Improving capacity to care for patients with intellectual and developmental disabilities: The value of an experiential learning model for family medicine residents

Teaching Physician Assistant Students to Care for People With Intellectual and Developmental Disabilities

ABSTRACT

The purposes of this educational activity were to instill in students a greater empathy for patients with intellectual developmental disabilities, give students a better understanding of how to obtain a medical history for patients with communication limitations, teach students practical tips for obtaining a medical history and physical examination to increase competence in their future practice, and to build a relationship with a local organization that serves people with intellectual disabilities. An experiential learning activity was added to the curriculum of two courses for first-year PA students to accomplish these goals. The course instructors engaged in several planning meetings with a local residential facility for people with intellectual disabilities, including choosing patients that the students would assess. The students made 3 visits to the facility. The visits included interactive lectures by a physical therapist, occupational therapist, nurse practitioner, medical doctor, and dentist. Two of the facility involved patient visits at designated homes on campus. The students then wrote comprehensive visit notes with patient identifying information removed and submitted them for grading. Students expressed feeling better prepared to assess people with intellectual disabilities and having an increased appreciation for obtaining quality medical histories. The partner facility also reported they received positive feedback from staff participants and indicated they would like to continue this partnership.

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.

Hearing Loss Diagnosis and Management in Adults with Intellectual and Developmental Disabilities

Hearing loss is a common concern in patients with intellectual and developmental disabilities (IDD), and early detection and intervention are crucial to prevent negative impacts on communication, cognition, socialization, safety, and mental health. Despite a lack of the literature specifically focused on hearing loss in adults with IDD, there is a substantial body of research demonstrating the prevalence of hearing loss in this population. This literature review examines the diagnosis and management of hearing loss in adult patients with IDD, with a focus on primary care considerations. Primary care providers must be aware of the unique needs and presentations of patients with IDD to ensure appropriate screening and treatment. This review highlights the importance of early detection and intervention, as well as the need for further research to guide clinical practice in this patient population.

A new measure of physicians' erroneous assumptions towards adults with intellectual disability: A first study

BACKGROUND

Incomplete knowledge and unfamiliarity with intellectual disability (ID) contribute to erroneous assumptions of physicians towards ID, which negatively impact the health equity of people with ID. This study aimed to identify the erroneous assumptions that, based on the ID stakeholders' perceptions, were the most prevalent in physicians and damaging for the healthcare of adults with ID, verify their unidimensionality and that no personal characteristics of ID stakeholders were associated with their ratings of erroneous assumptions' prevalence and damage.

METHODS

Seventy-four possible physician erroneous assumptions were developed concerning health, daily living skills and quality of life of individuals with ID. ID stakeholders rated each one for perceived prevalence in physicians and damage for the healthcare of adults with ID. Frequency analysis, exploratory factor analysis and correlations were run separately for participants' prevalence and damage ratings.

RESULTS

Twenty-seven erroneous assumptions were identified as those perceived most prevalent and damaging. Their unidimensionality was ascertained and participants' characteristics were not associated with their prevalence and damage ratings.

CONCLUSIONS

The identified assumptions are appropriate to represent the items of a new instrument that can be used in medical education to guide the development of curricula to change erroneous assumptions.

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.

Improving access to primary care and annual health checks for people who have a learning disability: a multistakeholder qualitative study

OBJECTIVES

To investigate key stakeholders' views on how to improve access to primary care in general practice settings for people with learning disabilities (or intellectual disabilities). Further to explore how inequalities and barriers in specific areas including annual health checks might be addressed.

DESIGN

A qualitative study design was used with data collected during focus groups, interviews and open-response surveys; data analysis was thematic and informed by stakeholder consultation. Processes to facilitate quality included triangulation of stakeholder perspectives, triangulation of data collection methods and checking interpretation of findings with participants.

SETTING

UK regional services including learning disability organisations, primary care general practitioner (GP) clinical practice networks and supported housing organisations.

PARTICIPANTS

Sixteen people participated in the study: four people with learning disabilities participated in a focus group; four relatives completed an interview or survey; eight GPs, practice nurses and supported housing managers participated in interviews.

RESULTS

Five overarching themes describing approaches to improve primary care access for people with learning disabilities were identified including: prioritisation, proactivity, innovation and improvement, personalisation and prevention and follow-up. Definitions of themes were described and illustrated with quotes. Ten recommendations informed by the thematic analysis, stakeholder consultation, research and primary care guidance were codeveloped with people with learning disabilities.

CONCLUSIONS

All stakeholders identified problems, with primary care interfaces being misaligned with the needs of people with learning disabilities. The recommendations informed by all stakeholders can be used to guide development of service provision to better meet the needs of people with learning disabilities in primary care. Future research should explore professionals' understanding of reasonable adjustments.