1
|
Adamson B, Thompson CM, Makos S, Pool K, Liechty T, Chiu CY, Woo M, Rice L. What happens post-pilot testing? A model for revising a disability awareness and competency training program. Disabil Health J 2024; 17:101612. [PMID: 38503622 DOI: 10.1016/j.dhjo.2024.101612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/19/2024] [Accepted: 03/07/2024] [Indexed: 03/21/2024]
Abstract
Disability awareness and competency trainings are an important component of addressing ableism and health equity in the health promotion context. This commentary describes our process of developing, implementing, and refining a disability competency training, the Inclusive Community Exercise Training, for community-based group exercise instructors. The training originated from a partnership between academic researchers, community organizations, and individuals with disabilities. After initial pilot testing, we used feedback from participants to enhance the training. To optimize successful dissemination of this training, we utilized the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, which is widely used in public health. The revision process focused on generalizing content to suit a wider audience, utilizing an eLearning platform for dissemination, and optimizing interactivity to improve learning effectiveness. The commentary emphasizes the lessons learned and the significance of systematic program revision, considering diverse expertise, content tailoring, and the benefits of accessible eLearning platforms.
Collapse
Affiliation(s)
- B Adamson
- Department of Health Sciences, University of Colorado Colorado Springs, 4925 N. Nevada Ave, Colorado Springs, CO, 80918, USA.
| | - C M Thompson
- Department of Communication, University of Illinois Urbana-Champaign, 702 S. Wright St, Urbana, IL, 61801, USA.
| | - S Makos
- Department of Communication, University of Illinois Urbana-Champaign, 702 S. Wright St, Urbana, IL, 61801, USA.
| | - K Pool
- Department of Communication, University of Illinois Urbana-Champaign, 702 S. Wright St, Urbana, IL, 61801, USA.
| | - T Liechty
- Department of Recreation, Sport, & Tourism, University of Illinois Urbana-Champaign, 1206 South Fourth St, Champaign, IL, 61820, USA.
| | - C Y Chiu
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, 906 S. Goodwin Ave, Urbana, IL 61801, USA.
| | - M Woo
- Department of Recreation, Sport, & Tourism, University of Illinois Urbana-Champaign, 1206 South Fourth St, Champaign, IL, 61820, USA.
| | - L Rice
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, 906 S. Goodwin Ave, Urbana, IL 61801, USA.
| |
Collapse
|
2
|
Houtrow AJ, Garcia AM, Edinger J, Akamagwuna U. Disability Competent Care in Pediatric Milestones. JAMA Pediatr 2024:2819570. [PMID: 38884981 PMCID: PMC11184493 DOI: 10.1001/jamapediatrics.2024.1555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/12/2024] [Indexed: 06/18/2024]
Abstract
This cross-sectional study examines how disability competencies are addressed in the Accreditation Council for Graduate Medical Education’s milestones for pediatric specialties.
Collapse
Affiliation(s)
- Amy J. Houtrow
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania
| | - Angela M. Garcia
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania
| | - Jason Edinger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania
| | - Unoma Akamagwuna
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
3
|
Miner DC, Ailey SH, Thompson RA, Squires A, Adarlo A, Brown H. "We have met the enemy and it is us": Healthcare professionals as the barrier to health equity for people with intellectual and developmental disability. Res Nurs Health 2024; 47:269-273. [PMID: 38415432 DOI: 10.1002/nur.22376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/13/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Dianne C Miner
- Golisano Institute for Developmental Disability Nursing, Rochester, New York, USA
- Wegmans School of Nursing, St John Fisher University, Pittsford, New York, USA
| | - Sarah H Ailey
- Rush University College of Nursing, Chicago, Illinois, USA
| | - Roy A Thompson
- Preparing Future Faculty for Inclusive Excellence Postdoctoral Fellow, Sinclair School of Nursing, University of Missouri, Kansas City, Missouri, USA
| | - Allison Squires
- NYU Rory Meyers College of Nursing, New York, New York, USA
- Department of General Internal Medicine, Grossman School of Medicine, New York City, New York, USA
- National Academy of Medicine, Washington, District of Columbia, USA
| | - Amyela Adarlo
- Loma Linda University, School of Nursing, Loma Linda, California, USA
- Gamma Alpha Chapter of Sigma Theta Tau International, Indianapolis, Indiana, USA
| | - Holly Brown
- Golisano Institute for Developmental Disability Nursing, Rochester, New York, USA
- Wegmans School of Nursing, St John Fisher University, Pittsford, New York, USA
| |
Collapse
|
4
|
Smeltz L, Carpenter S, Benedetto L, Newcomb N, Rubenstein D, King T, Lunsford C, Shaw T, DeWaters AL. Introduction to Disability and Antiableist Health Care: A Pilot, Student-Led Module for Preclinical Medical Students. Am J Phys Med Rehabil 2024; 103:e54-e57. [PMID: 38261784 PMCID: PMC11031297 DOI: 10.1097/phm.0000000000002399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
ABSTRACT Physical medicine and rehabilitation physicians often care for disabled patients, who comprise America's largest marginalized population. Despite medical students' and physicians' discomfort with caring for disabled patients and the pervasiveness of ableism in health care, medical education lacks disability-focused education. Kern's approach to curriculum development and disability community input were used to design a three-part, elective curriculum for first-year medical students. Part one introduced disability models and language. Part two described how to perform a comprehensive history and physical examination for a disabled patient using ADEPT-CARE. Part three provided an overview of disability history and the disability rights movement. The curriculum's goal was to improve students' attitudes regarding disability health and self-perceived knowledge and confidence in caring for patients with disabilities. The curriculum was evaluated through presurvey and postsurvey. Students favorably reviewed the curriculum. One hundred percent of students ( n = 21) agreed or strongly agreed that the curriculum improved their knowledge of disability health, increased their perceived confidence in caring for patients with disabilities, and enhanced their medical education. There were no statistically significant differences in students' attitudes toward patients with disabilities after curriculum completion. Our asynchronous module provides one potential curriculum for increasing preclinical medical students' self-perceived knowledge of disability health.
Collapse
Affiliation(s)
- Lydia Smeltz
- Medical Student, Penn State College of Medicine, Hershey, PA
| | | | | | - Nora Newcomb
- Medical Student, University of South Florida Morsani College of Medicine
| | | | - Tonya King
- Adjunct Professor of Biostatistics within the Division of Biostatistics & Bioinformatics, Department of Public Health Sciences at Penn State College of Medicine, Hershey, PA
| | - Christopher Lunsford
- Assistant Professor of Orthopaedics and Pediatrics, Duke University School of Medicine
| | - Tanya Shaw
- Curriculum Manager, Penn State College of Medicine
| | - Ami L. DeWaters
- Associate Professor of Medicine, Interim Director of Health Systems Science at Penn State College of Medicine, Hershey, PA
| |
Collapse
|
5
|
Smythe T, Ssemata AS, Slivesteri S, Mbazzi FB, Kuper H. Co-development of a training programme on disability for healthcare workers in Uganda. BMC Health Serv Res 2024; 24:418. [PMID: 38570820 PMCID: PMC10988913 DOI: 10.1186/s12913-024-10918-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 03/27/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Approximately 1.3 billion people worldwide face barriers in accessing inclusive healthcare due to disabilities, leading to worse health outcomes, particularly in low and middle-income countries (LMIC). However, there is a lack of training of healthcare workers about disability, both globally and in Uganda. OBJECTIVES To use mixed research methods to develop a comprehensive training program with standardisedelements for healthcare workers in Uganda, focusing on improving their knowledge, attitudes, and skills inproviding care for people with disabilities. METHODS The Medical Research Council (MRC) approach was employed to guide the development of the training intervention. We conducted an umbrella review to gather relevant literature on disability training for healthcare workers. Interviews were conducted with international experts to gain insights and perspectives on the topic. Additionally, interviews were undertaken with people with disabilities and healthcare workers in Uganda to understand their experiences and needs. A participatory workshop was organised involving key stakeholders, to collaboratively design the training material based on the findings from these data sources. RESULTS Eight review articles examined training programs for healthcare workers on disability. Training settings ranged from specialised clinical settings to non-clinical settings, and the duration and evaluation methods of the training varied widely. Lectures and didactic methods were commonly used, often combined with other approaches such as case studies and simulations. The impact of the training was assessed through healthcare worker reports on attitudes, knowledge, and self-efficacy. Interviews emphasised the importance of involving people with disabilities in the training and improving communication and understanding between healthcare providers and people with disabilities. Five themes for a training on disability for healthcare workers were generated through the workshop, including responsibilities and rights, communication, informed consent, accommodation, and referral and connection, which were used to guide the development of the curriculum, training materials and training approach. CONCLUSION This study presents a novel approach to develop a training program that aims to enhance healthcare services for people with disabilities in Uganda. The findings offer practical insights for the development of similar programs in LMICs. The effectiveness of the training program will be evaluated through a pilot test, and policy support is crucial for its successful implementation at scale.
Collapse
Affiliation(s)
- Tracey Smythe
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK.
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Andrew Sentoogo Ssemata
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Sande Slivesteri
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Femke Bannink Mbazzi
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
6
|
Turk MA, Mitra M. The recurring role of advocacy for disability rights and the health of people with disability. Disabil Health J 2024; 17:101592. [PMID: 38402004 DOI: 10.1016/j.dhjo.2024.101592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2024]
|
7
|
Hoang AQ, Lerman DC, Nguyen JT. Virtual Training of Medical Students to Promote the Comfort and Cooperation of Patients with Neurodevelopmental Disabilities. J Autism Dev Disord 2024; 54:1249-1263. [PMID: 36648564 PMCID: PMC9844946 DOI: 10.1007/s10803-023-05896-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2023] [Indexed: 01/18/2023]
Abstract
Patients with neurodevelopmental disabilities generally have less access to necessary medical care compared to those without disabilities. Barriers to adequate care include patient fear and uncooperative behavior during routine medical procedures and inadequate preparation of medical professionals to treat this population. Researchers have identified multiple behavior-analytic procedures for promoting comfort and cooperation during medical treatments. Efficient, cost-effective training programs are needed to widely disseminate behavior-analytic procedures to medical students and professionals. The purpose of this study was to assess the efficacy of a virtual training to prepare medical students to implement behavioral procedures that could be easily incorporated into typical wellness examinations. Seven medical students received behavioral skills training (BST) delivered remotely via the Internet. Results showed that the training successfully increased students' correct implementation of the procedures in roleplay with the experimenter and with patients with neurodevelopmental disabilities. Responding also maintained at high levels 2 weeks after the training. These findings suggest that virtual BST is an efficient, practical approach for training health care professionals to implement general behavior management strategies to increase the comfort and cooperation of patients with NDD.
Collapse
Affiliation(s)
- Andrea Q Hoang
- Clinical, Health, and Applied Sciences, University of Houston-Clear Lake, 2700 Bay Area Blvd., Campus Box 245, Houston, TX, 77058, USA
| | - Dorothea C Lerman
- Clinical, Health, and Applied Sciences, University of Houston-Clear Lake, 2700 Bay Area Blvd., Campus Box 245, Houston, TX, 77058, USA.
| | - Jennifer Trang Nguyen
- Clinical, Health, and Applied Sciences, University of Houston-Clear Lake, 2700 Bay Area Blvd., Campus Box 245, Houston, TX, 77058, USA
| |
Collapse
|
8
|
Brown HK, Mitra M. Perinatal health framework for people with intellectual disability. Disabil Health J 2024; 17:101576. [PMID: 38216418 DOI: 10.1016/j.dhjo.2023.101576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 01/14/2024]
Abstract
We propose a framework for guiding research on perinatal health in people with intellectual disability (ID). We developed this framework based on the perinatal health framework for people with physical disabilities, American Association on Intellectual and Developmental Disabilities conceptual framework of human functioning, disability reproductive justice framework, trauma-informed care, and socio-ecological model. The framework reflects health outcomes of birthing people with ID and their infants that result from interactions of factors across the life course at policy (health, social, and disability policies), community (attitudes, social and physical environment), institutional (health care delivery-related factors, access to information/resources), interpersonal (social determinants of health/histories of trauma, social support, interactions with service-providers), and individual levels (demographics, intellectual functioning, adaptive behavior, health conditions, genetic factors, psychosocial factors, health behaviors). This framework will facilitate research to identify factors leading to perinatal health disparities in people with ID and development and evaluation of resources to address them.
Collapse
Affiliation(s)
- Hilary K Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
| | - Monika Mitra
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| |
Collapse
|
9
|
Stillman MD, Mallow M, Ankam N, Ojeda J, Stephens M, Heckert K, Gustafson K. The Dearth of Disability Medical Education and a Partial Solution. TEACHING AND LEARNING IN MEDICINE 2024; 36:83-88. [PMID: 36082770 DOI: 10.1080/10401334.2022.2119239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
Issue: While over one-quarter of adult Americans have a disability, there is a paucity of disability-specific curricula in American medical schools and residency programs. Potential consequences of this educational dearth include persistent inaccessibility of health care facilities and delivery of inequitable health care to individuals with disabilities. Evidence: Several working groups have proposed disability-specific competencies for health professions education and means by which to integrate them into existing curricula. A limited number of medical schools and residency programs have formally introduced disability-specific materials into their curricula. To our knowledge, however, there are no generalist (internal medicine or family medicine) residency programs that offer specialized training in the clinical care of people with disabilities. Implications: Offering generalist physicians the opportunity to acquire the clinical and cognitive skills required to provide thorough and equitable health care to people with disabilities is critically important. There are too few physiatrists to see to their care needs. In this manuscript, we present a novel concentration in an Internal Medicine residency program in the care of individuals with a variety of disabilities. Our hope is that this work will initiate discussions among educational leaders about how to address the lack of graduate medical education-level training in disability care. We also hope it will afford program directors the opportunity to implement similar concentrations and tracks and will eventually produce a generation of generalists who are well-equipped to help care for people with disabilities.
Collapse
Affiliation(s)
- Michael D Stillman
- Department of Internal Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael Mallow
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nethra Ankam
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jason Ojeda
- Department of Internal Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mary Stephens
- Department of Family & Community Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kimberly Heckert
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kirstin Gustafson
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
10
|
Lee D, Pollack SW, Mroz T, Frogner BK, Skillman SM. Disability competency training in medical education. MEDICAL EDUCATION ONLINE 2023; 28:2207773. [PMID: 37148284 PMCID: PMC10167870 DOI: 10.1080/10872981.2023.2207773] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
PURPOSE Lack of health care providers' knowledge about the experience and needs of individuals with disabilities contribute to health care disparities experienced by people with disabilities. Using the Core Competencies on Disability for Health Care Education, this mixed methods study aimed to explore the extent the Core Competencies are addressed in medical education programs and the facilitators and barriers to expanding curricular integration. METHOD Mixed-methods design with an online survey and individual qualitative interviews was used. An online survey was distributed to U.S. medical schools. Semi-structured qualitative interviews were conducted via Zoom with five key informants. Survey data were analyzed using descriptive statistics. Qualitative data were analyzed using thematic analysis. RESULTS Fourteen medical schools responded to the survey. Many schools reported addressing most of the Core Competencies. The extent of disability competency training varied across medical programs with the majority showing limited opportunities for in depth understanding of disability. Most schools had some, although limited, engagement with people with disabilities. Having faculty champions was the most frequent facilitator and lack of time in the curriculum was the most significant barrier to integrating more learning activities. Qualitative interviews provided more insight on the influence of the curricular structure and time and the importance of faculty champion and resources. CONCLUSIONS Findings support the need for better integration of disability competency training woven throughout medical school curriculum to encourage in-depth understanding about disability. Formal inclusion of the Core Competencies into the Liaison Committee on Medical Education standards can help ensure that disability competency training does not rely on champions or resources.
Collapse
Affiliation(s)
- Danbi Lee
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, USA
| | - Samantha W Pollack
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, USA
| | - Tracy Mroz
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, USA
| | - Bianca K Frogner
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, USA
| | - Susan M Skillman
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, USA
| |
Collapse
|
11
|
Bracken RC, Richman KA, Garden R, Fischbein R, Bhambra R, Ragina N, Dawson S, Cascio A. Developing Disability-Focused Pre-Health and Health Professions Curricula. THE JOURNAL OF MEDICAL HUMANITIES 2023; 44:553-576. [PMID: 38099998 PMCID: PMC10733220 DOI: 10.1007/s10912-023-09828-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/21/2023]
Abstract
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.
Collapse
Affiliation(s)
| | - Kenneth A Richman
- Center for Health Humanities, Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA
| | | | - Rebecca Fischbein
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Raman Bhambra
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Neli Ragina
- College of Medicine, Central Michigan University, Mount Pleasant, MI, USA
| | - Shay Dawson
- College of Education and Human Services, Central Michigan University, Mount Pleasant, MI, USA
| | - Ariel Cascio
- Center for Bioethics and Social Justice, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| |
Collapse
|
12
|
Epstein R, Fuerstman L, Heidlebaugh A, Schiller J, Zayhowski K. Experiences of genetic counseling students with disabilities and chronic illnesses: A qualitative study. J Genet Couns 2023; 32:1161-1173. [PMID: 37194122 DOI: 10.1002/jgc4.1726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/21/2022] [Accepted: 04/18/2023] [Indexed: 05/18/2023]
Abstract
While many patients with disabilities or chronic illnesses are served by genetic counselors, little effort has been made to promote the inclusion of individuals with disabilities and chronic illnesses as professionals in the genetic counseling field. Genetic counselors with disabilities and chronic illnesses have reported insufficient support from their colleagues throughout all stages of their professional journeys, but there is a lack of research exploring these challenges. To gain an understanding of the experiences of this community during graduate training, we conducted semi-structured interviews with 13 recent graduates of genetic counseling programs who identify as having a disability or chronic illness. Questions explored various aspects of the graduate school experience including challenges, strengths, relationships, disclosure, and accommodations. Qualitative thematic analysis of interview transcripts resulted in six themes: (1) decisions around disclosure are complex, (2) interactions with others contribute to feeling misunderstood, (3) the high-performance culture in graduate programs makes it challenging to meet personal needs, (4) interpersonal relationships provide support, (5) the accommodation process is often disappointing, and (6) lived experiences are valuable to patients. This study reveals opportunities to better support genetic counseling students with disabilities and chronic illnesses through strengthening inclusion efforts, shifting away from ableist ideologies, and promoting more flexible training options.
Collapse
Affiliation(s)
- Rachel Epstein
- Department of Graduate Medical Sciences, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | | | - Alexis Heidlebaugh
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania, USA
| | - Julia Schiller
- Department of Graduate Medical Sciences, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Kimberly Zayhowski
- Department of Obstetrics and Gynecology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
13
|
Douglas L, Czerwinski J, Vukovic R, Ashfaq M, Lunstroth R, Wagner C. Disability education and implications for genetic counselor training. J Genet Couns 2023; 32:1131-1143. [PMID: 37877329 DOI: 10.1002/jgc4.1800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/13/2023] [Accepted: 09/18/2023] [Indexed: 10/26/2023]
Abstract
The genetic counseling (GC) community has faced criticism about the duality of promoting patient autonomy while also advocating for individuals with disabilities. This study assessed the attitudes of the disability community and GCs to identify content that should be included in GC disability education and evaluate the landscape of GC disability education. Members of the disability community and GCs completed an electronic survey distributed through electronic listservs and partnering organizations. A total of 672 responses were analyzed from both the disability community (n = 596) and the GC community (n = 76). Members of the disability community noted differences in GC comfort level discussing different aspects of disability with GCs being perceived as being very knowledgeable about medical aspects 71% of the time versus 49% of the time when discussing social/lifestyle aspects of disability. This discordance was reflected in GCs reported comfort level in discussing medical aspects (89%) and social aspects of disability (65%) during a session. Most GC respondents (71%) felt they received adequate knowledge during their disability education and variation was reported in the execution of disability education by training programs. Disability education content recommendations from the disability community and GCs included emphasizing four key aspects of disability: medical, social/lifestyle, lived experience, and the disability rights movement. Respondents of both cohorts stressed the inclusion of and exposure to persons with disabilities in disability education to understand the lived experience of persons with disabilities. The disability community identified additional disability education content to be included such as empathy training, family hardships, and mental health. The results of this study have practice implications and provide a foundation for training expectations to ensure future GCs possess the necessary skills to improve the quality of services provided to families and persons with disabilities.
Collapse
Affiliation(s)
- Lauren Douglas
- University of Texas MD Anderson Cancer Center UT Health Graduate School Biomedical Sciences, Houston, Texas, USA
- Minnesota Health Fairview, Minneapolis, Minnesota, USA
| | - Jennifer Czerwinski
- University of Texas MD Anderson Cancer Center UT Health Graduate School Biomedical Sciences, Houston, Texas, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern School of Medicine, Houston, Texas, USA
| | - Rose Vukovic
- Department of Education Psychology, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Educational Psychology and Leadership Studies, University of Victoria, Victoria, British Columbia, Canada
| | - Myla Ashfaq
- University of Texas MD Anderson Cancer Center UT Health Graduate School Biomedical Sciences, Houston, Texas, USA
- Department of Pediatrics, Division of Medical Genetics, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Rebecca Lunstroth
- University of Texas MD Anderson Cancer Center UT Health Graduate School Biomedical Sciences, Houston, Texas, USA
- Department of Humanities & Ethics, McGovern Medical School, Houston, Texas, USA
| | - Chelsea Wagner
- University of Texas MD Anderson Cancer Center UT Health Graduate School Biomedical Sciences, Houston, Texas, USA
- Billion to One, Menlo Park, California, USA
| |
Collapse
|
14
|
Verdugo MÁ, Schalock RL, Gómez LE, Navas P. A Systematic Approach to Implementing, Evaluating, and Sustaining the Shared Citizenship Paradigm in the Disability Field. Behav Sci (Basel) 2023; 13:970. [PMID: 38131825 PMCID: PMC10740522 DOI: 10.3390/bs13120970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/01/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
The disability field continues to face challenges in transforming and implementing meaningful and effective changes in person-centered services and supports aligned with the principles of the Convention on the Rights of Persons with Disabilities. To guide this transformative process effectively, a paradigm must be operationalized through a systematic approach. This article outlines such a systematic approach, consisting of two components: (a) aligning the paradigm's foundational pillars to the elements of an explanatory/implementation model (the Quality of Life and Supports Model) to facilitate the paradigm's operationalization, acceptance, and application and (b) aligning implementation, evaluation, and sustainability strategies with ecological systems, implementation targets, and the paradigm's foundational pillars to drive change across systems. The synergy and alignment between these components underscore the importance of linking public policies with professional and organizational practices to promote social inclusion and enhance the quality of life for people with disabilities. We provide practical examples highlighting the collaborative potential of this synergy and emphasize the significance of evidence-based and person-centered practices in promoting equal rights and social inclusion for people with disabilities.
Collapse
Affiliation(s)
| | | | - Laura E. Gómez
- Department of Psychology, Universidad de Oviedo, 33003 Oviedo, Spain
| | - Patricia Navas
- INICO, Universidad de Salamanca, 37005 Salamanca, Spain; (M.Á.V.); (P.N.)
| |
Collapse
|
15
|
Czech H, Hildebrandt S, Reis SP, Chelouche T, Fox M, González-López E, Lepicard E, Ley A, Offer M, Ohry A, Rotzoll M, Sachse C, Siegel SJ, Šimůnek M, Teicher A, Uzarczyk K, von Villiez A, Wald HS, Wynia MK, Roelcke V. The Lancet Commission on medicine, Nazism, and the Holocaust: historical evidence, implications for today, teaching for tomorrow. Lancet 2023; 402:1867-1940. [PMID: 37951225 DOI: 10.1016/s0140-6736(23)01845-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/07/2023] [Accepted: 08/29/2023] [Indexed: 11/13/2023]
Affiliation(s)
- Herwig Czech
- Ethics, Collections, and History of Medicine, Medical University of Vienna, Vienna, Austria
| | - Sabine Hildebrandt
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Shmuel P Reis
- Center for Medical Education, Hebrew University Hadassah Medical School, Jerusalem, Israel; Department of Digital Medical Technologies, Holon Institute of Technology, Holon, Israel
| | - Tessa Chelouche
- Rappaport Faculty of Medicine, Technion Institute, Haifa, Israel
| | - Matthew Fox
- Jakobovits Center for Jewish Medical Ethics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Esteban González-López
- Division of Family Medicine and Primary Care, Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Etienne Lepicard
- Center for Medical Education, Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Astrid Ley
- Memorial and Museum Sachsenhausen, Oranienburg, Germany
| | - Miriam Offer
- Center of the Study of Jewish Medicine during the Holocaust, Western Galilee College, Acre, Israel
| | - Avi Ohry
- Rehabilitation Medicine, School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maike Rotzoll
- Institute for the History of Pharmacy and Medicine, Marburg University, Marburg, Germany
| | - Carola Sachse
- Institute of Contemporary History, University of Vienna, Vienna, Austria
| | - Sari J Siegel
- Center for Medicine, Holocaust, and Genocide Studies, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michal Šimůnek
- Institute of Contemporary History of the Academy of Sciences of the Czech Republic, Prague, Czech Republic
| | - Amir Teicher
- Department of History, Tel Aviv University, Tel Aviv, Israel
| | - Kamila Uzarczyk
- Department of Humanities and Social Sciences, Wrocław Medical University, Wrocław, Poland
| | - Anna von Villiez
- Memorial Israelitische Töchterschule, Hamburger Volkshochschule, Hamburg, Germany
| | - Hedy S Wald
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Matthew K Wynia
- Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Volker Roelcke
- Institute for the History, Theory and Ethics of Medicine, Giessen University, Gießen, Germany
| |
Collapse
|
16
|
Tarasoff LA, Lunsky Y, Welsh K, Havercamp S, Vigod SN, Brown HK. The disability-related education and training experiences of perinatal care providers in Ontario. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023:S1701-2163(23)00412-7. [PMID: 37271344 DOI: 10.1016/j.jogc.2023.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023]
Abstract
We describe the disability-related education and training experiences of perinatal care providers in Ontario. Twenty perinatal care providers (e.g., obstetricians, midwives) participated in semi-structured interviews. Using a content analysis approach, we found most acquired disability-related training through their own initiative as opposed to education through professional training programs. Barriers to training included lack of data on disability and pregnancy, and limited experiential learning opportunities. Providers recommended that future training focus on experiential learning and social determinants of health, with people with disabilities involved in developing and delivering training. These efforts are vital to optimize pregnancy outcomes for people with disabilities.
Collapse
Affiliation(s)
- Lesley A Tarasoff
- Department of Health and Society, University of Toronto Scarborough, Scarborough, Ontario, Canada; Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kate Welsh
- Department of Health and Society, University of Toronto Scarborough, Scarborough, Ontario, Canada
| | - Susan Havercamp
- Nisonger Center, The Ohio State University, Columbus, Ohio, USA
| | - Simone N Vigod
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Women's College Hospital and Research Institute, Toronto, Ontario, Canada
| | - Hilary K Brown
- Department of Health and Society, University of Toronto Scarborough, Scarborough, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Women's College Hospital and Research Institute, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
17
|
Vi L, Jiwa MI, Lunsky Y, Thakur A. A systematic review of intellectual and developmental disability curriculum in international pre-graduate health professional education. BMC MEDICAL EDUCATION 2023; 23:329. [PMID: 37170246 PMCID: PMC10176941 DOI: 10.1186/s12909-023-04259-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/13/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Despite the increasing global population of individuals with intellectual and developmental disabilities (IDD), this population remains especially vulnerable to health disparities through several factors such as a lack of access to sufficient medical care and poor determinants of health. To add, numerous studies have shown that healthcare professionals are still insufficiently prepared to support this population of patients. This review synthesizes the literature on current pre-graduate IDD training programs across healthcare professions with the goal of informing the creation of evidence-based curricula. METHODS Four major databases were searched for current pre-graduate IDD training interventions for healthcare professionals. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis flow diagram and the Best Evidence Medical Educations systematic review guide were used to frame our collection and analysis. RESULTS Of the 8601 studies screened, 32 studies were identified, with most studies involving medical students (50%). Of note, 35% of studies were interprofessional. Most interventions utilized multiple pedagogical methods with a majority including clinical experiences (63%) followed by theoretical teaching (59%). Kirkpatrick levels showed 9% were level 0, 6% were level 1, 31% were level 2A, 31% were level 2B, 19% were level 3, 3% were level 4A, and none were level 4B. CONCLUSIONS There is a paucity of formally evaluated studies in pre-graduate health professional IDD education. As well, there are a lack of longitudinal learning opportunities and integration into formal curriculum. Strengths identified were the use of multimodal approaches to teaching, including interprofessional approaches to optimize team competencies.
Collapse
Affiliation(s)
- Lisa Vi
- University of Toronto, Temerty Faculty of Medicine, Toronto, ON, Canada.
| | - Muhammad Irfan Jiwa
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Yona Lunsky
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, Toronto, ON, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Anupam Thakur
- University of Toronto, Temerty Faculty of Medicine, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, Toronto, ON, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| |
Collapse
|
18
|
Stahl D. Misuses of "Quality of Life" Judgments in End-of-Life Care. Chest 2023; 163:1228-1231. [PMID: 37164577 DOI: 10.1016/j.chest.2022.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/02/2022] [Accepted: 11/23/2022] [Indexed: 05/12/2023] Open
Affiliation(s)
- Devan Stahl
- Department of Religion, Baylor University, Waco, TX.
| |
Collapse
|
19
|
Bacherini A, Havercamp SM, Balboni G. A new measure of physicians' erroneous assumptions towards adults with intellectual disability: A first study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:447-461. [PMID: 36751012 DOI: 10.1111/jir.13013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 01/12/2023] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Incomplete knowledge and unfamiliarity with intellectual disability (ID) contribute to erroneous assumptions of physicians towards ID, which negatively impact the health equity of people with ID. This study aimed to identify the erroneous assumptions that, based on the ID stakeholders' perceptions, were the most prevalent in physicians and damaging for the healthcare of adults with ID, verify their unidimensionality and that no personal characteristics of ID stakeholders were associated with their ratings of erroneous assumptions' prevalence and damage. METHODS Seventy-four possible physician erroneous assumptions were developed concerning health, daily living skills and quality of life of individuals with ID. ID stakeholders rated each one for perceived prevalence in physicians and damage for the healthcare of adults with ID. Frequency analysis, exploratory factor analysis and correlations were run separately for participants' prevalence and damage ratings. RESULTS Twenty-seven erroneous assumptions were identified as those perceived most prevalent and damaging. Their unidimensionality was ascertained and participants' characteristics were not associated with their prevalence and damage ratings. CONCLUSIONS The identified assumptions are appropriate to represent the items of a new instrument that can be used in medical education to guide the development of curricula to change erroneous assumptions.
Collapse
Affiliation(s)
- A Bacherini
- Department of Philosophy, Social Sciences and Education, University of Perugia, Perugia, Italy
- Nisonger Center, The Ohio State University, Columbus, OH, USA
| | - S M Havercamp
- Nisonger Center, The Ohio State University, Columbus, OH, USA
| | - G Balboni
- Department of Philosophy, Social Sciences and Education, University of Perugia, Perugia, Italy
| |
Collapse
|
20
|
Tarasoff LA, Saeed G, Lunsky Y, Welsh K, Proulx L, Havercamp SM, Parish SL, Brown HK. Prenatal Care Experiences of Childbearing People With Disabilities in Ontario, Canada. J Obstet Gynecol Neonatal Nurs 2023; 52:235-247. [PMID: 36940781 DOI: 10.1016/j.jogn.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/16/2023] [Accepted: 02/25/2023] [Indexed: 03/19/2023] Open
Abstract
OBJECTIVE To explore the care experiences of childbearing people with physical, sensory, and/or intellectual/developmental disabilities during pregnancy. DESIGN Descriptive qualitative. SETTING Ontario, Canada, where physician and midwifery care during pregnancy are provided at no direct cost to residents. PARTICIPANTS Thirty-one people with physical, sensory, and/or intellectual/developmental disabilities (who self-identified as cisgender women [n = 29] and trans or nonbinary persons [n = 2]) who gave birth in the last 5 years. METHODS We recruited childbearing people with disabilities through disability and parenting organizations, social media, and our team's networks. Using a semistructured guide, we conducted in-person and virtual (e.g., telephone or Zoom) interviews with childbearing people with disabilities in 2019 to 2020. We asked participants about the services they accessed during pregnancy and if services met their needs. We used a reflexive thematic analysis approach to analyze interview data. RESULTS Across disability groups, we identified four common themes: Unmet Accommodation Needs, Lack of Coordinated Care, Ableism, and Advocacy as a Critical Resource. We found that these experiences manifested in unique ways based on disability type. CONCLUSION Our findings suggest the need for accessible, coordinated, and respectful prenatal care for people with disabilities, with the requirements of such care depending on the needs of the individual person with a disability. Nurses can play a key role in identifying the needs and supporting people with disabilities during pregnancy. Education and training for nurses, midwives, obstetricians, and other prenatal care providers should focus on disability-related knowledge and respectful prenatal care.
Collapse
|
21
|
Smeltz L, Carpenter S, Benedetto L, Newcomb N, Rubenstein D, King T, Lunsford C, DeWaters AL. ADEPT-CARE: A Pilot, Student-Led Initiative to Improve Care for Persons with Disabilities via a Novel Teaching Tool. Disabil Health J 2023:101462. [PMID: 37061363 DOI: 10.1016/j.dhjo.2023.101462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Over one-quarter of United States adults live with a disability. Despite persistent ableism, defined as discrimination and prejudice against people with disabilities, in healthcare, disability-focused training remains largely absent from medical education. OBJECTIVE The aim of this study was to pilot and evaluate a novel teaching mnemonic (ADEPT-CARE) for performing a comprehensive history and physical exam for disabled patients. METHODS In Spring 2022, first-year medical students at a suburban Mid-Atlantic institution could electively participate in a learning module that included ADEPT-CARE. Surveys were administered to students before and following exposure to the ADEPT-CARE protocol. RESULTS Of 142 eligible students, 33 and 21 completed the pre- and post-surveys, respectively. The ADEPT-CARE protocol made sense to 95.2% of students. All (100%) students reported that they will use the ADEPT-CARE protocol in the assessment of patients with disabilities. Students were more likely to agree or strongly agree that they had a consistent approach or strategy in mind when assessing a patient with a disability after exposure to ADEPT-CARE (85.7% vs. 39.4%, respectively, p = 0.002). There was no statistically significant difference in students' perceived confidence in their ability to assess a patient with a disability after curriculum completion compared to before (85.7% vs. 81.8%, respectively, p = 1.0). CONCLUSIONS The ADEPT-CARE protocol has the potential to be an effective teaching tool by providing a framework to equitably care for disabled patients. Future research should assess whether students' self-reported increased confidence and intention to utilize ADEPT-CARE translates into the clinical setting.
Collapse
Affiliation(s)
- Lydia Smeltz
- Penn State College of Medicine, 700 HMC Cres Road, Hershey, 17033, PA, USA.
| | - Sandra Carpenter
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, 02215, MA, USA
| | - Lauren Benedetto
- Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, 90027, CA, USA
| | - Nora Newcomb
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, 33602, FL, USA
| | - Dana Rubenstein
- Duke University School of Medicine, 40 Duke Medicine Circle, 124 Davison Building, Durham, 27710, NC, USA
| | - Tonya King
- Penn State College of Medicine, 700 HMC Cres Road, Hershey, 17033, PA, USA
| | - Christopher Lunsford
- Duke University School of Medicine, 40 Duke Medicine Circle, 124 Davison Building, Durham, 27710, NC, USA
| | - Ami L DeWaters
- Penn State College of Medicine, 700 HMC Cres Road, Hershey, 17033, PA, USA
| |
Collapse
|
22
|
Evans W, Lisiecka D, Farrell D. Exploring the impact educational interventions have on nursing and medical students' attitudes and empathy levels towards people with disability. A systematic review. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023:17446295231155781. [PMID: 36798039 DOI: 10.1177/17446295231155781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This systematic review aimed to explore the impact educational interventions have on undergraduate nursing and medical students' attitudes and empathy levels towards people with disability. There are over one billion people with some form of disability currently. A growing body of research reveals that nurses and doctors display negative attitudes including decreased empathy towards people with disability. A systematic review using narrative synthesis of chosen randomized controlled trials was employed. A comprehensive search was completed in June 2021 on six databases (CINAHL, Medline, Science Direct, Health Research Premium - PROQUEST, Scopus. Cochrane Library). The search strategy yielded 21,616 studies and only three randomised controlled trials fulfilled the eligibility criteria. These trials included 125 participants (n = 50 medical students and n = 75 nursing students) and evaluated the effectiveness of a disabled health course, disability education module with bedside teaching and wheelchair workshop intervention. Findings from one study revealed that a disabled health course using affective learning method based on a transformative learning theory significantly improves attitudes to disability amongst nursing students however there was no statistically significant difference in empathy levels. More high-quality randomised controlled trials with greater theoretical and methodological complexity are needed to identify more effective educational approaches that enhance attitude and empathy levels of these key stakeholders.
Collapse
Affiliation(s)
- William Evans
- 8813Department of Nursing and Healthcare Sciences, School of Health and Social Sciences, Munster Technology University Tralee, Ireland
| | | | - Dawn Farrell
- 8813Munster Technology University Kerry, Tralee, Ireland
| |
Collapse
|
23
|
Tint A, Chung H, Lai MC, Balogh R, Lin E, Durbin A, Lunsky Y. Health conditions and service use of autistic women and men: A retrospective population-based case-control study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023:13623613221144353. [PMID: 36588296 PMCID: PMC10374994 DOI: 10.1177/13623613221144353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
LAY ABSTRACT This study used administrative data from Ontario, Canada to compare the health conditions and service use of autistic women and men with adults with other developmental disabilities and with adults without developmental disabilities. Autistic women and men were more likely to have physical and mental health conditions compared to adults without developmental disabilities. Rates of health conditions were similar or lower among autistic adults compared to adults with other developmental disabilities, except more autistic adults had psychiatric conditions. Autistic women and men used higher rates of psychiatric services compared to all other groups. When comparing autistic women with same aged autistic men, sex differences were found for specific physical (Crohn's disease/colitis, rheumatoid arthritis) and psychiatric conditions (psychotic disorders, non-psychotic disorders), as well differences in service use (emergency department visits, hospitalizations, family doctor and neurologist visits). These results further highlight the high health needs and service use of autistic women and men, as well as adults with other developmental disabilities. It is critical for future research to focus on mental health support for autistic adults and to better understand how to tailor supports to best serve autistic women.
Collapse
Affiliation(s)
- Ami Tint
- Centre for Addiction and Mental Health, Canada
| | | | - Meng-Chuan Lai
- Centre for Addiction and Mental Health, Canada.,University of Toronto, Canada.,The Hospital for Sick Children, Canada.,University of Cambridge, United Kingdom.,National Taiwan University Hospital, Taiwan
| | | | - Elizabeth Lin
- Centre for Addiction and Mental Health, Canada.,University of Toronto, Canada
| | - Anna Durbin
- ICES, Canada.,University of Toronto, Canada.,Unity Health, Canada
| | - Yona Lunsky
- Centre for Addiction and Mental Health, Canada.,ICES, Canada.,University of Toronto, Canada
| |
Collapse
|
24
|
Barber A, Flach A, Bonnington J, Pattinson EM. LGBTQ+ Healthcare Teaching in UK Medical Schools: An Investigation into Medical Students' Understanding and Preparedness for Practice. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231164893. [PMID: 37008793 PMCID: PMC10052488 DOI: 10.1177/23821205231164893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 03/04/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES Lesbian, gay, bisexual, trans* and queer/questioning + (LGBTQ+) healthcare teaching within UK medical schools is currently lacking, potentially impacting on patients' confidence in health services and ability to access care. The current study conducted a multi-site analysis aiming to investigate medical students' perceptions towards the teaching of LGBTQ+ healthcare in UK medical schools, as well as to gain a greater understanding of medical students' level of knowledge of LGBTQ+ healthcare, and preparedness for working with LGBTQ+ patients. METHODS Medical students (N = 296) from 28 UK institutions responded to a 15-question online survey distributed via course leads and social media. Thematic analysis of qualitative data was conducted, as well as statistical analysis of quantitative data using SPSS. RESULTS Only 40.9% of students reported having any teaching on LGBTQ+ healthcare, 96.6% of whom said this was one-off or very irregular sessions. Only 1 in 8 felt their knowledge and skills on LGBTQ+ healthcare was sufficient. 97.2% of students questioned wanted more knowledge on LGBTQ+ healthcare. CONCLUSION The current study highlighted that UK medical students felt underprepared for working with LGBTQ+ patients due to insufficient education. Given that teaching on LGBTQ+ healthcare is often optional and extra-curricular, it may not be reaching those who need it most. The authors are calling for the mandatory inclusion of LGBTQ+ healthcare in the teaching of all UK medical schools, within their individual curriculum frameworks, and with regulatory support from the General Medical Council. This will ensure a wider understanding among medical students, and subsequently qualified doctors, of the health inequities and unique health issues LGBTQ+ people face, which will better equip them to provide high-quality care to LGBTQ+ patients, and start to tackle the inequities they face.
Collapse
Affiliation(s)
- Alice Barber
- School of Medicine, University of Leeds, Leeds, UK
| | | | | | | |
Collapse
|
25
|
Singh S, Meeks LM. Disability inclusion in medical education: Towards a quality improvement approach. MEDICAL EDUCATION 2023; 57:102-107. [PMID: 35837829 DOI: 10.1111/medu.14878] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
THE ISSUE The shift to a more diverse workforce that includes physicians with disabilities has gained considerable international traction. Indeed, disability inclusion is experiencing a renaissance in medical education. However, the philosophy of disability inclusion must be adjusted from one where disabled trainees are viewed as problematic and having to 'overcome' disability to one where institutions anticipate and welcome disabled trainees as a normative part of a diverse community. OBSERVATIONS Most trainees with disabilities will enter an unregulated, uninformed system leaving them vulnerable to under-accommodation, systems barriers and lack of informed support. Further, the perception of the super human good doctor creates disincentives for candidates to disclose their disability, creating structural barriers that the system needs to address. A less often discussed contributor to health care inequities is the inadequate training of health professional educators on disability rights and disability competencies. Indeed, the lack of education, coupled with minimal exposure to disability outside of the hierarchical patient-provider relationship, perpetuates to stereotypes and biases that impact clinical care. APPROACH Disability inclusion has not been reviewed through the lens of quality improvement. To close this gap, we examine the state of the science through the lens of disability inclusion and offer considerations for a quality improvement approach in medical education that addresses the global revised trilogy of World Federation for Medical Education standards of quality improvement at all three levels of education, training and practice. CONCLUSION We propose a vision of systems-based disability-inclusive, accessible and equitable medical education using 9 of Deming's 14 points as applicable to medical education.
Collapse
Affiliation(s)
- Satendra Singh
- University College of Medical Sciences, University of Delhi, Delhi, India
| | - Lisa M Meeks
- Departments of Learning Health Sciences and Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| |
Collapse
|
26
|
Ozkara San E, Marx KA, Robertiello G, Latimer B, Nahum JL, Pasklinsky N. Inclusion of Disability Content in Simulation: An Evaluation of the Learners' Perspective on the Effectiveness of a Pediatric Tabletop Simulation. Nurse Educ 2023; 48:24-28. [PMID: 36126162 DOI: 10.1097/nne.0000000000001291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite recommendations to include disability content in nursing education, nursing students have little exposure to disability education, which would help to develop necessary knowledge, skills, and attitudes in learning to care for patients with disabilities. PURPOSE This study evaluated learners' perceptions of the effectiveness of a tabletop simulation in meeting their learning needs related to nursing care for children with disabilities and their families. METHODS The research design was a descriptive educational intervention study. Nursing students (n = 234) enrolled in the pediatric nursing course attended the simulation as a required part of their coursework. RESULTS The majority of the students found the tabletop simulation with disability content to be an effective educational intervention. CONCLUSIONS The results obtained from this study indicated that the tabletop simulation was an effective educational strategy for nursing students' learning to provide care for children with disabilities and their families.
Collapse
Affiliation(s)
- Eda Ozkara San
- Clinical Assistant Professor (Dr Ozkara San), Clinical Simulation Learning Center (CSLC) Education Specialist (Ms Marx), Assistant Director of Simulation Learning, Undergraduate Nursing Program (Ms Robertiello), Clinical Associate Professor (Dr Latimer), and Executive Director of Simulation Learning (Dr Pasklinsky), NYU Rory Meyers College of Nursing, New York, New York; and Clinical Assistant Professor of Nursing (Dr Nahum), NYU Rory Meyers College of Nursing, New York, New York, and Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Hackensack University Medical Center-Joseph M. Sanzari Children's Hospital, Hackensack Meridian Health, Hackensack, New Jersey
| | | | | | | | | | | |
Collapse
|
27
|
Ratakonda S, Argersinger DP, Auchus GC, McGowan C, Ship H, Wang DR, McKee MM. A call for disability health curricula in medical schools. Trends Mol Med 2022; 28:1012-1015. [PMID: 36109318 DOI: 10.1016/j.molmed.2022.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/11/2022] [Indexed: 01/21/2023]
Abstract
People with disabilities encounter significant health and health-care inequities yet disability health training in medical education remains inadequate. This Scientific Life article examines the need to integrate disability health education into medical school curricula and shares successful training examples that can serve as a framework for how to accomplish this.
Collapse
Affiliation(s)
- Sanjana Ratakonda
- University of Michigan, Department of Family Medicine, Ann Arbor, MI, USA
| | | | | | | | - Hannah Ship
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - David R Wang
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael M McKee
- University of Michigan, Department of Family Medicine, Ann Arbor, MI, USA.
| |
Collapse
|
28
|
Iezzoni LI, McKee MM, Meade MA, Morris MA, Pendo E. Have Almost Fifty Years Of Disability Civil Rights Laws Achieved Equitable Care? Health Aff (Millwood) 2022; 41:1371-1378. [PMID: 36190880 PMCID: PMC10359967 DOI: 10.1377/hlthaff.2022.00413] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
For almost fifty years, federal civil rights laws such as Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act (ADA) of 1990 and the ADA Amendments Act of 2008, and Section 1557 and other provisions of the 2010 Patient Protection and Affordable Care Act have prohibited discrimination against Americans with disabilities, including in health care. Despite these laws, disabled Americans continue to experience disparities in health and health care, from preventive care to home and community-based services. In its 2022 Health Equity Framework for People with Disabilities, the National Council on Disability highlighted some of these disparities and recommended remedies. To explore these concerns, this article examines disability inequities and potential solutions within six areas. It concludes by recommending the ratification of the 2006 United Nations Convention on the Rights of Persons with Disabilities to reinvigorate US efforts to maximize the health and dignity of disabled Americans and support their full participation in the community.
Collapse
Affiliation(s)
- Lisa I. Iezzoni
- Lisa I. Iezzoni , Harvard University and Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | - Elizabeth Pendo
- Elizabeth Pendo, Saint Louis University, St. Louis, Missouri
| |
Collapse
|
29
|
Rimmer JH. Addressing Disability Inequities: Let's Stop Admiring the Problem and Do Something about It. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11886. [PMID: 36231189 PMCID: PMC9565910 DOI: 10.3390/ijerph191911886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/11/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
The healthcare system and public health community are often underprepared to support the needs of people with disabilities and to include them equitably in wellness programs (e.g., exercise, leisure, nutrition, stress management) offered to the general community. Consequently, the vast majority of people with disabilities are unable to make the transition from "patient" to "participant," which contributes to many of the health disparities reported in this population. People with disabilities have a disproportionately higher rate of acquiring secondary conditions such as obesity, cardiovascular comorbidity, pain, fatigue, depression, deconditioning, and type 2 diabetes, often resulting from poor access to home and community-based health promotion/wellness programs that include physical activity, nutrition, stress reduction, and sleep hygiene, among others. Achieving health equity in people with disabilities requires a multi-stage approach that includes person-centered referral to wellness programs, empowering people with disabilities to become self-managers of their own health and ensuring that community-based programs and services are inclusive. A three-stage model for addressing health and wellness needs across the home and community settings is described, which is currently being used in a large federally funded center in the US with potential generalizability across the world.
Collapse
Affiliation(s)
- James H Rimmer
- School of Health Professions, Lakeshore Foundation Research Collaborative, University of Alabama, Birmingham, AL 35206, USA
| |
Collapse
|
30
|
Young KM, Newell KG. Disability as Diversity: Educational Opportunities for Family Medicine. Int J Psychiatry Med 2022; 57:387-395. [PMID: 35952410 DOI: 10.1177/00912174221112829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Disability is an aspect of diversity that often receives less attention in healthcare and medical education than other aspects of diversity, such as gender or race. Approximately one in four Americans has some type of disability, and individuals with disabilities have less access to healthcare, greater dissatisfaction with their healthcare, and report being in poorer health than individuals without a disability. Although many factors likely contribute to these disparities, physician perception and understanding of disability have been examined as potential pathways that influence health inequity. It is important to incorporate disability as a form of diversity in family medicine education to train physicians that provide excellent care to patients with disabilities and work toward equitable healthcare for them. In this article, we review definitions and data related to disability. We examine disparities and forms of stigmatization toward individuals with disabilities. We then present scenarios in the context of family medicine residency education that involve stigmatization of a person with a disability. Following each scenario, we identify the stigmatizing problem and its potential impact on the individual with a disability. In addition, we outline a potential intervention as an individual witnessing this scenario, and an alternative, non-stigmatizing approach to the scenario. Finally, we present proposed core competencies on disability for health care education and potential strategies to incorporate these competencies into family medicine curricula.
Collapse
Affiliation(s)
- Kathleen M Young
- Family Medicine Residency, 24520Novant Health New Hanover Regional Medical Center, Wilmington, NC, USA
- University of North Carolina Department of Family Medicine, Chapel Hill, NC, USA
| | - Kathryn G Newell
- Family Medicine Residency, 24520Novant Health New Hanover Regional Medical Center, Wilmington, NC, USA
| |
Collapse
|
31
|
Marzolf BA, Plegue MA, Okanlami O, Meyer D, Harper DM. Are Medical Students Adequately Trained to Care for Persons With Disabilities? PRIMER (LEAWOOD, KAN.) 2022; 6:34. [PMID: 36132541 PMCID: PMC9484532 DOI: 10.22454/primer.2022.878147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Insufficient provider training contributes to health care disparities for 61 million Americans with disabilities.2,4 This study examines medical students' perceptions of their disability training and the perceived effect training has on students' preparedness to care for people with disabilities (PWD) in future practice. METHODS Principles of the Core Competencies on Disability for Health Care Education5 generated 10 questions. The questions were included in a survey conducted by the Council of Academic Family Medicine Educational Research Alliance (CERA) and sent to medical student members of the American Academy of Family Physicians (AAFP). We compared responses using unadjusted χ2 tests. RESULTS One hundred forty-seven surveys were returned, with 126 used for this analysis; 36% of students reported that their medical training provided them with the knowledge necessary to provide high-quality, comprehensive health care for PWD in their future practice and 97.6% agreed or strongly agreed that they needed to learn more. Six of the curricular exposures demonstrating variations of the health care needs of PWD were associated with higher percentages of medical students agreeing they are trained to perform high-quality health care for PWD in future practice. CONCLUSION Medical students continue to report deficiencies in training, knowledge, and preparedness to care for PWD. Based on the Core Competencies framework, we have identified six curricular exposures that increase readiness to care for PWD. Therefore, we recommend the Liaison Committee on Medical Education formally integrate requirements for disability training in the standards of accreditation.7.
Collapse
Affiliation(s)
- Brianna A Marzolf
- Department of Family Medicine, University of Michigan, Ann Arbor, MI
| | - Melissa A Plegue
- Department of Family Medicine, University of Michigan, Ann Arbor, MI
| | - Oluwaferanmi Okanlami
- Departments of Family Medicine, Physical Medicine and Rehabilitation, and Urology, University of Michigan, Ann Arbor, MI
| | - Daniel Meyer
- Maine-Dartmouth Family Medicine Residency, Augusta/Waterville, ME (retired)
| | - Diane M Harper
- Department of Family Medicine, University of Michigan, Ann Arbor, MI
| |
Collapse
|
32
|
Barriers to and facilitators of effective communication in perinatal care: a qualitative study of the experiences of birthing people with sensory, intellectual, and/or developmental disabilities. BMC Pregnancy Childbirth 2022; 22:364. [PMID: 35473673 PMCID: PMC9044670 DOI: 10.1186/s12884-022-04691-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 04/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background Effective provider-patient communication is a key element of quality health care, including perinatal care. What constitutes “effective communication” in perinatal care may vary according to the population seeking care, such as women with intellectual and developmental disabilities (IDD) and sensory disabilities. Research broadly indicates that communication issues are among the barriers to perinatal care experienced by women with disabilities. However, few studies have explicitly explored their communication experiences in this context. The purpose of this study was to understand the communication experiences of birthing people with IDD and/or sensory disabilities in perinatal care. Methods We conducted semi-structured interviews with 17 people with IDD (e.g., autism, cognitive delay) and/or sensory disabilities (e.g., d/Deaf, blind) in Ontario, Canada, who had recently given birth, to explore barriers to and facilitators of effective communication in perinatal care. A combination of deductive and inductive thematic analysis guided data analysis. Results We found that birthing people with IDD and/or sensory disabilities encountered multiple barriers to effective communication in perinatal care, namely, lack of policies and guidelines, lack of provider experience, lack of provider effort, as well as ableism and provider assumptions. Facilitators included knowledgeable, aware, and supportive providers; access to communication aids and services; tailoring information to patients’ disability-related communication needs; empathic communication; and, communication among providers. Conclusion Unmet communication needs may contribute to negative health and social outcomes for birthing people with disabilities and their newborns. Accessibility policy implementation and practice change are needed to meet the communication needs of people with IDD and/or sensory disabilities in perinatal care to ensure positive experiences and outcomes.
Collapse
|
33
|
Improving capacity to care for patients with intellectual and developmental disabilities: The value of an experiential learning model for family medicine residents. Disabil Health J 2022; 15:101282. [DOI: 10.1016/j.dhjo.2022.101282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 01/15/2022] [Accepted: 02/08/2022] [Indexed: 11/20/2022]
|
34
|
Iezzoni LI, Rao SR, Ressalam J, Bolcic-Jankovic D, Agaronnik ND, Lagu T, Pendo E, Campbell EG. US Physicians' Knowledge About The Americans With Disabilities Act And Accommodation Of Patients With Disability. Health Aff (Millwood) 2022; 41:96-104. [PMID: 34982624 PMCID: PMC8740697 DOI: 10.1377/hlthaff.2021.01136] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
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.
Collapse
Affiliation(s)
- Lisa I Iezzoni
- Lisa I. Iezzoni , Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Sowmya R Rao
- Sowmya R. Rao, Massachusetts General Hospital and Boston University School of Public Health, Boston, Massachusetts
| | - Julie Ressalam
- Julie Ressalam, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Tara Lagu
- Tara Lagu, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth Pendo
- Elizabeth Pendo, Saint Louis University, St. Louis, Missouri
| | - Eric G Campbell
- Eric G. Campbell, University of Colorado Anschutz Medical Campus
| |
Collapse
|
35
|
Kaundinya T, Schroth S. Dismantle Ableism, Accept Disability: Making the Case for Anti-Ableism in Medical Education. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2022; 9:23821205221076660. [PMID: 35128061 PMCID: PMC8814984 DOI: 10.1177/23821205221076660] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
There currently exists an exciting impetus for increased diversity among medical trainees and improved equity in medical care received by patients. Yet, inclusion of disability within these efforts is often forgotten, allowing the current cultural narrative of ableism to shape medical training. National structural challenges as early as medical school admissions and ableist barriers throughout the educational pipeline have yielded 1) a concerningly low prevalence of medical students and physicians in the US who identify as disabled and 2) propagation of systemic misunderstandings on disability in our healthcare system. This perspective addresses the need for a re-evaluation of diversity in medicine which includes ability status and a commitment to anti-ableism as a critical part of the conversation. We propose reforms and important considerations that could have meaningful implications necessary for improving the culture of disability inclusion in medical education.
Collapse
Affiliation(s)
- Trisha Kaundinya
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA 60611
- Both authors contributed equally to this manuscript
| | - Samantha Schroth
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA 60611
- Both authors contributed equally to this manuscript
| |
Collapse
|
36
|
Koçak Akgün M, İldan Çalım S. Breast self-examination training video with the sign language for deaf women: An interventional study. Eur J Cancer Care (Engl) 2021; 31:e13543. [PMID: 34935220 DOI: 10.1111/ecc.13543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/09/2021] [Accepted: 12/02/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Breast self-examination is an important component for the early detection of breast cancer. The lack of knowledge of deaf women regarding breast examination and screenings may delay diagnosis of breast cancer. The objective of the study is to examine the effect of a video prepared with the sign language giving breast self-examination (BSE) skills to deaf women. METHODS This study used a quantitative, quasi-experimental, comparison group research design. Participants were recruited from the Izmir Association for the Protection and Development of the Deaf, Izmir, Turkey. The research was conducted between March 2018 and March 2019. BSE training video was prepared by the researchers. One group (n = 30) watched a BSE training video with sign language. The other group (n = 30) watched a BSE training video without sign language. After the training video, the BSE Skill Assessment of all women were assessed on a female torso mannequin model using BSE Skill Assessment Form. RESULTS The BSE skills of the women who watched the training video with sign language were significantly different from those who watched the training video without sign language (p < 0.05). CONCLUSION The training video with the sign language prepared by the researchers can significantly improve the BSE skills of deaf women.
Collapse
Affiliation(s)
| | - Selda İldan Çalım
- Department of Midwifery, Faculty of Health Sciences, Manisa Celal Bayar University, Manisa, Turkey
| |
Collapse
|
37
|
Khan M, Brown HK, Lunsky Y, Welsh K, Havercamp SM, Proulx L, Tarasoff LA. A Socio-Ecological Approach to Understanding the Perinatal Care Experiences of People with Intellectual and/or Developmental Disabilities in Ontario, Canada. Womens Health Issues 2021; 31:550-559. [PMID: 34556400 PMCID: PMC8595790 DOI: 10.1016/j.whi.2021.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Accessible and quality care during the perinatal period is critical for optimal maternal and neonatal health. Using the socio-ecological model, the purpose of this study was to explore barriers and facilitators that shape the perinatal care experiences of people with intellectual and/or developmental disabilities (IDD). METHODS Semi-structured interviews were conducted with 10 individuals with IDD in Ontario, Canada, who had given birth within the past 5 years. Interviews focused on care experiences before, during, and after pregnancy. Data were analyzed using a directed content analysis approach, and the socio-ecological model guided analysis. RESULTS Barriers at the societal (e.g., cultural norms of motherhood), policy/institutional (e.g., child protection policies and practices), interpersonal (e.g., inadequate formal and informal support), and intrapersonal levels (e.g., internalized stigma) contributed to participants having negative perinatal care experiences. Conversely, we identified facilitators on the interpersonal level (e.g., positive interactions with perinatal care providers and familial and social service supports) as positively shaping participants' perinatal care experiences. CONCLUSIONS Findings reveal that the perinatal care experiences of people with IDD are shaped by several interrelated factors that largely stem from societal-level barriers, such as dominant (stigmatizing) discourses of disability. To improve the perinatal care experiences of people with IDD, there is a need for interventions at multiple levels. These include the development of policies to support perinatal care for diverse populations and training care providers to enact policies at the institutional and interpersonal levels.
Collapse
Affiliation(s)
- Momina Khan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hilary K Brown
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada.
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kate Welsh
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | | | - Laurie Proulx
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Lesley A Tarasoff
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada; Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| |
Collapse
|
38
|
Singh S, Khan AM, Dhaliwal U, Singh N. Using the health humanities to impart disability competencies to undergraduate medical students. Disabil Health J 2021; 15:101218. [PMID: 34620568 DOI: 10.1016/j.dhjo.2021.101218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/10/2021] [Accepted: 09/19/2021] [Indexed: 11/20/2022]
Abstract
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.
Collapse
Affiliation(s)
- Satendra Singh
- Health Humanities Group, University College of Medical Sciences, University of Delhi, India.
| | - Amir Maroof Khan
- Medical Education Unit, University College of Medical Sciences, University of Delhi, India.
| | - Upreet Dhaliwal
- Health Humanities Group, University College of Medical Sciences, University of Delhi, India.
| | - Navjeevan Singh
- Health Humanities Group, University College of Medical Sciences, University of Delhi, India.
| |
Collapse
|
39
|
Havercamp SM. Competency-Based Curriculum Development: Essential Disability Competencies for Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:168-169. [PMID: 33492832 DOI: 10.1097/acm.0000000000003825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Susan M Havercamp
- Professor, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio; ; ORCID: http://orcid.org/0000-0002-8764-7987
| |
Collapse
|