externship

ABSTRACT

The Medical Student Summer Clinical Externship is an 8-wk program hosted by the Association of Academic Physiatrists and offered to first year medical students. Various institutions sponsor participants and provide clinical exposure and mentorship opportunities to promote interest in the field. The program has had more than 100 medical student participants. Students were asked to complete a preparticipation and postparticipation survey. Results revealed a statistically significant increase in interest in physiatry and participants' scores for comfort and experience level in obtaining a history of present illness, general physical examination, and managing developmental, musculoskeletal, and neurologic disabilities. The Medical Student Summer Clinical Externship program provides an opportunity for mentorship and exposure to various subspecialties that likely reinforces student interest in those who are predisposed to physiatry. Students' increased comfort level in treating patients with developmental, musculoskeletal, and neurologic disabilities may lead to improvements in the quality of and access to care received by these populations. All participants gain an increased awareness of the scope of practice of physiatry that will hopefully lead to the increased integration of physical medicine and rehabilitation into the care plans and as a standard of care for patients who might greatly benefit.

Awareness of Physical Medicine and Rehabilitation as a Specialty Among US Medical Students

ABSTRACT

The objectives were to assess US medical students' awareness about physical medicine and rehabilitation, their career goals that may align with physical medicine and rehabilitation, and their exposure to physical medicine and rehabilitation and to compare the demographics of those applying to, interested, or not interested in physical medicine and rehabilitation residency. This was a descriptive cross-sectional study. An online survey was distributed to 76 medical schools, and 2067 students responded. First-generation and Hispanic/Latino students are less likely to know about physical medicine and rehabilitation. Medical students who heard about physical medicine and rehabilitation before or during college or who are first-generation students to attend medical school are more likely to be interested in physical medicine and rehabilitation. Medical students identified as female, Black or African American, and more advanced in medical training have lesser interest. Rotating in physical medicine and rehabilitation at their home institution and shadowing a physical medicine and rehabilitation physician also increase the likelihood of respondents to apply to physical medicine and rehabilitation residency. This study highlights that female students and underrepresented minorities in medicine are less likely to know about physical medicine and rehabilitation or be interested in physical medicine and rehabilitation. First-generation medical students know less about the field but the ones who do have increased interest in physical medicine and rehabilitation. These findings support the need for pipeline programs to improve exposure, recruitment, development, promotion, and retention of first-generation minorities and women into physical medicine and rehabilitation.

Accessible Medical Education & TIC: Increasing Equitable Care for Disabled Patients

An estimated 1 in 4 U.S. adults has a disability, and this number continues to increase. Disabled individuals face significant healthcare inequities, including but not limited to inaccessibility and mistreatment. Our current healthcare system is ill-equipped to provide equitable care to this population. There is a lack of accessibility in healthcare environments, lack of accessible medical training to enable disabled people to become healthcare providers serving their own community, and lack of thorough medical education that encompasses care for disabled patients. Furthermore, the increased risk of trauma, as well as increased risk of medical trauma specifically, endured by disabled people puts them at greater risk of long-lasting adverse effects. In this commentary, we analyze three key areas: 1) the current state of healthcare for disabled patients, 2) disability in medical education & physician workforce, and 3) the relationship between trauma and disability. We argue that the road to more equitable care for disabled patients involves changes to medical education that address all three of these areas. Medical training should expose trainees to disability early and throughout their training, should be made more accessible to support disabled physicians, and finally, should be trauma-informed in a manner that explicitly includes caring for disabled patients and their other intersecting identities.