Teaching medical students about disability: the use of standardized patients

Interplay between representations, practices, and stigma variables towards people with intellectual disabilities among healthcare professionals: A cross-sectional study

Disparities in healthcare are observed among people with intellectual disabilities. They generally face stigmatisation and negative attitudes from healthcare professionals. The aim of this study is to investigate the link of diagnostic label and social distance on inclusive health representations and practices towards people with intellectual disabilities among healthcare professionals. We conducted an online survey of 163 healthcare professionals living in French-speaking Belgium. The results highlighted that the diagnostic label and a lower social distance predict better representations and practices in inclusive health. In addition, an analysis of mediation showed the mediating effect of social distance on the link between being in contact with people with intellectual disabilities (through employment) and better representations and practices in inclusive health. This study enabled us to assess the interplay between stigma variables and healthcare professionals' representations and practices towards people with intellectual disabilities and to identify potential facilitators for promoting health equity.

Integration of Disability Awareness Improves Medical Students' Attitudes Toward People with Disabilities

Persons with disabilities (PWD) often require special accommodations and more comprehensive healthcare yet frequently have encounters with physicians who are unprepared to provide tailored and complete care. A multipronged disability awareness curriculum for second-year medical students was implemented, including content on disability etiquette, patient-centered and interprofessional learning sessions for individuals with physical disabilities and intellectual and developmental disabilities, and a debriefing session with physiatrists. The objective of this study was to utilize a mixed methods approach to evaluate the disability awareness curriculum in undergraduate medical education (UME). Assessment was conducted using course evaluations, pre- and post-surveys including the Attitudes and Perspectives Towards Persons with Disabilities (APPD) scale and Multidimensional Attitudes Scale Toward Persons with Disabilities (MAS), and student focus groups. The mean scores from both the APPD (2.11 ± 0.43 pre-score vs. 1.7 ± 0.39 post-score) and MAS (2.45 ± 0.43 pre-score vs. 2.25 ± 0.55 post-score) indicate the curriculum improved medical students' attitudes toward PWD (p < 0.05), with lower numbers representing more favorable attitudes. After completing the curriculum, medical students' attitudes were comparable to those of doctor of physical therapy (DPT) students. Qualitative analysis from focus groups highlighted four major themes: education, comfort level, impact on future practice, and disability differences. This curriculum has potential as a valuable framework for delivering effective disability education to medical students to prepare future physicians to serve PWD and their unique needs. It meets core competencies, provides an opportunity to learn in interprofessional environments, and integrates PWD into the educational process.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-024-02004-0.

Trainee advocacy for medical education on the care of people with intellectual and/or developmental disabilities: a sequential mixed methods analysis

BACKGROUND

Medical trainees (medical students, residents, and fellows) are playing an active role in the development of new curricular initiatives; however, examinations of their advocacy efforts are rarely reported. The purpose of this study was to understand the experiences of trainees advocating for improved medical education on the care of people with intellectual and/or developmental disabilities.

METHODS

In 2022-23, the authors conducted an explanatory, sequential, mixed methods study using a constructivist paradigm to analyze the experiences of trainee advocates. They used descriptive statistics to analyze quantitative data collected through surveys. Participant interviews then yielded qualitative data that they examined using team-based deductive and inductive thematic analysis. The authors applied Kern's six-step approach to curriculum development as a framework for analyzing and reporting results.

RESULTS

A total of 24 participants completed the surveys, of whom 12 volunteered to be interviewed. Most survey participants were medical students who reported successful advocacy efforts despite administrative challenges. Several themes were identified that mapped to Steps 2, 4, and 5 of the Kern framework: "Utilizing Trainee Feedback" related to Needs Assessment of Targeted Learners (Kern Step 2); "Inclusion" related to Educational Strategies (Kern Step 4); and "Obstacles", "Catalysts", and "Sustainability" related to Curriculum Implementation (Kern Step 5).

CONCLUSIONS

Trainee advocates are influencing the development and implementation of medical education related to the care of people with intellectual and/or developmental disabilities. Their successes are influenced by engaged mentors, patient partners, and receptive institutions and their experiences provide a novel insight into the process of trainee-driven curriculum advocacy.

Come Roll with Me: An Interprofessional Experience to Promote Disability Awareness

Problem: One in four American adults have a disability, which makes people with disabilities the largest minority group in the United States (U.S.). Chronic diseases are prevalent within this population, which faces myriad barriers that limit access to healthcare and create significant health care disparities. Yet, disability awareness programs are limited in U.S. medical schools and graduates report a sense of unpreparedness to care for this population. Intervention: Come Roll with Me (CRWM) was implemented as an interprofessional, preclinical experience to provide medical and Doctor of Physical Therapy (DPT) students an opportunity to engage with wheelchair users and one another. Students rotated through four stations with a licensed physical therapist and wheelchair user facilitator. Stations included (1) manual wheelchair self-propulsion, (2) accessible parking, (3) transfers, and (4) open dialog on barriers to healthcare led by the wheelchair user. Context: This study sought to assess the impact of CRWM on students' understanding of the barriers and health disparities faced by individuals with disabilities. Assessment was conducted using course evaluations, thematic analysis of student reflection essays and a focus group with the wheelchair user facilitators to determine if CRWM met pre-implementation program goals and objectives, including the Interprofessional Educational Collaborative (IPEC) core competencies. Impact: Student reflections from both disciplines indicated that learners were able to identify a variety of barriers faced by people with disabilities and prioritize methods to mitigate these factors. Approximately 91% of medical students agreed or strongly agreed that CRWM was effective in their learning on course evaluations. Wheelchair user facilitators noted three important outcomes of CRWM: educating, teaming, and impact on students. Lesson Learned: Come Roll with Me is a robust educational activity, as evidenced by the program meeting all goals and objectives as well as (IPEC) core competencies. It provides students a unique opportunity to learn about disability from another profession and wheelchair users. People with disabilities and DPT students are a unique and underutilized pool of educators in undergraduate medical education.

Developing Disability-Focused Pre-Health and Health Professions Curricula

People with disabilities (PWD) comprise a significant part of the population yet experience some of the most profound health disparities. Among the greatest barriers to quality care are inadequate health professions education related to caring for PWD. Drawing upon the expertise of health professions educators in medicine, public health, nursing, social work, and physician assistant programs, this forum showcases innovative methods for teaching core disability skills and concepts grounded in disability studies and the health humanities. Each of the essays offers practical guidance for developing curricular interventions appropriate for students at various levels of training and familiarity with disability to be implemented in classroom discussions, case-based learning, lectures, panels, and clinical simulations across the full spectrum of pre-health and health professions education.

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.

Experiences and recommendations from people with spinal cord injury following participation in a disability education session at an allopathic medical school: a qualitative study

BACKGROUND

Students in half of US medical schools do not receive formal instruction in providing medical care for people with disabilities. To address this gap in training, our medical school developed several strategies, including a session for second year medical students to address communication skills, knowledge, and attitudes relevant to delivering healthcare for people with disabilities. Here, our objective was to explore perceptions of people with spinal cord injury (SCI) who participated in the session on its content and structure.

METHODS

Qualitative research using a focus group of people with SCI who participated in an educational session for medical students in an LCME accredited allopathic US medical school. A purposive sample of adults with SCI (N = 8) participated in a focus group. Data were analyzed using a six-phase thematic analysis.

RESULTS

Participants favorably viewed the educational session, felt their participation was valuable, and had suggestions for its improvement. Four major themes were identified: (1) session format, content; (2) addressing student discomfort and avoidance behaviors; (3) increasing student knowledge and preparation; and (4): important lessons from discussions of past and role-played doctor-patient interactions.

CONCLUSIONS

First-person input from people with SCI is critical to improve medical education and healthcare provision to the SCI community. To our knowledge, this is the first study to report feedback from stakeholders providing specific recommendations for teaching disabilities awareness to undergraduate medical students. We expect these recommendations to be relevant to the SCI and medical education communities in improving healthcare for people with SCI and other disabilities.

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.

Expanding Diversity, Equity, and Inclusion to Disability: Opportunities for Biological Psychiatry

Given its subject matter, biological psychiatry is uniquely poised to lead STEM (science, technology, engineering, and mathematics) DEI (diversity, equity, and inclusion) initiatives related to disability. Drawing on literatures in science, philosophy, psychiatry, and disability studies, we outline how that leadership might be undertaken. We first review existing opportunities for the advancement of DEI in biological psychiatry around axes of gender and race. We then explore the expansion of biological psychiatry's DEI efforts to disability, especially along the lines of representation and access, community accountability, first-person testimony, and revised theoretical frameworks for pathology. We close with concrete recommendations for scholarship and practice going forward. By tackling head-on the challenge of disability inclusion, biological psychiatry has the opportunity to be a force of transformation in the biological sciences and beyond.

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.

US Physicians' Knowledge About The Americans With Disabilities Act And Accommodation Of Patients With Disability

More than thirty years since the enactment of the Americans with Disabilities Act (ADA), people with disability continue to experience health care disparities. The ADA mandates that patients with disability receive reasonable accommodations. In our survey of 714 US physicians in outpatient practices, 35.8 percent reported knowing little or nothing about their legal responsibilities under the ADA, 71.2 percent answered incorrectly about who determines reasonable accommodations, 20.5 percent did not correctly identify who pays for these accommodations, and 68.4 felt that they were at risk for ADA lawsuits. Physicians who felt that lack of formal education or training was a moderate or large barrier to caring for patients with disability were more likely to report little or no knowledge of their responsibilities under the law and were more likely to believe that they were at risk for an ADA lawsuit. To achieve equitable care and social justice for patients with disability, considerable improvements are needed to educate physicians and make health care delivery systems more accessible and accommodating.

Curriculum development on the human rights of people with disabilities for future medical education: using a modified Delphi

BACKGROUND

In order for doctors to effectively provide medical services to patients with disabilities, an understanding of this population is necessary, along with the knowledge, attitudes, and technical abilities necessary to address health problems associated with each type of disability. One way of doing this is by educating doctors about disabilities and ensuring their frequent contact with people with disabilities while they are in medical school. Therefore, this study aimed to develop a systematic medical education curriculum to enhance doctors' understanding of people with disabilities.

METHODS

The authors conducted a systematic literature review to develop and verify the basic framework of the educational content and curriculum. Two surveys were also developed using the Delphi method to evaluate the adequacy and necessity of educational topics. Items with a content validity ratio equal to or greater than the minimum value were considered valid. Survey panels comprised academic experts and health care practitioners who were working with people with disabilities. We conducted two surveys, one for a basic and the other for an advanced course, in which 13 to 16 respondents took part.

RESULTS

The authors selected 13 topics for the 'Basic Introductory Course' and included general educational content on the health rights of people with disabilities focused on improving students' knowledge of disabilities. The authors also selected 12 topics for the 'Care and Communication for Patients with Disabilities Course' designed to improve students' understanding of interviewing and communicating with patients with disabilities.

CONCLUSIONS

In Korea, disability has received little attention in the medical curriculum to date. The curriculum developed in this study provides preliminary data for guiding future directions in medical education and developing specific support plans for an education that promotes people with disabilities' health rights.

Evaluation of Veterinary Students' Communication Skills with a Service Dog Handler in a Simulated Client Scenario

Effective communication skills serve as a key component of excellent veterinary care and provide a foundation for building trusting relationships with clients. While many veterinary clients value their pets for companionship, the focus of other relationships may be based on a partnership between the human and animal, as is the case with the handlers of service dogs. As the use of service dogs in the US continues to grow, it is important that veterinary professionals are educated on how best to meet the unique needs of service dogs and their handlers. This article evaluates the interactions of veterinary students with a service dog handler in a simulated client scenario. Ten videotaped interactions were coded to assess third-year students' communication skills (nonverbal communication, open-ended questions, reflective listening, and empathy), and their ability to discuss the diagnostic and therapeutic options for a dog with suspected intervertebral disk disease. Results showed that the majority of students demonstrated competence in the use of nonverbal communication skills and in discussing the biomedical aspects of the disease. Students require development in the use of open-ended questions, reflective listening statements, and expression of empathy, as well as building client rapport and discussing the psychosocial aspect of the disease on the client and patient. These findings suggest that veterinary students may benefit from targeted instruction on "best practices" in caring for service dogs and their handlers, including greater attention to the psychosocial aspects of a disease, and from additional communication practice using standardized clients with service dogs.

Using the health humanities to impart disability competencies to undergraduate medical students

BACKGROUND

Disability competencies were included, for the first time, in India's new undergraduate competency-based curriculum as a result of physician-led advocacy in 2019; the regulatory body also recommended the use of the humanities in medicine.

OBJECTIVE

To use tools from the health humanities to impart disability competencies and help students appreciate the social and human rights issues associated with disability.

METHODS

A module was developed and piloted in the foundation course on the new cohort of students. The tools included storytelling, visual art, poetry, narratives, and Forum Theatre; many facilitators were doctors and patients with disabilities. Learners were introduced to the concept of universal design through a field visit. Quantitative and open-ended feedback was taken from learners after module delivery; reflections were sought after four months.

RESULTS

The data revealed that the humanities tools used in the module had the potential to help learners explore struggle and oppression and to expose discriminatory attitudes. Learners were able to think beyond the hegemony of normalcy, and show an understanding of diversity, dignity, autonomy, disableism, social inclusion, equity, and universal design. They admitted to the misconceptions they carried and showed keenness to advocate for change.

CONCLUSION

This study piloted a novel disability competencies module using tools from the health humanities and found that learners were able to engage with and show an understanding of the social and human rights issues associated with disability. Conversations by, for, and with people with disabilities must be part of such interventions in developing and delivering disability courses.

Nothing about me without me: a scoping review of how illness experiences inform simulated participants’ encounters in health profession education

Background

Person-centred simulation in health professions education requires involvement of the person with illness experience.

Objective

To investigated how real illness experiences inform simulated participants’ (SP) portrayals in simulation education using a scoping review to map literature.

Study selection

Arksey and O’Malley’s framework was used to search, select, chart and analyse data with the assistance of personal and public involvement. MEDLINE, Embase, CINAHL, Scopus and Web of Science databases were searched. A final consultation exercise was conducted using results.

Findings

37 articles were within scope. Reporting and training of SPs are inconsistent. SPs were actors, volunteers or the person with the illness experience. Real illness experience was commonly drawn on in communication interactions. People with illness experience could be directly involved in various ways, such as through conversation with an SP, or indirectly, such as a recording of heart sounds. The impact on the learner was rarely considered.

Conclusion

Authentic illness experiences help create meaningful person-centred simulation education. Patients and SPs may both require support when sharing or portraying illness experience. Patients’ voices profoundly enrich the educational contributions made by SPs.

Disability-competence training influences health care providers' conceptualizations of disability: An evaluation study

BACKGROUND

Often, health care providers' approach to people with disabilities is grounded in a medical model perspective. This view highlights individual deficits and does not foster patient-centeredness. Learning about and adopting a more social model, focused on creating accessible and inclusive approaches and environments, could help providers to reshape their attitudes about disability, dismantling barriers to care.

OBJECTIVE

This study used innovative methods to evaluate a recorded, online disability-competence training for health care providers. It was hypothesized that the training would 1) shift providers' conceptualizations of disability away from a medical model view toward a social model view of disability and 2) equip providers with actionable strategies to improve access to care for people with disabilities.

METHODS

Quantitative and qualitative evaluation data were analyzed for n = 192 training participants. Measures included participants' pre- and post-training conceptualizations of disability, proposed actions steps to facilitate patient-centered care, and measures of satisfaction and self-assessed knowledge gain.

RESULTS

Both hypotheses were supported. After the training, participants' conceptualizations of disability were more reflective of the social model, and participants were better able to articulate specific action steps they could take to promote accessible, responsive care.

CONCLUSIONS

This study demonstrates that health care provider training can positively affect providers' knowledge, outlook, and approach to caring for people with disabilities. Its findings can inform broader efforts aimed at systematically changing the way health professionals are educated and trained to provide care in disability-competent ways.

Improved detection of patient centeredness in objective structured clinical examinations through authentic scenario design

OBJECTIVE

In current objective structured clinical examinations (OSCEs), simulated encounters lacking realism reduce authenticity of assessment as students can take the OSCEs with a search-and-scan approach and trained empathy. Accordingly, patient-centeredness, the fundamental goal of OSCE, is not well assessed. This study evaluated the effect of a change in the OSCE scenario and checklist with respect to detecting students' patient-centeredness.

METHODS

A scenario script for valid representation of a real clinical encounter was developed and defined as authenticated scenario. The OSCE scores and the measure of patient-centered communication (MPCC) scores of 79 medical students were compared between the two OSCE stations, one using the traditional scenario and another using the authenticated scenario.

RESULTS

The MPCC total score was higher in the OSCE station using the authenticated scenario than that of the traditional scenario (p < 0.001). For the OSCE scores, the patient satisfaction score and the patient-physician interaction score were higher in the station using the authenticated scenario than the traditional one (p < 0.001).

CONCLUSION

The OSCE station using the authenticated scenario better detected medical student level of patient-centeredness.

PRACTICE IMPLICATIONS

Strengthening the authenticity of the OSCE scenario is critical for detecting the medical students' levels of patient-centeredness.

The Prevalence of Disability Health Training and Residents With Disabilities in Emergency Medicine Residency Programs

OBJECTIVES

Individuals with disabilities experience significant health care disparities due to a multitude of barriers to effective care, which include a lack of adequate physician training on this topic and negative attitudes of physicians. This results in disparities through inadequate physical examination and diagnostic testing, withholding or inferior treatment, and neglecting preventative care. While much has been published about disability education in undergraduate medical education, little is known about the current state of disability education in emergency medicine (EM) residency programs.

METHODS

In 2019, a total of 237 EM residency program directors (PDs) in the United States were surveyed about the actual and desired number of hours of disability health instruction, perceived barriers to disability health education, prevalence of residents and faculty with disabilities, and confidence in providing accommodations to residents with disabilities.

RESULTS

A total of 104 surveys were completed (104/237, 43.9% response rate); 43% of respondents included disability-specific content in their residency curricula for an average of 1.5 total hours annually, in contrast to average desired hours of 4.16 hours. Reported barriers to disability health education included lack of time and lack of faculty expertise. A minority of residency programs have faculty members (13.5%) or residents (26%) with disabilities. The prevalence of EM residents with disabilities was 4.02%. Programs with residents with disabilities reported more hours devoted to disability curricula (5 hours vs 1.54 hours, p = 0.017) and increased confidence in providing workplace accommodations for certain disabilities including mobility disability (p = 0.002), chronic health conditions (p = 0.022), and psychological disabilities (p = 0.018).

CONCLUSIONS

A minority of EM PDs in our study included disability health content in their residency curricula. The presence of faculty and residents with disabilities is associated with positive effects on training programs, including a greater number of hours devoted to disability health education and greater confidence in accommodating learners with disabilities. To reduce health care disparities for patients with disabilities, we recommend that a dedicated disability health curriculum be integrated into all aspects of the EM residency curriculum, including lectures, journal clubs, and simulations and include direct interaction with individuals with disabilities. We further recommend that disability be recognized as an aspect of diversity when hiring faculty and recruiting residents to EM programs, to address this training gap and to promote a diverse and inclusive learning environment.

Physicians' Perceptions Of People With Disability And Their Health Care

More than sixty-one million Americans have disabilities, and increasing evidence documents that they experience health care disparities. Although many factors likely contribute to these disparities, one little-studied but potential cause involves physicians' perceptions of people with disability. In our survey of 714 practicing US physicians nationwide, 82.4 percent reported that people with significant disability have worse quality of life than nondisabled people. Only 40.7 percent of physicians were very confident about their ability to provide the same quality of care to patients with disability, just 56.5 percent strongly agreed that they welcomed patients with disability into their practices, and 18.1 percent strongly agreed that the health care system often treats these patients unfairly. More than thirty years after the Americans with Disabilities Act of 1990 was enacted, these findings about physicians' perceptions of this population raise questions about ensuring equitable care to people with disability. Potentially biased views among physicians could contribute to persistent health care disparities affecting people with disability.

Emergency Medicine Resident Education on Caring for Patients With Disabilities: A Call to Action

People with disabilities constitute a marginalized population who experience significant health care disparities resulting from structural, socioeconomic, and attitudinal barriers to accessing health care. It has been reported that education on the care of marginalized groups helps to improve awareness, patient-provider rapport, and patient satisfaction. Yet, emergency medicine (EM) residency education on care for people with disabilities may be lacking. The goal of this paper is to review the current state of health care for patients with disabilities, review the current state of undergraduate and graduate medical education on the care of patients with disabilities, and provide suggestions for an improved EM residency curriculum that includes education on the care for patients with disabilities.

Getting comfortable with disability: The short- and long-term effects of a clinical encounter

BACKGROUND

Physicians report discomfort when interacting with patients with disabilities, which can negatively impact the quality of healthcare they provide.

OBJECTIVE/HYPOTHESIS

An intervention structured around a formative clinical encounter was assessed for its effectiveness in changing comfort towards treating patients with disabilities. It was predicted that this encounter would have a positive short- and long-term impact on medical students.

METHOD

During the 2017-2018 academic year, 169 third-year medical students conducted a patient encounter with a person who had a disability. Students met individually with the "patient" and completed a brief social and medical history as if they were meeting a new patient to establish care. A measure of perceived comfort caring for patients with disabilities was administered to students before and after the encounter. One year after the patient encounter, 59 students were surveyed about their satisfaction and the impact of the patient encounter.

RESULTS

The impact of encountering people with disabilities in a clinical setting was positive, with statistically significant improvements across all items on the measure of perceived comfort. Students were highly satisfied with the experience and anticipated feeling more confident, more comfortable, less awkward, and more skilled and efficacious when encountering a person with a disability in their future practice. A thematic analysis of the one year follow-up data suggest that students valued the encounter and desired more content on disability throughout their education.

CONCLUSIONS

Medical education should include dedicated exposure to persons with disabilities and a simulated patient experience allowing for a safe environment to gain skills and confidence.

What should we teach about disability? National consensus on disability competencies for health care education

BACKGROUND

Health care providers are unprepared to meet the health needs of patients who have disabilities. Disability training is needed, yet there is little agreement about what should be taught.

OBJECTIVE

Establish a national consensus on what healthcare providers across disciplines need to know to provide quality care to patients with all types of disabilities (e.g., mobility, sensory, developmental, mental health).

METHODS

People with disabilities, disability advocates, family members of people with disabilities, disability and health professionals, and inter-disciplinary health educators systematically evaluated and provided feedback on a draft set of disability competencies. Based on this feedback, competencies were iteratively refined.

RESULTS

After two waves of feedback, six competencies, 49 sub-competencies, and 10 principles and values emerged that addressed topics such as respect, person-centered care, and awareness of physical, attitudinal, and communication health care barriers. An overwhelming majority (89%) agreed or strongly agreed that the disability competencies reflected the core understandings needed to provide quality care for patients with disabilities, were relevant across disability types (85%), and across health care disciplines (96%). Averaging evaluative feedback across competencies, participants reported that the competencies were important (98%) and clear (96%).

CONCLUSIONS

This consensus on what to teach is an important milestone in preparing a disability competent health care workforce. Future directions for research, training, and policy are discussed. When disability is included in health care education, the health care workforce will be prepared to deliver accessible, patient-centered, quality health care to patients with disabilities.

A call to action: Preparing a disability-competent health care workforce

People with disabilities make up the largest minority population in the country, yet our health care workforce is unprepared to meet their needs. Two initiatives - and the Alliance for Disability in Health Care Education's Disability Competencies and the Resources for Integrated Care Disability-Competent Care model-provide essential tools to build a health care workforce prepared to meet the health needs of people with disabilities. We note gaps in health education and continuing education curricula, document barriers to progress, and demonstrate how the two initiatives offer a clear roadmap to effect systemic change. Finally, we issue a call to action for health care education, practice, and research to ensure a health care workforce prepared to provide quality health care to people with disabilities.

Maternal disability and risk for pregnancy, delivery, and postpartum complications: a systematic review and meta-analysis

BACKGROUND

Women with disabilities are increasingly becoming pregnant, and growing evidence suggests maternal disability may be associated with increased risk for perinatal complications.

OBJECTIVE

A systematic review and meta-analysis were undertaken to examine the association between maternal disabilities and risk for perinatal complications.

STUDY DESIGN

Medline, CINAHL, EMBASE, and PsycINFO were searched from inception to July 2018 for full-text publications in English on pregnancy, delivery, and postpartum complications in women with any disability and those with physical, sensory, and intellectual and developmental disabilities specifically. Searches were limited to quantitative studies with a comparison group of women without disabilities. Reviewers used standardized instruments to extract data from and assess the quality of included studies. Pooled odds ratios and 95% confidence intervals were generated using DerSimonian and Laird random effects models for outcomes with data available from ≥3 studies.

RESULTS

The review included 23 studies, representing 8,514,356 women in 19 cohorts. Women with sensory (pooled unadjusted odds ratio, 2.85, 95% confidence interval, 0.79-10.31) and intellectual and developmental disabilities (pooled unadjusted odds ratio, 1.10, 95% confidence interval, 0.76-1.58) had elevated but not statistically significant risk for gestational diabetes. Women with any disability (pooled unadjusted odds ratio, 1.45, 95% confidence interval, 1.16-1.82) and intellectual and developmental disabilities (pooled unadjusted odds ratio, 1.77, 95% confidence interval, 1.21-2.60) had increased risk for hypertensive disorders of pregnancy; risk was elevated but not statistically significant for women with sensory disabilities (pooled unadjusted odds ratio, 2.84, 95% confidence interval, 0.85-9.43). Women with any (pooled unadjusted odds ratio, 1.31, 95% confidence interval, 1.02-1.68), physical (pooled unadjusted odds ratio, 1.60, 95% confidence interval, 1.21-2.13), and intellectual and developmental disabilities (pooled unadjusted odds ratio, 1.29, 95% confidence interval, 1.02-1.63) had increased risk for cesarean delivery; risk among women with sensory disabilities was elevated but not statistically significant (pooled unadjusted odds ratio, 1.28, 95% confidence interval, 0.84-1.93). There was heterogeneity in all analyses, and 13 studies had weak-quality ratings, with lack of control for confounding being the most common limitation.

CONCLUSION

Evidence that maternal disability is associated with increased risk for perinatal complications demonstrates that more high-quality research is needed to examine the reasons for this risk and to determine what interventions could be implemented to support women with disabilities during the perinatal period.

Cluster Randomized Controlled Trial of Disability Education Module During Clinical Clerkship

The effect of a randomized disability education program on medical student knowledge and attitudes concerning disability was performed. Intervention group received bedside teaching of physical examination/interview skills and case-based discussion. Twenty-three participants completed the study (control group n = 11; intervention group n = 12). Pre-clerkship, 39% of all participants reported no personal experience and 43% reported no professional experience with people with disabilities. Post-clerkship knowledge was higher for both groups; the test of group-by-time interaction was not significant. Qualitative analysis of post-clerkship attitude responses demonstrated that intervention group gave more detailed answers. Intervention group used terms representing functional aspects of disability twice as frequently as control group. Intervention group responses described long-term experience of a disability within community and family; control group responses focused on acute medical management. Participation in disability education resulted in changed attitude toward disability and better understanding of aspects of disability.

Is an obesity simulation suit in an undergraduate medical communication class a valuable teaching tool? A cross-sectional proof of concept study

OBJECTIVE

With the growing prevalence of overweight and obesity, medical students should be prepared to engage in weight management and obesity-related communications in order to prevent patients from having stigmatising experiences. In addition, medical students should have training to reduce anti-fat prejudices.

DESIGN

Cross-sectional proof of concept study.

SETTING

University Hospital Tuebingen, Germany.

PARTICIPANTS

246 participants (207 second-year medical students, 13 standardised patients (SPs) and 22 teachers) took part in the study.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was the assessment of degree of reality of the encounter with the SP wearing an obesity simulation suit (OSS). The secondary outcome was the evaluation of students' awareness and prejudice against patients with obesity in a simulated role play. Additionally, a description of the advantages and disadvantages when using such a teaching tool is delivered.

RESULTS

The OSS contributed to a realistic perception of the patient group depicted in a role play according to students, teachers and SPs. OSS body mass index estimation by students, teachers and SPs correctly was over 30 kg/m²-thus in the range of obesity. In a selected subscale of the Anti-Fat Attitudes Test, students showed significantly stronger anti-fat stigmatisation compared with teachers and SPs.

CONCLUSIONS

An OSS worn by an SP is a valuable teaching tool to raise awareness about patients with obesity. It gives a realistic picture of the encounter. Stigmatisation was low in general but was especially present in the students. Further research should include intervention studies to address this issue.

Patient involvement in health professionals' education: a meta-narrative review

More than 100 years ago, Osler inspired educators to consider health professions education (HPE) as intricately reliant on patients. Since that time, patient involvement in HPE has taken on many different meanings. The result is a disparate body of literature that is challenging to search, making it difficult to determine how to continue to build knowledge in the field. To address this problem, we conducted a review of the literature on patient involvement in HPE using a meta-narrative approach. The aim of the review was to synthesize how questions of patient involvement in HPE have been considered across various research traditions and over time. In this paper, we focus on three scholarly communities concerned with various interpretations of patient involvement in HPE-patient as teachers, real patients as standardized patients, and bedside learning. Focus on these three research communities served as a way to draw out various meta-narratives in which patients are thought of in particular ways, specific rationales for involvement are offered, and different research traditions are put to use in the field. Attending to the intersections between these meta-narratives, we focus on the potentially incommensurate ways in which "active" patient engagement is considered within the broader field and the possible implications. We end by reflecting on these tensions and what they might mean for the future of patient involvement, specifically patient involvement as part of future iterations of competency based education.

Group randomized trial of teaching tobacco-cessation counseling to senior medical students: a peer role-play module versus a standardized patient module

BACKGROUND

An important barrier to smoking-cessation counseling for physicians is a lack of education at the undergraduate level. Interactive methods such as peer role-play (RP) or modules utilizing standardized patients (SPs) may be effective for medical students to enhance their performance on tobacco cessation counseling. This study compared the effectiveness of a module using SPs to that of a RP module for undergraduate medical students on tobacco cessation counseling.

METHODS

This study was conducted over a single week of the family medicine clerkship. One hundred and thirteen fourth-year medical students were randomized into either the SP group or the RP group. A RP module involved a ten-minute encounter between the student doctor and the student patient followed by five minutes of feedback from the observer student using a group developed checklist. In a SP module, each student was asked to interview a SP portraying a smoker with willingness to quit. After the encounter, the SP provided five minutes of direct oral feedback to the student. In both modules, the total intervention lasted three-and-half hours and was supervised by faculty staff. Students' objective structured clinical examination (OSCE) scores were evaluated to determine their tobacco cessation counseling skills. Four evaluation periods were conducted at baseline, postintervention, post-clerkship, and before receiving the Korean medical licensing examination (KMLE). Students' smoking knowledge test scores and counseling self-confidence levels at pre- and post-intervention were also compared.

RESULTS

In both groups, post-intervention OSCE scores increased significantly compared to baseline (Cohen's d 0.87, p < 0.001 in SP group; d 0.77, p < 0.001 in RP group). However, there were no differences between the two groups. Students achieved the highest OSCE score for smoking-cessation counseling before the KMLE. After training, student self-confidence and smoking-knowledge test scores increased significantly, regardless of the type of module. Self-confidence was higher in the SP group compared with the RP group (d 0.37, p = 0.01).

CONCLUSIONS

Peer role-play may be equivalent to the SP method with regard to knowledge and skills reported during smoking-cessation counseling and SP method may be better in self-confidence. Cost and student self-confidence may be important factors when choosing among the teaching methods for smoking-cessation counseling.

Competency-Based Curriculum Development to Meet the Needs of People With Disabilities: A Call to Action

People with disabilities constitute 22.2% of the population in the United States, and virtually all physicians have people with disabilities in their clinical practice across a wide range of diagnostic groups. However, studies demonstrate that people with disabilities are inadequately served by the health care system, leading to high costs and poor outcomes. The authors argue that one cause of this discrepancy is that medical students receive limited training in the care of people with disabilities and may therefore not be able to adequately meet the competencies that underlie the Core Entrustable Professional Activities for Entering Residency. To address these gaps, the authors present practical examples of integrating concepts of disability into the curriculum with minimal additional time requirements. A comprehensive disability curriculum is suggested to include active classroom learning, clinical, and community-based experiences. At institutions that do not have a comprehensive curriculum, the authors recommend adding disability-related knowledge and skill acquisition to existing curricula through modifications to current case-based learning, simulated patients, and objective structured clinical examinations. To facilitate curriculum development, they recommend that the World Health Organization International Classification of Functioning, Disability, and Health be used as a tool to build disability concepts into active learning. The goal of these recommended curricular changes is to enhance student performance in the clinical management of people with disabilities and to better train all future physicians in the care of this population.

A pilot study of integrating standardized patients in problem-based learning tutorial in Taiwan

BACKGROUND

Problem-based learning (PBL) has been widely adopted in medical education; however, its application has been questioned due to the lack of interaction with a real patient. Standardized patients (SPs) might solve this problem. Herein, we tested the impact of integrating SPs in a PBL tutorial.

METHODS

In 2017, a total of 313 students, 66 facilitators, and 36 SPs were enrolled at National Yang-Ming University, Taiwan. The SPs presented the symptoms/signs of the cases then the students interviewed them to obtain the detail history. All students, facilitators, and SPs were invited to complete the questionnaires before and after this program.

RESULTS

Most SPs considered that both the second-year dental medical student and third-year medical students participated actively and were competent enough but students and facilitators considered that the fourth-year medical students might be more prepared. Overall, the students thought highly of the interactions with the SPs. Only about one-fifth felt that this design caused unnecessary pressure among the students and facilitators. They agreed that this program significantly inspired the student's learning motivation (pre- vs post-course: 4.1 ± 0.7 vs 4.3 ± 0.7, p < 0.001), increased their confidence level in interviewing patients (4.0 ± 0.8 vs 4.2 ± 0.7, p < 0.001), and encouraging critical thinking (4.0 ± 0.7 vs 4.2 ± 0.7, p < 0.001).

CONCLUSION

The SPs, facilitators, and students had different viewpoints with regards to integrating SPs in the PBL tutorial. However, a majority agreed that this design enhanced the motivation of students and supported such an application in PBL tutorials.

Innovative Approach to Address Disability Concepts and Standardized Patients With Disability in an Undergraduate Curriculum

BACKGROUND

Despite a growing population of people with disabilities (PWD), health care professionals, including nurses, receive little educational preparation to provide health care to them. To address this issue in nursing education, the faculty of a school of nursing designed and implemented an innovative teaching strategy that can be adopted by other nursing programs and faculty.

METHOD

A systematic plan was developed and implemented to integrate standardized patients with disabilities (SPWD) into an existing undergraduate nursing program. Steps included careful planning, review, and modification of existing simulation-based scenarios, obtaining buy-in of faculty across the curriculum, recruitment and training of PWD to be SPWD, and implementation of the project.

RESULTS

The program in which all undergraduate nursing students have repeated contact with SPWD has been successfully implemented throughout the curriculum.

CONCLUSION

The project addressed the multiple calls to improve the preparation of health care professionals to provide quality care to PWD. [J Nurs Educ. 2018;57(12):760-764.].

Completing Disability Forms Efficiently and Accurately: Curriculum for Residents

INTRODUCTION

The completion of a patient's disability assessment form (DAF) is a task expected of family and internal medicine physicians. Residency curricula rarely address this task. Thus, some residents are reluctant to conduct functional assessments because of inadequate training, the time required to conduct such an exam, and fear of jeopardizing the doctor-patient relationship. This article describes a curricular intervention to prepare residents to complete a focused functional capacity assessment during a 30-minute office visit.

METHODS

Developing the curriculum for DAF completion involved a literature review, conducting needs assessment interviews, and a review of existent residency training materials. Instructional strategies included lecture, panel discussions, and demonstrations. The learner evaluation strategies were knowledge tests, direct observation of residents, and a review of disability cases with an expert panel consisting of federally certified Social Security Administration workers. This work represents information gained from four pilot tests.

RESULTS

The residents' knowledge scores increased significantly. Knowledge of state, federal, and employer disability programs increased as well as their ability to distinguish sedentary, light, medium, and heavy work capacity when related to patients' medical conditions. All the residents could perform the assessment, but none of them were confident that they could complete the DAF in a 30-minute office visit. This was an expected outcome.

CONCLUSIONS

It is possible to teach family and internal medicine residents the knowledge and skills required to determine their patients' functional capacity as it relates to a specific problem. By applying what they have learned to their patients, they will eventually be able to complete a DAF during a 30-minute office visit. Residency programs are encouraged to incorporate a functional assessment curriculum.

Obstetric clinicians' experiences and educational preparation for caring for pregnant women with physical disabilities: A qualitative study

BACKGROUND

Women with physical disabilities (WPD) experience major barriers to care during pregnancy. Lack of education about disability in health professionals' education is a pervasive barrier to quality care. In an effort to explore this issue, this study examined the issue from the perspective of obstetric clinicians who provide care to WPD.

OBJECTIVE

This qualitative descriptive study explored perspectives of obstetric clinicians who provide perinatal care for WPD to inform the educational preparation of clinicians to care for women with disabilities.

METHOD

We contacted 33 obstetric clinicians who care for pregnant WPD. Thirteen obstetricians and one nurse midwife participated in semi-structured telephone interviews. Interview transcriptions were content analyzed to identify initial themes. Investigators discussed and revised the themes as additional transcripts were reviewed and new themes were identified.

RESULTS

Themes identified from transcript analyses included: lack of education at any level including during postgraduate residency and fellowship on care of pregnant WPD, unplanned career pathway, educating other clinicians, and positive and negative experiences providing obstetrical care to women with physical disability. Several clinicians provided this care because of requests from other clinicians and did not begin their careers with the goal of providing obstetric care to women with physical disabilities. None had received formal education or training including during their residencies or fellowships. The clinicians described very rewarding experiences caring for WPD.

CONCLUSIONS

The experiences reported by this study's participants suggest the need to include disability in undergraduate and postgraduate education and training to improve obstetric care to WPD.

Experiences and unmet needs of women with physical disabilities for pain relief during labor and delivery

BACKGROUND

Childbirth is widely acknowledged as one of the most painful experiences most women will undergo in their lifetimes. Alleviating labor and delivery pain for women with physical disabilities can involve an additional level of complexity beyond that experienced by most women, but little research has explored their experiences.

OBJECTIVE

The purpose of this study was to explore the experiences of women with physical disabilities with respect to pain relief during labor and delivery with the goal of informing their care.

METHODS

Data were collected using semi-structured interviews with twenty-five women with physical disabilities from across the United States.

RESULTS

Women expressed specific preferences for the method of pain relief. Some confronted systemic barriers in exploring their options for pain relief, while others were given a choice. At times, anesthesiologists lacked knowledge and experience in caring for women with disabilities. Conversely, some women described how the administration of anesthesia was meticulously planned and attributed their positive labor and delivery experiences to this careful planning.

CONCLUSIONS

Advanced, individualized planning and evaluation of their options for pain relief was most satisfying to women and enabled them to make an informed choice. This approach is consistent with the recommendations of clinicians who have successfully provided pain relief during labor to women with complex physical disabilities. Clinicians who have successfully delivered babies of women with these and similar disabilities emphasize the importance of a team approach where the anesthesiologist and other specialists are involved early on in a woman's care.

Systematic Review of Health Promotion Programs Focused on Behavioral Changes for People With Intellectual Disability

People with intellectual disability (ID) experience high rates of chronic health problems and poor overall health compared to people without disabilities. Recent attention to health risk behaviors such as poor diet, lack of physical activity, and underuse of health care has led to the development of several programs intended to reduce disparities in this population through health promotion programs. A review of the literature was conducted focusing on programs developed to target behavioral changes in the person with ID. Thirteen studies, evaluating 10 different health promotion programs, were found. Programs varied significantly in design, targeted health change, and demonstrated effectiveness. Components of each program are systematically reviewed and recommendations made for future programs based upon the current evidence.

Patient experiences of participation in a medical student teaching workshop

OBJECTIVES

To investigate the motivations for and experiences of patients who actively participate in a workshop to teach medical students about chronic disease.

DESIGN

Descriptive study using structured telephone or e-mail-based questionnaire exploring the views of 'patient tutors' who participate in a 'living with chronic disease' workshop.

PARTICIPANTS

'Patient tutors' with a chronic medical condition who had participated in at least one 'living with chronic disease' workshop for medical students at Oxford University Medical School.

RESULTS

Patient motivating factors can be divided into two groups, direct benefits such as companionship or improved knowledge of their condition, and a teaching role involving an altruistic desire to give something back, and wanting to educate the doctors of the future. Importantly, most patients participated multiple times over a number of years despite no remuneration for their time other than expenses.

CONCLUSIONS

Patients appear highly motivated to educate medical students about chronic disease, due to a combination of personal benefits and an altruistic desire to 'give something back'. This suggests that they present an invaluable and currently undermobilized resource for the future of medical education.

National health surveillance of adults with disabilities, adults with intellectual and developmental disabilities, and adults with no disabilities

BACKGROUND

People with disabilities experience worse health and poorer access to health care compared to people without disability. Large-scale health surveillance efforts have largely excluded adults with intellectual and developmental disability. This study expands knowledge of health status, health risks and preventative health care in a representative US sample comparing the health of adults with no disability to adults with intellectual and developmental disability and to adults with other types of disability.

OBJECTIVES

The purposes of this study were (1) to identify disparities between adults with intellectual and developmental disability and adults with no disability and (2) compare this pattern of disparities to the pattern between adults with other types of disability and adults without disability.

METHODS

This study compares health status, health risks and preventative health care in a national sample across three groups of adults: No Disability, Disability, and Intellectual and Developmental Disability. Data sources were the 2010 Behavior Risk Factor Surveillance Survey and the National Core Indicators Consumer Survey.

RESULTS

Adults with disability and with intellectual and developmental disability were more likely to report being in poor health compared to adults without disability. Disability and intellectual and developmental disability conferred unique health risks and health care utilization patterns.

CONCLUSIONS

Significant disparities in health and health care utilization were found for adults with disability and developmental disability relative to adults without disability. Disability training for health care providers and health promotion research that identifies disability as a demographic group is needed.

Standardised patients with intellectual disabilities in training tomorrow's doctors

Aims and method To develop a programme to help undergraduate medical students and postgraduate trainees to improve their skills in communicating with people with intellectual disabilities through teaching sessions that had input from simulated patients with intellectual disabilities. We conducted four sessions of training for 47 undergraduate 4th-year medical students. The training involved a multiprofessional taught session followed by a clinical scenario role-play with simulated patients who were people with intellectual disabilities. The training was assessed by completing the healthcare provider questionnaire before and after the training.

Results There were improvements in the students’ perceived skill, comfort and the type of clinical approach across all three scenarios.

Clinical implications By involving people with intellectual disabilities in training medical students there has been a significant improvement in students’ communication skills in areas of perceived skills, comfort and type of clinical approach which will raise the quality of care provided by them in the future.

Medical student self-efficacy, knowledge and communication in adolescent medicine

OBJECTIVE

To evaluate student self-efficacy, knowledge and communication with teen issues and learning activities.

METHODS

Data were collected during the 8-week pediatric rotation for third-year medical students at a local children's hospital. Students completed a self-efficacy instrument at the beginning and end of the rotation; knowledge and communication skills were evaluated during standardized patient cases as part of the objective structured clinical examination. Self-efficacy, knowledge and communication frequencies were described with descriptive statistics; differences between groups were also evaluated utilizing two-sample t-tests.

RESULTS

Self-efficacy levels of both groups increased by the end of the pediatric rotation, but students in the two-lecture group displayed significantly higher self-efficacy in confidentiality with adolescents (t(35)=-2.543, p=0.02); interviewing adolescents, assessing risk, sexually transmitted infection risk and prevention counseling, contraception counseling were higher with marginal significance. No significant differences were found between groups for communication; assessing sexually transmitted infection risk was marginally significant for knowledge application during the clinical exam.

CONCLUSIONS

Medical student self-efficacy appears to change over time with effects from different learning methods; this higher self-efficacy may increase future comfort and willingness to work with this high-risk, high-needs group throughout a medical career.

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.

An innovative clerkship module focused on patients with disabilities

Lack of medical training results in physicians being unprepared to provide care to people with disabilities, which, in turn, contributes to the substantial health disparities that are evident in this population. Few medical schools or primary care residencies address the care of adults with disabilities. Competencies and guidelines to assist American physicians in caring for patients with physical or intellectual disabilities have yet to be established, thus making educational goals unclear. This article describes one novel training module regarding people with disabilities that was developed at the University of South Florida Health, Morsani College of Medicine (USF) and inserted into the primary care clerkship during a major curriculum redesign in 2005. Since then, all USF third-year medical students have been required to participate in this disability-related course component. The authors describe the module's development and integration into the primary care clerkship, as well as the specific elements of their curriculum. By using a variety of teaching modalities in the classroom and community, and especially by involving people with disabilities themselves, the medical students have a very comprehensive learning experience regarding people who have physical, sensory, or intellectual disabilities. The authors have been able to show that USF medical students, on completion of this module, demonstrate improved knowledge, attitudes, and comfort in caring for people with disabilities, which the authors believe will lead to improved health and health care access for this underserved population. Suggestions for program replication, including common challenges, are also discussed.