Virtual Patient Training to Improve Reproductive Health Care for Women With Intellectual Disabilities

Health professionals' education related to people with intellectual and developmental disabilities: A scoping review

BACKGROUND

People with intellectual and developmental disabilities are among the most underserved in an inequitable healthcare system.

METHODS

Using Arksey and O'Malley's methodology and a social determinants of health framework, we conducted a scoping review of literature on the state of practice in education of healthcare professionals in the health and healthcare needs of this population.

RESULTS

Searches found 4948 articles, with 182 included in the final review. Themes identified included gaps of not being informed by workforce needs, continued use of the medical model of care, not addressing intersectionality with racial/ethnic and other discriminations, and lack of involvement of the population in developing/evaluating programs and promising trends of development of competency-based interprofessional programs with experiential learning.

CONCLUSION

We provide recommendations for best practices in a concerted effort to educate a healthcare workforce equipped with the knowledge and skills to address the health needs of this population.

Clinician perspectives on the need for training on caring for pregnant women with intellectual and developmental disabilities

BACKGROUND

Women with intellectual and developmental disabilities (IDDs) experience disparities in obstetric care access and quality, in addition to communication gaps with healthcare providers. Many obstetric providers are untrained and uneducated about critical aspects of providing care to persons with IDDs.

OBJECTIVE

The study was conducted to describe obstetric clinicians' training experiences related to providing obstetric care to women with IDDs, to assess the perceived need for formalized training, and to identify recommendations for training content.

METHODS

This study involved qualitative individual interviews (n = 9) and one focus group (n = 8) with obstetric clinicians who self-reported experience caring for women with IDDs during pregnancy. Descriptive coding and content analysis techniques were used to develop an iterative codebook related to education and training; codes were applied to the data. Coded data were analyzed for larger themes and relationships.

RESULTS

Analysis revealed three main themes: 1. Need for obstetric training and education: No participant reported receiving any training in caring for pregnant women with IDDs. Participants expressed a need for formal education. 2. Recommendations for formal training: Participants noted the need for training during residency and beyond, and all healthcare staff members should be included in training. 3. Training outcomes should increase knowledge, enhance attitudes, and develop practical skills related to care for pregnant women with IDDs.

CONCLUSION

Results indicate a need for systematic training efforts regarding obstetric care for women with IDDs. Improved training and education may decrease health inequities and improve the quality of care, and thus pregnancy outcomes, for women with IDDs.

LEVEL OF EVIDENCE

VI.

Training Healthcare Professionals to Work With People With Intellectual and Developmental Disabilities

This study assessed 155 healthcare providers, from nine disciplines, who work professionally with people with intellectual and developmental disabilities (IDD). Using a national, web-based survey, respondents rated their experience, comfort, and competence in treating individuals with different disability types and preferred methods of continuing education; respondents also provided suggestions for attracting others to work with the IDD population. Findings revealed that experiences, comfort, and competence were all higher concerning persons with autism spectrum disorder (ASD) and intellectual disability (ID), lower for those with deaf-blindness. Overall, levels of experience exceeded levels of comfort, which in turn exceeded levels of competence. The most helpful venues for continued training involved day-to-day contact with persons with IDD, which also characterized open-ended responses. Research and practical implications are discussed.

Training Medical Professionals to Work with Patients with Neurodevelopmental Disorders: A Systematic Review

Background: Patients with neurodevelopmental disorders are not always provided the quality of medical care they deserve. Medical personnel report limited preparation and education in caring for patients with neurodevelopmental disorders.  Aim: The purpose of this systematic review is to summarize the research on medical personnel training programs, identify effective training methods, and provide directions for future application and research. Methods: Thirty-four studies met inclusion criteria. The studies were summarized in terms of training components, the medical personnel trained, and the effectiveness of the training in achieving target outcomes.  Results: Seventy-nine percent of studies demonstrated improvement in target outcomes. A variety of training components were used in combination throughout the studies, demonstrating a possibility of significant change to medical personnel's abilities for and attitudes about working with patients with neurodevelopmental disorders.  Conclusion: Further research is needed to determine specifically which types of training can affect which target outcomes.

Medical students' attitudes towards people with intellectual disabilities: a literature review

The present paper provides a review of research on medical students' attitudes to people with intellectual disabilities. The attitudes of medical students warrant empirical attention because their future work may determine people with intellectual disabilities' access to healthcare and exposure to health inequalities. An electronic search of Embase, Ovid MEDLINE(R), PsycINFO, Scopus, and Web of Science was completed to identify papers published up to August 2013. Twenty-four studies were identified, most of which evaluated the effects of pedagogical interventions on students' attitudes. Results suggested that medical students' attitudes to people with intellectual disabilities were responsive to interventions. However, the evidence is restricted due to research limitations, including poor measurement, self-selection bias, and the absence of control groups when evaluating interventions. Thus, there is a dearth of high-quality research on this topic, and past findings should be interpreted with caution. Future research directions are provided.

Computerized virtual patients in health professions education: a systematic review and meta-analysis

PURPOSE

Educators increasingly use virtual patients (computerized clinical case simulations) in health professions training. The authors summarize the effect of virtual patients compared with no intervention and alternate instructional methods, and elucidate features of effective virtual patient design.

METHOD

The authors searched MEDLINE, EMBASE, CINAHL, ERIC, PsychINFO, and Scopus through February 2009 for studies describing virtual patients for practicing and student physicians, nurses, and other health professionals. Reviewers, working in duplicate, abstracted information on instructional design and outcomes. Effect sizes were pooled using a random-effects model.

RESULTS

Four qualitative, 18 no-intervention controlled, 21 noncomputer instruction-comparative, and 11 computer-assisted instruction-comparative studies were found. Heterogeneity was large (I²>50%) in most analyses. Compared with no intervention, the pooled effect size (95% confidence interval; number of studies) was 0.94 (0.69 to 1.19; N=11) for knowledge outcomes, 0.80 (0.52 to 1.08; N=5) for clinical reasoning, and 0.90 (0.61 to 1.19; N=9) for other skills. Compared with noncomputer instruction, pooled effect size (positive numbers favoring virtual patients) was -0.17 (-0.57 to 0.24; N=8) for satisfaction, 0.06 (-0.14 to 0.25; N=5) for knowledge, -0.004 (-0.30 to 0.29; N=10) for reasoning, and 0.10 (-0.21 to 0.42; N=11) for other skills. Comparisons of different virtual patient designs suggest that repetition until demonstration of mastery, advance organizers, enhanced feedback, and explicitly contrasting cases can improve learning outcomes.

CONCLUSIONS

Virtual patients are associated with large positive effects compared with no intervention. Effects in comparison with noncomputer instruction are on average small. Further research clarifying how to effectively implement virtual patients is needed.