Teaching medical students about disability and rehabilitation: methods and student feedback

Sustained Impact of a Virtual Disability Education Curriculum With Fourth-Year Medical Students in a Mandatory Physical Medicine and Rehabilitation Clerkship

OBJECTIVE

The aim of the study was to measure the short- and long-term impact of a virtual disability education curriculum associated with a 2-wk mandatory physical medicine and rehabilitation clerkship for fourth-year medical students.

DESIGN

A prospective pre-post intervention survey-based study measuring the impact of a virtual disability education series at 1-wk and 6-mo time points after a mandatory physical medicine and rehabilitation clerkship including 8 hrs of virtual didactics with an emphasis on physical disabilities. The surveys assessed the overall virtual curriculum, perceived benefit of a virtual encounter, and the long-term applicability of the information learned from the clerkship.

RESULTS

The physical medicine and rehabilitation clerkship was effective in improving medical students' perceived comfort and clinical knowledge regarding treatment of persons with disabilities ( P < 0.01). There were no statistical differences at the 6-mo time point, indicating sustained benefit and integration of knowledge in the long term ( P > 0.05). In addition, 84% of students reported using the information in clinical experiences at 6 mos.

CONCLUSIONS

The physical medicine and rehabilitation clerkship including a virtual disability education curriculum improved long-term perceived medical student comfort and knowledge of treating persons with disabilities, with a focus on those with physical disabilities. Virtual encounters with persons with disabilities are viable and impactful avenues to provide this education.

A scoping review for designing a disability curriculum and its impact for medical students

Background

There is an increasing need for a standardized undergraduate disability curriculum for medical students to better equip students with the proper training, knowledge, and skills to provide holistic care for individuals with disabilities.

Objectives

The aim of this scoping review was to better understand and analyze the current body of literature focusing on best practice for including disability curricula and its impact on undergraduate medical students.

Results

Three major components for designing a disability curriculum for undergraduate medical students were obtained from our analysis. The components were: (1) effective teaching strategies, (2) competencies required for disability curriculum, and (3) impact of disability curriculum on medical students.

Conclusions

Current literature revealed that exposing medical students to a disability curriculum impacted their overall perceptions about people with disabilities. This allowed them to develop a sense of understanding towards patients with disabilities during their clinical encounters. The effectiveness of a disability curriculum is dependent on the extent to which these interventions are incorporated into undergraduate medical education.

Pharmacy Students' Attitudes Toward Persons With Disabilities and Perceptions of Right to Self-Determination

Objective. As the number of persons with disabilities increases, pharmacists are responsible for providing optimal pharmaceutical care services to more patients in this population. The purpose of this study was to assess pharmacy students' perceptions of the right of persons with disabilities to self-determination and to identify factors that affect pharmacists' attitudes and perceptions.Methods. A survey of 370 pharmacy students was conducted. The revised Korean versions of the Scale of Attitudes Towards Disabled Persons (SADP) and the Attitudes Toward Disabled Persons Form O (ATDP-O) were used to measure attitudes toward persons with disabilities. Pharmacy students' perception of the right of persons with disabilities to self-determination was measured in 2 subdomains developed by education and ethics experts: absoluteness of right and social support.Results. Responses from 363 pharmacy students were included in the analysis. We found that the more contact students had with persons with disabilities in the past, the more positive attitudes they had toward this patient group. In addition, students' understanding of self-determination and positive attitudes toward persons with disabilities were determined to be statistically significant factors affecting pharmacy students' perceptions of both the absoluteness of right of persons with disabilities and the level of social support that should be given to this patient group.Conclusion. Since experience relating to people with disabilities is associated with pharmacy students' positive perceptions about the right of persons with disabilities to self-determination, education and activities are needed in the pharmacy curriculum to ensure students have experiences with this patient group.

Effect of Adding a Wheelchair Immersion Program to a Physical Medicine and Rehabilitation Clerkship on Emotions, Behavior, and Attitude: A Prospective Pilot Study

ABSTRACT

People with disabilities encounter significant barriers in health care and report that healthcare providers often lack an understanding in caring for them. Currently, there is limited disability awareness training in medical school curricula. This mixed-methods pilot study examined the effects of integrating a short wheelchair immersion program in a physical medicine and rehabilitation clerkship, versus the clerkship alone, on attitudes toward people with disabilities, comfort in treating people with disabilities, knowledge of wheelchair etiquette, and understanding of wheelchair-associated challenges. The standard training group underwent the physical medicine and rehabilitation clerkship, consisting of a 2-wk clinical rotation and didactic program. The intervention group additionally underwent a newly developed 1-hr wheelchair program where they simulated mobility and some activities of daily living as a "wheelchair user" and "caregiver." Quantitative analysis demonstrated that all students who completed the clerkship had significantly improved attitudes toward and comfort in treating people with disabilities, knowledge of wheelchair etiquette, and understanding of wheelchair-associated challenges, whereas students in the wheelchair immersion program had a greater change in understanding wheelchair-associated challenges. Qualitative analysis revealed that the intervention resulted in positive attitudinal changes. These findings suggest that integrating a brief wheelchair immersion program with a physical medicine and rehabilitation clerkship may enhance disability awareness training in medical school curricula.

Disability awareness arena in Sweden: voices of learning toward community facilities, universal design and disability perspective

Purpose

The purpose of this study is to describe knowledge, awareness and experience of different employees in a Swedish municipality (City of Gothenburg) concerning the disability perspective, accessibility and universal design in practice.

Design/methodology/approach

This study is based on an online survey. A total of 119 different employees responded to the survey. The data was analyzed from a mixed-method approach, using descriptive statistics and textual analysis. The study also included personal interviews with 19 employees in the City of Gothenburg.

Findings

A total of 521 employees in the City of Gothenburg participated in disability awareness exercises (DAE) at the Disability Awareness Arena to gain greater knowledge and insight on disability perspectives in different environments and services. Of these, 119 people representing different professions in soft and hard services and companies participated in the survey; and 19 people participated in personal interviews. The study showed that a vast majority of them were very satisfied and they have developed and practiced their new knowledge and attitude toward disability and accessibility.

Research limitations/implications

One limitation in this study is that it has investigated the experiences and effects of the DAE 6–12 months after its implementation. Therefore, it is not possible to analyze long-term effects that the DAE can have in practice.

Originality/value

To the best of the authors’ knowledge, no prior study of these issues has been conducted in Sweden. This study is deemed to have significant social benefit because of the steadily increasing demand for disability simulations, awareness of disability perspective and accessibility in municipality settings. No other study has addressed the importance of the DAE in these perspectives. DAE is defined in this article as a unique concept for promoting the usage of the disability perspective in the everyday workplace.

Working With People With Disabilities: An Interactive Video/Lecture Session for First- and Second-Year Medical Students

INTRODUCTION

Negative physician attitudes toward people with disabilities create barriers to health care for these individuals. Barriers can include withholding of standard medical and preventive care, provision of inferior treatment, and patient mistrust of the health care system. Thus, preparing medical students to care for people with disabilities is especially important. Educating health care providers early in their careers can shape their interactions while their approach to patients is still deliberate.

METHODS

We developed an interactive introductory session for first- and second-year medical students on how to approach individuals with observable disability in clinical settings. In the session, we explored-through a combination of lecture, discussion, and patient perspective-how negative physician behavior can create health care barriers, as well as proposed a framework for approaching patients with disability. We presented this session in two formats: (a) a slide deck with instructions that a presenter can use to deliver the session and (b) a stand-alone video introduction with reflective questions.

RESULTS

The session was evaluated by 151 first-year medical students, with 79% reporting either somewhat or much more comfort approaching individuals with disability following the session.

DISCUSSION

The integration of patient and physician perspectives, as well as the use of reflective questions, provides the opportunity for students to actively explore reasons for provider discomfort with disability and delineate clinical setting strategies to approach patients with disability.

A validation of the disability attitudes in health care scale using the Rasch analysis on a sample of Korean medical students

BACKGROUND AND PURPOSE

The "Disability Attitudes in Health Care" scale contains 17 items and measures attitudes toward persons with disabilities in healthcare settings. This study aimed to analyze the psychometric properties of the Disability Attitudes in Health Care in order to improve its measurement quality.

MATERIALS AND METHODS

The Disability Attitudes in Health Care scale was administered to 272 students at a medical school. Rasch analysis was conducted to assess the category use, the overall fit of the model, and the person-item fit.

RESULTS

Compared to the previous 5-point Likert scoring system, the combination of category 1 (strongly disagree) and 2 (disagree), which transformed the Disability Attitudes in Health Care into a 4-point scale, was more appropriate. Items 2 and 13 had a poor fit with the model because of low construct homogeneity and low point-measure correlation, respectively; therefore, they were removed. However, there were not enough questions regarding the difficulty level for distinguishing medical students' attitudes toward persons with disabilities more sensitively.

CONCLUSIONS

The results of this study suggest that constructing Disability Attitudes in Health Care with 15 items and using a 4-category scoring method could help to increase the scale's reliability and validity. The revised version of Disability Attitudes in Health Care could be of value to those who educate medical students and train rehabilitation professionals. IMPLICATIONS FOR REHABILITATIONConstructing a Disability Attitudes in Health Care scale with 15 items by using a 4-category scoring method could increase the reliability and validity of the scale.To improve the sensitivity of the Disability Attitudes in Health Care, it is necessary to add more difficult items to the scale.The Disability Attitudes in Health Care could be of value to those who educate medical students and train rehabilitation professionals.

Self-other overlap: A unique predictor of willingness to work with people with disability as part of one's career

BACKGROUND

People with disability (PWD) often rely on others, both for direct support and for the creation of enabling environments to meet their needs. This need makes it crucial for professionals to be willing to work with PWD, and for people to pursue careers that focus on supporting PWD.

OBJECTIVES

To explore self-other overlap as a unique predictor of willingness to work with PWD as part of one's career, using three studies.

METHODS

Studies 1 and 2 used cross-sectional surveys of college undergraduates to explore: 1. whether an association between self-other overlap and willingness to work with PWD exists, and 2. whether self-other overlap is a unique predictor, controlling for attitudes and empathy. Study 3 investigated whether self-other overlap is associated with the groups with whom the students indicated they want (and do not want) to work as part of their career.

RESULTS

Across the three studies, self-other overlap was uniquely associated with students' willingness to work with PWD as part of one's profession, even when controlling for attitudes and empathy.

CONCLUSIONS

Self-other overlap may be an important additional factor to take into consideration when developing interventions targeted toward promoting working with PWD.

A qualitative study on feedback provided by students in nurse education

BACKGROUND

This study aims to help nurse educators/academics understand the perspectives and expectations of students providing their feedback to educators about teaching performance and subject quality.

AIM

The aim of this study is to reveal students' voices regarding their feedback in nurse education in order to shed light on how the current student feedback practice may be modified.

DESIGN

A qualitative study using focus group inquiry.

METHODS

Convenience sampling was adopted and participants recruited from one school of nursing in Hong Kong. A total of 66 nursing students from two pre-registration programs were recruited for seven focus group interviews: one group of Year 1 students (n=21), two groups of Year 3 students (n=27), and four groups of Final Year students (n=18). The interviews were guided by a semi-structured interview guideline and the interview narratives were processed through content analysis. The trustworthiness of this study was guaranteed through peer checking, research meetings, and an audit trail. The participants' privacy was protected throughout the study.

RESULTS

Four core themes were discerned based on the narratives of the focus group interviews: (1) "timing of collecting feedback at more than one time point"; (2) "modify the questions being asked in collecting student feedback"; (3) "are electronic means of collecting feedback good enough?; and (4) "what will be next for student feedback?".

CONCLUSIONS

This study is significant in the following three domains: 1) it contributed to student feedback because it examined the issue from a student's perspective; 2) it explored the timing and channels for collecting feedback from the students' point of view; and 3) it showed the preferred uses of student feedback.

Developing competencies among health professions students related to the care of people with disabilities: a pilot study

This is a two-phase study, the first was a literature review that aimed to identify a set of competencies for professional practice that would be relevant for the health care of People with disabilities (PwD). These competencies were then used to plan a thirty-hour multidisciplinary course for undergraduate health care students. The educational intervention led to improvements in the students’ learning experiences, including the development of empathy and knowledge related to the care of PwD, improved knowledge around accessibility, and an awareness of the need to humanize the care of PwD. Students reported enhanced learning experiences and an increase in knowledge related to the care of PwD, and also highlighted the need to humanize the care.

Barriers to providing maternity care to women with physical disabilities: Perspectives from health care practitioners

BACKGROUND

Women with physical disabilities are known to experience disparities in maternity care access and quality, and communication gaps with maternity care providers, however there is little research exploring the maternity care experiences of women with physical disabilities from the perspective of their health care practitioners.

OBJECTIVE

This study explored health care practitioners' experiences and needs around providing perinatal care to women with physical disabilities in order to identify potential drivers of these disparities.

METHODS

We conducted semi-structured telephone interviews with 14 health care practitioners in the United States who provide maternity care to women with physical disabilities, as identified by affiliation with disability-related organizations, publications and snowball sampling. Descriptive coding and content analysis techniques were used to develop an iterative code book related to barriers to caring for this population. Public health theory regarding levels of barriers was applied to generate broad barrier categories, which were then analyzed using content analysis.

RESULTS

Participant-reported barriers to providing optimal maternity care to women with physical disabilities were grouped into four levels: practitioner level (e.g., unwillingness to provide care), clinical practice level (e.g., accessible office equipment like adjustable exam tables), system level (e.g., time limits, reimbursement policies), and barriers relating to lack of scientific evidence (e.g., lack of disability-specific clinical data).

CONCLUSION

Participants endorsed barriers to providing optimal maternity care to women with physical disabilities. Our findings highlight the needs for maternity care practice guidelines for women with physical disabilities, and for training and education regarding the maternity care needs of this population.

Reflective impressions of a precepted clinical experience caring for people with disabilities

There is evidence that early and frequent encounters with people with disabilities can improve medical students' knowledge, skills, and attitudes about disability. As part of a 4-year integrated curriculum in caring for patients with disabilities, third-year medical students (n = 144) in a Family Medicine clerkship participated in a day-long precepted clinical experience at a medical facility serving people with disabilities, predominantly developmental disabilities, where they met patients and worked with clinicians. At the conclusion of the program, students completed a reflective survey about their experience. These data were analyzed qualitatively using a constructivist grounded-theory approach. Students' responses indicated that the experience improved their comfort levels in working with people with disabilities and increased their awareness of attitudinal factors that influence patient care. Responses also demonstrated that students achieved an awareness of technical accommodations and organizational adaptations that improve patient care.

Active-learning diabetes simulation in an advanced pharmacy practice experience to develop patient empathy

OBJECTIVE

To develop and integrate an active-learning diabetes simulation into an advanced pharmacy practice experience to improve pharmacy students' empathy toward patients with diabetes mellitus.

DESIGN

Students simulated the experience of having diabetes mellitus by conducting activities commonly prescribed to those with this disease state for 7 days, after which they submitted a standardized diabetes log and narrative reflection. Interpretive phenomenology design with thematic analysis was used to determine the impact of this experience on the students.

ASSESSMENT

As shown in student reflections, 95% developed empathy, 97% found the experience beneficial, and 67% improved their ability to relate to and counsel patients. Most (95%) found difficulty adhering to the regimen. On average, students consumed 179 grams of carbohydrates per day and exercised 5 days or 215 minutes per week. Additionally, 69% decided to modify their personal habits to become healthier.

CONCLUSIONS

Inclusion of the 7-day active-learning exercise greatly impacted student pharmacists' self-reported empathy toward and ability to relate to patients with diabetes mellitus. Completion of this experience may result in long-lasting personal behavior modifications.

Development of an instrument to measure medical students' attitudes toward people with disabilities

As curricula to improve medical students' attitudes toward people with disabilities are developed, instruments are needed to guide the process and evaluate effectiveness. The authors developed an instrument to measure medical students' attitudes toward people with disabilities. A pilot instrument with 30 items in four sections was administered to 342 medical students. Internal consistency reliability and factor analysis were conducted. The Cronbach's alpha coefficient was 0.857, indicating very good internal consistency. Five components were identified: comfort interacting with people with disabilities, working with people with disabilities in a clinical setting, negative impressions of self-concepts of people with disabilities, positive impressions of self-concepts of people with disabilities, and conditional comfort with people with disabilities. The instrument appears to have good psychometric properties and requires further validation.

DrivAbility: teaching medical aspects of driving

CONTEXT

Teaching medical aspects of fitness to drive (FTD) is currently inconsistent across UK medical schools, with almost one-third of UK medical schools offering no tuition on medical aspects of FTD. It is, therefore, not surprising to find that medical students and doctors tend to lack confidence regarding the medical aspects of FTD and Driver and Vehicle Licensing Agency (DVLA) medical standards.

INNOVATION

In response to this inconsistency we developed an innovative new learning module to teach our medical students the importance of giving appropriate advice to patients about driving, the role of the DVLA regarding medical aspects of FTD, how to recognise when patients should be referred to a driving assessment centre and what adaptations are available to allow patients with physical disabilities to drive safely. As far as we are aware Derby is the first centre in the world to incorporate the practical experience of driving adapted vehicles (at a driving assessment centre) into the undergraduate medical curriculum as an aid to teaching medical aspects of FTD. This practical learning module has proven popular with the students.

IMPLICATIONS

Driving these adapted vehicles has allowed our students to appreciate some of the practical difficulties disabled drivers experience when learning new driving techniques. However, as only 18 driving assessment centres exist within the UK, an exact replication of this learning module will be limited elsewhere. Nevertheless, we would encourage other medical schools to evaluate the local resources that could enhance the delivery of their undergraduate curricula.

Desired educational outcomes of disability-related training for the generalist physician: knowledge, attitudes, and skills

The problems adults with disabilities face obtaining quality primary care services are persistent and undermine national efforts to improve the health status of this group. Efforts to address this issue by providing disability-related training to physicians are hampered by limited information about what generalist physicians need to know to care for patients with disabilities. The authors consider the desired outcomes of disability-related training for generalists by exploring the contributions of the domains of knowledge, attitudes, and skills to patient-directed behavior and summarizing the empirical data.Because disability reflects a complex interplay among individual, interpersonal, institutional, community, and societal factors, generalist physicians can promote and protect the health of adults with disabilities by interventions at multiple levels. Thus, the authors use the social-ecological framework, an approach to health promotion that recognizes the complex relationships between individuals and their environments, to delineate the recommended knowledge, attitudes, and skills in the context of primary care. The importance of role models who demonstrate the three domains, the interactions among them, and issues in evaluation are also discussed. This clear delineation of the recommended educational outcomes of disability-related training in terms of knowledge, attitudes, and skills will support efforts to better prepare generalist physicians-in training and in practice-to care for adults with disabilities and to evaluate these training strategies.

Disability in cultural competency pharmacy education

Improving health care providers' knowledge and ability to provide culturally competent care can limit the health disparities experienced by disadvantaged populations. As racial and ethnic cultures dominate cultural competency topics in education, alternative cultures such as disability have consistently been underrepresented. This article will make the case that persons with disabilities have a unique cultural identity, and should be addressed as an important component of cultural competency education in pharmacy schools. Examples of efforts in pharmacy education to incorporate cultural competency components are highlighted, many of which contain little or no mention of disability issues. Based on initiatives from other health professions, suggestions and considerations for the development of disability education within pharmacy curricula also are proposed.

Validated instruments used to measure attitudes of healthcare students and professionals towards patients with physical disability: a systematic review

Background

Instruments to detect changes in attitudes towards people with disabilities are important for evaluation of training programs and for research. While we were interested in instruments specific for medical students, we aimed to systematically review the medical literature for validated survey instruments used to measure attitudes of healthcare students and professionals towards patients with physical disability.

Methods

We electronically searched Medline, EMBASE, PsycINFO, Health and Psychosocial Instruments. We included papers reporting on the development and/or validation of survey instruments to measure attitudes of healthcare students and professionals towards patients with physical disability. We excluded papers in which the attitudes were not measured in a provider-patient context. Two reviewers carried out titles and abstracts screening, full texts screening, and data abstraction in a duplicate and independent manner using standardized and pilot tested forms.

Results

We identified seven validated survey instruments used for healthcare students and professionals. These instruments were originally developed for the following target populations: general population (n = 4); dental students (n = 1); nursing students (n = 1); and rehabilitation professionals (n = 1). The types of validity reported for these instruments were content validity (n = 3), criterion-related validity (n = 1), construct validity (n = 2), face validity (n = 1), discriminant validity (n = 1), and responsiveness (n = 1). The most widely validated and used tool (ATDP) was developed in the late 1960s while the most recent instrument was developed in the early 1990s.

Conclusion

Of the seven identified validated instruments, less than half were specifically designed for healthcare students and professionals and none for medical students. There is a need to develop and validate a contemporary instrument specifically for medical students.

Evaluation of medical student performance on objective structured clinical exams with standardized patients with and without disabilities

PURPOSE

To investigate whether medical students' performance on a family medicine clerkship objective structured clinical exam (OSCE) differed when the standardized patient (SP) had a disability versus when the SP did not have a disability.

METHOD

SPs with spinal cord injury (SP-SCI), SPs with intellectual disability (SP-ID), and SPs without a disability participated separately in two OSCE scenarios that were administered by the University of South Carolina School of Medicine's Department of Family and Preventive Medicine from 2007 to 2009. OSCE scores were determined based on the number of critical actions completed by the student, and scores were analyzed to determine differences among scenarios.

RESULTS

Students scored lower in history, physical exam, lab tests, and interpersonal skills with an SP-SCI, and lower in history, physical exam, and lab tests with an SP-ID than did students interacting with SPs without a disability. The odds ratio for ordering a hemoglobin A1c in one scenario was 4.16 times higher in cases when the SP did not have a disability (95% confidence interval [CI] 1.78-9.17, P = .001). In the second scenario, the odds ratio was 3.08 times higher for ordering a urinalysis (95% CI 1.34-7.08, P = .006) and was 2.15 times higher for providing lifestyle counseling (95% CI 1.04-4.44, P = .038) in students interacting with SPs without a disability.

CONCLUSIONS

Students performed better when the SP did not have a disability. This suggests that greater emphasis should be placed on teaching appropriate care of patients with a disability.

Evaluation of nursing and medical students' attitudes towards people with disabilities

AIMS AND OBJECTIVES

The aim of this study is to assess the attitudes of students towards disabled people and provide suggestions to make necessary changes in the curricula.

BACKGROUND

Disabled people suffer from rejection, exclusion and discrimination. The undergraduate education of future health professionals should include processes of critical thinking towards and analysis of the disabled.

DESIGN

Cross-sectional design was used.

METHODS

All the preclinical medical and nursing students in our institution were included in study. Data were collected using the Turkish Attitudes towards Disabled Person Scale (TATDP) and demographical variables. TATDP Scale was scored according to five-point Likert Scale.

RESULTS

Students' mean attitude score is 120.57 (SD 15.24). Subscale mean scores are 53.61 (SD 7.25) for compassion (CP), 50.47 (SDS 7.26) for social value (SV) and 16.49 (SD 2.89) for resource distribution (RD). Whilst nursing students had less contact with the disabled, medical students had a closer contact with them. Medical students acquired more prior knowledge about attitudes towards the disabled. Total attitude scores of female students were above the students' mean attitude score when compared to those of male students.

CONCLUSION

Only if early contact is established with patients and the disabled, practical educational strategies are adopted, and the students are provided with information on attitudes about the disabled, will a social model of disability be introduced into the curriculum.

RELEVANCE TO CLINICAL PRACTICE

This study results were presented to curriculum planning committees of nursing and medical schools, so that they should use them as needs assessment data in developing a disability awareness curriculum. The curriculum will be implemented in cooperation with not only schools but also other social institutions. For instance, clerkship applications will be accomplished by cooperating with nursing homes and organisations of disabled people.

What can I learn from this interaction? A qualitative analysis of medical student self-reflection and learning in a standardized patient exercise about disability

Patients with disabilities receive fewer health services than the general population, yet they have greater health needs. Similarly, physicians report limited training in disability. The current project examines medical students' learning about disability in a project using individuals with disabilities as medical educators. Family medicine clerkship students (N = 138) across an academic year were videotaped during interviews with standardized patient educators with disabilities and during feedback sessions following the interactions. Qualitative analysis of feedback transcripts identifies three primary areas of integrating learning, reflective practice, and disability: (1) learning how disability impacts the treatment plan, (2) self-reflection and recognizing attitudes about disability, and (3) learning about the practice of medicine generally from the disability exercise. Themes are identified within each of the primary learning areas. Medical student reflection provides evidence of learning to connect disability with pain, everyday life, and treatment. Medical students learned to recognize patients' expertise in their own condition and in health care navigation. Medical students also examined how their language implies attitude. The current investigation provided evidence of the ways examining disability can serve as a cornerstone for building relationship-centered patient care and encouraging reflective practice overall.

Medical education and disability studies

The biomedicalist conceptualization of disablement as a personal medical tragedy has been criticized by disability studies scholars for discounting the difference between disability and impairment and the ways disability is produced by socio-environmental factors. This paper discusses prospects for partnerships between disability studies teaching/research and medical education; addresses some of the themes around the necessity of critical disability studies training for medical students; and examines a selection of issues and themes that have arisen from disability education courses within medical schools globally. The paper concludes that providing there is a commitment from senior management, universities are well positioned to apply both vertical and horizontal approaches to teaching disability studies to medical students.

Teaching and learning about chronic conditions management for undergraduate medical students: utilizing the patient-as-teacher approach

OBJECTIVES

This study was undertaken to evaluate the impact on medical student learning of a revised chronic conditions teaching programme based on the chronic care model utilizing patients-as-teachers.

METHODS

A qualitative questionnaire was completed by students at the start of a primary healthcare rotation to determine existing impressions/understandings about chronic conditions. Following the revised teaching programme, a reflective essay about a home-visit to a person with chronic conditions was completed by students at the end of the rotation.

RESULTS

Analysis of the questionnaire at the start of the rotation showed students have some knowledge of the differences between acute and chronic care, have rather negative impressions of what it means to have chronic conditions and know little of overall patient management including the work of an interdisciplinary team. Analysis of the reflective essays completed by students at the end of the rotation showed an increased understanding of chronic conditions, what it means to have a chronic condition and who supports management.

DISCUSSION

A structured chronic conditions teaching programme including patient-as-teacher is an effective way of building knowledge and changing students' impressions of what it means to have a chronic condition.

Enfermagem em Reabilitação: ampliando os horizontes, legitimando o saber

A autora faz reflexões sobre a Enfermagem em Reabilitação, marcando a trajetória dessa especialidade na assistência, no ensino e na pesquisa em enfermagem. Aborda conceitos e a aplicabilidade destes na prática da Enfermagem em Reabilitação, apresenta a atual demanda por assistência em reabilitação, bem como a capacitação do enfermeiro para a atuação neste mercado de trabalho, destacando o pioneirismo de instituições públicas e de ensino superior, no município de São Paulo, o que possibilitou a especialização do enfermeiro em Reabilitação.

Cross-cultural differences in preference for recovery of mobility among spinal cord injury rehabilitation professionals

STUDY DESIGN

Direct observation of a constrained consensus-building process in three culturally independent five-person panels of rehabilitation professionals from the US, Italy and Canada.

OBJECTIVES

To illustrate cultural differences in belief among rehabilitation professionals about the relative importance of alternative functional goals during spinal cord injury (SCI) rehabilitation.

SETTING

Spinal Cord Injury Units in Philadelphia-USA, Rome-Italy and Vancouver-Canada.

METHODS

Each of the three panels came to independent consensus about recovery priorities in SCI utilizing the features resource trade-off game. The procedure involves trading imagined levels of independence (resources) across different functional items (features) assuming different stages of recovery.

RESULTS

Sphincter management was of primary importance to all three groups. The Italian and Canadian rehabilitation professionals, however, showed preference for walking over wheelchair mobility at lower stages of assumed recovery, whereas the US professionals set wheelchair independence at a higher priority than walking.

CONCLUSIONS

These preliminary results suggest cross-cultural recovery priority differences among SCI rehabilitation professionals. These dissimilarities in preference may reflect disparities in values, cultural expectations and health care policies.

What does "disability" mean for medical students? An exploration of the words medical students associate with the term "disability"

CONTEXT

Disability teaching is a core theme in undergraduate medical education. Medical students bring a range of experiences of disability to their medical training.

AIM

The principal aim of this study was to explore the words that medical students associate with the term "disability" and to consider how the resulting information could inform teaching. A secondary aim was to see if a short disability course changed the word associations.

METHODS

Students were asked to write down 2 words that came to mind when they heard the word "disability", before and after a 4-day course in disability. Words from 4 cohorts were analysed by frequency and the following word dichotomies: visual icons/personal attributes; loss/enabling, and medical model/social model. A random sample of students took part in focus groups at the beginning and end of the course.

RESULTS

A total of 381 students provided 667 before-course words and 189 students provided 336 after-course words. Before the course, words denoting visual icons of disability, and loss were prominent, accounting for 85% of the words, and 74% of the words describing personal attributes were negative. Focus group responses at this stage reflected an eagerness to help but patronising terms were prominent, along with concern about political correctness. Students also expressed nervousness about encountering disabled people. In response, teaching was adapted to make it more learner-focused, to offer a safe environment in which students can test out their language, to build on the positive associations and to develop a range of pre-course creative activities with disabled people. After the course a considerable and significant shift in emphasis was observed, with a reduction in the use of visual icon words, an increase in words denoting enablement, and an increase in words relating to the social model of disability and to positive personal attributes (P < 0.001). Focus group participants at this stage reported greater confidence in approaching disabled people but continued to question political correctness.

CONCLUSIONS

Medical students associate disability predominantly with depersonalised or negative words. A short disability course appears to change these associations. Reasons for this and implications for teaching are discussed.

Cerebral palsy: what do medical students know and believe?

OBJECTIVES

Negative attitudes toward people with disabilities, including cerebral palsy, may be related to misunderstandings or lack of knowledge about the disability. If held by medical practitioners, they can have detrimental implications for the care of people with disabilities. The purposes of this study were to examine the knowledge and attitudes of medical students regarding cerebral palsy and to examine the effects of the videotape 'Understanding Cerebral Palsy' on these two areas.

METHODS

The attitudes and knowledge regarding cerebral palsy of 54 medical students in their penultimate year were measured before and after watching a video produced to educate health professionals about cerebral palsy. They were assessed using a self-administered questionnaire constructed specifically for the study, adapted from previously validated questionnaires.

RESULTS

These medical students generally had limited knowledge about cerebral palsy and displayed negative attitudes toward people with cerebral palsy. It was also found that males had less positive attitudes than females (P = 0.014) and that students educated mainly in Asia had less positive attitudes than students educated mainly in Australia (P = 0.012). The videotape was shown to be effective in improving the students' knowledge about cerebral palsy. A small but significant improvement in attitudes was also shown (P = 0.014), with the attitudes of some students improving dramatically. However, negative attitudes remained in many.

CONCLUSIONS

Based on the findings, structured teaching about cerebral palsy is necessary within the medical curriculum at the University of Melbourne. Greater promotion of positive attitudes toward people with cerebral palsy and other disabilities is required.

Effects of a disability awareness and skills training workshop on senior medical students as assessed with self ratings and performance on a standardized patient case

BACKGROUND

People with disabilities compose one of the largest and fastest growing subgroups of the U.S. population. Disability and rehabilitation issues are not well covered in most North American medical school curricula. This article describes the development and assessment of a 3-hr workshop for medical students on disability skills and awareness.

DESCRIPTION

Fourth-year medical students on a required clerkship participated in the workshop on alternate months. The efficacy of the intervention was measured by a comparison between the participant and control students using a pretest and posttest self-efficacy questionnaire and a one-station Standardized Patient (SP) Clinical Case depicting a hemiplegic patient and a caregiver.

EVALUATION

Factor analysis of the survey yielded 4 subscales: Attitude, Advocacy, Interaction, Obtaining Services. There was a significant difference between the treatment and control group on the advocacy scale and on the SP communication and interstation exercises.

CONCLUSION

A targeted educational intervention can have a positive effect on medical students' knowledge, skills, and attitudes toward patients with disabilities.

Reforming medical education to enhance the management of chronic disease

Medical education must adapt to change if it is to remain relevant to the needs of doctors, patients and society. Ideally, it should anticipate and lead change. Undergraduate education remains rooted in urban medical schools where the focus is on acute disease, while most graduates spend their working lives in the community, dealing mainly with chronic health problems. Medical graduates need to acquire specific knowledge, skills and attitudes if they are to effectively manage people with chronic disease. Strategies that create a better balance between education in acute and chronic disease are being developed. These include a transfer of clinical teaching to community and nursing home settings and the development of interdisciplinary teaching.

Dissatisfaction with medical services among Medicare beneficiaries with disabilities

OBJECTIVE

To test the hypothesis that Medicare beneficiaries who have difficulties performing activities of daily living (ADLs) are more likely to report dissatisfaction with their health care than those without ADL difficulties.

DESIGN

Cross-sectional study.

SETTING

Sample from the 1998 Medicare Current Beneficiaries Survey.

PARTICIPANTS

A population-based sample (N=19,650) of noninstitutionalized Medicare beneficiaries.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Satisfaction with overall quality and 9 specific aspects of medical services received in the last year.

RESULTS

After adjusting for sociodemographic, behavioral, and system characteristics and compared with those without ADL difficulties, Medicare enrollees were more likely to report dissatisfaction with the overall quality of their health care as their number of activity restrictions increased (1-2 ADLs: odds ratio [OR]=1.5; 95% confidence interval [CI], 1.2-2.0; 3-4 ADLs: OR=1.7; 95% CI, 1.2-2.4; 5-6 ADLs: OR=1.9; 95% CI, 1.4-2.8). Analysis of satisfaction with the 9 specific aspects of care yielded similar results.

CONCLUSION

Disability is a significant independent risk factor for dissatisfaction with health care in the Medicare population. Efforts should be made to identify individuals with ADL difficulties and to improve their ease and convenience of getting to a doctor, the availability of care off hours, the access to specialists, and the follow-up care received.

Is there a problem with the problems in problem-based learning?

OBJECTIVE

To determine the balance between acute and chronic medical problems in the PBL cases at 2 Australian medical schools.

METHODS

Analysis of 162 PBL cases.

RESULTS

Cases concentrate on acute problems in young people and neglect chronic disease in the old.

CONCLUSION

This imbalance may contribute to negative attitudes towards elderly patients and people with chronic disease.