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Parish A, Carver C, Lein DH, Wylie E, Byrd WA, Pirlo OJ, Brooks WS. Come Roll with Me: An Interprofessional Experience to Promote Disability Awareness. TEACHING AND LEARNING IN MEDICINE 2024; 36:183-197. [PMID: 36426664 DOI: 10.1080/10401334.2022.2148107] [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: 04/29/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
Problem: One in four American adults have a disability, which makes people with disabilities the largest minority group in the United States (U.S.). Chronic diseases are prevalent within this population, which faces myriad barriers that limit access to healthcare and create significant health care disparities. Yet, disability awareness programs are limited in U.S. medical schools and graduates report a sense of unpreparedness to care for this population. Intervention: Come Roll with Me (CRWM) was implemented as an interprofessional, preclinical experience to provide medical and Doctor of Physical Therapy (DPT) students an opportunity to engage with wheelchair users and one another. Students rotated through four stations with a licensed physical therapist and wheelchair user facilitator. Stations included (1) manual wheelchair self-propulsion, (2) accessible parking, (3) transfers, and (4) open dialog on barriers to healthcare led by the wheelchair user. Context: This study sought to assess the impact of CRWM on students' understanding of the barriers and health disparities faced by individuals with disabilities. Assessment was conducted using course evaluations, thematic analysis of student reflection essays and a focus group with the wheelchair user facilitators to determine if CRWM met pre-implementation program goals and objectives, including the Interprofessional Educational Collaborative (IPEC) core competencies. Impact: Student reflections from both disciplines indicated that learners were able to identify a variety of barriers faced by people with disabilities and prioritize methods to mitigate these factors. Approximately 91% of medical students agreed or strongly agreed that CRWM was effective in their learning on course evaluations. Wheelchair user facilitators noted three important outcomes of CRWM: educating, teaming, and impact on students. Lesson Learned: Come Roll with Me is a robust educational activity, as evidenced by the program meeting all goals and objectives as well as (IPEC) core competencies. It provides students a unique opportunity to learn about disability from another profession and wheelchair users. People with disabilities and DPT students are a unique and underutilized pool of educators in undergraduate medical education.
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Affiliation(s)
- Ashley Parish
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Cathy Carver
- Spain Rehabilitation Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Donald H Lein
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth Wylie
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Spain Rehabilitation Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Will A Byrd
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Obadiah J Pirlo
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - William S Brooks
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Hartsgrove C, DeLauter G, Kirshblum S. Sustained Impact of a Virtual Disability Education Curriculum With Fourth-Year Medical Students in a Mandatory Physical Medicine and Rehabilitation Clerkship. Am J Phys Med Rehabil 2023; 102:780-786. [PMID: 36753447 DOI: 10.1097/phm.0000000000002201] [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: 02/09/2023]
Abstract
OBJECTIVE The aim of the study was to measure the short- and long-term impact of a virtual disability education curriculum associated with a 2-wk mandatory physical medicine and rehabilitation clerkship for fourth-year medical students. DESIGN A prospective pre-post intervention survey-based study measuring the impact of a virtual disability education series at 1-wk and 6-mo time points after a mandatory physical medicine and rehabilitation clerkship including 8 hrs of virtual didactics with an emphasis on physical disabilities. The surveys assessed the overall virtual curriculum, perceived benefit of a virtual encounter, and the long-term applicability of the information learned from the clerkship. RESULTS The physical medicine and rehabilitation clerkship was effective in improving medical students' perceived comfort and clinical knowledge regarding treatment of persons with disabilities ( P < 0.01). There were no statistical differences at the 6-mo time point, indicating sustained benefit and integration of knowledge in the long term ( P > 0.05). In addition, 84% of students reported using the information in clinical experiences at 6 mos. CONCLUSIONS The physical medicine and rehabilitation clerkship including a virtual disability education curriculum improved long-term perceived medical student comfort and knowledge of treating persons with disabilities, with a focus on those with physical disabilities. Virtual encounters with persons with disabilities are viable and impactful avenues to provide this education.
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Affiliation(s)
- Caitlin Hartsgrove
- From the Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey (CH, SK); Rutgers New Jersey Medical School, Newark, New Jersey (CH, SK); Kessler Institute for Rehabilitation, West Orange, New Jersey (CH, SK); and Select Medical, Mechanicsburg, Pennsylvania (GD)
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Grau Canét-Wittkampf C, Diemers A, Van den Bogerd K, Schönrock-Adema J, Damoiseaux R, Zwart D, Jaarsma D, Mol S, Bombeke K, de Groot E. Learning patient-centredness with simulated/standardized patients: A realist review: BEME Guide No. 68. MEDICAL TEACHER 2023; 45:347-359. [PMID: 35917585 DOI: 10.1080/0142159x.2022.2093176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Given the positive outcomes of patient-centred care on health outcomes, future doctors should learn how to deliver patient-centred care. The literature describes a wide variety of educational interventions with standardized patients (SPs) that focus on learning patient-centredness. However, it is unclear which mechanisms are responsible for learning patient-centredness when applying educational interventions with SPs. OBJECTIVE This study aims to clarify how healthcare learners and professionals learn patient-centredness through interventions involving SPs in different healthcare educational contexts. METHODS A realist approach was used to focus on what works, for whom, in what circumstances, in what respect and why. Databases were searched through 2019. Nineteen papers were included for analysis. Through inductive and deductive coding, CIC'MO configurations were identified to build partial program theories. These CIC'MOs describe how Interventions with SPs change the Context (C→C') such that Mechanisms (M) are triggered that are expected to foster patient-centredness as Outcome. RESULTS Interventions with SPs create three contexts which are 'a safe learning environment,' 'reflective practice,' and 'enabling people to learn together.' These contexts trigger the following seven mechanisms: feeling confident, feeling a sense of comfort, feeling safe, self-reflection, awareness, comparing & contrasting perspectives, combining and broadening perspectives. A tentative final program theory with mechanisms belonging to three main learning components (cognitive, regulative metacognitive and affective) is proposed: Interventions with SPs create a safe learning environment (C') in which learners gain feelings of confidence, comfort and safety (affective M). This safe learning environment enables two other mutual related contexts in which learners learn together (C'), through comparing & contrasting, combining and broadening their perspectives (cognitive M) and in which reflective practice (C') facilitates self-reflection and awareness (metacognitive M) in order to learn patient-centeredness. CONCLUSION These insights offer educators ways to deliberately use interventions with SPs that trigger the described mechanisms for learning patient-centredness.
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Affiliation(s)
| | - Agnes Diemers
- Department of General Practice and Elderly Care, and Center for Education Development and Research, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Kristin Van den Bogerd
- Department of Primary and Interdisciplinary Care, Skills Lab, University of Antwerp, Antwerpen, België
| | - Johanna Schönrock-Adema
- Centre for Education Development and Research in Health Professions (CEDAR) and LEARN, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Roger Damoiseaux
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dorien Zwart
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Debbie Jaarsma
- Center for Education Development and Research in Health Professions (CEDAR) and LEARN, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands and Faculty of Veterinary Medicine, Utrecht, The Netherlands
| | - Saskia Mol
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Katrien Bombeke
- Department of Primary and Interdisciplinary Care, Skills Lab, University of Antwerp, Antwerpen, België
| | - Esther de Groot
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Leo J, Tomasone JR, Bassett-Gunter RL, Knibbe TJ, Latimer-Cheung A. We want more! Examining the perceived training and information needs of health and fitness practitioners about disability and physical activity. Appl Physiol Nutr Metab 2023; 48:226-230. [PMID: 36423353 DOI: 10.1139/apnm-2022-0239] [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: 11/25/2022]
Abstract
A lack of disability-specific knowledge among practitioners poses a significant barrier to physical activity (PA) participation for persons with physical disabilities (PWPDs). This study aimed to identify perceived training needs of health and fitness practitioners to support PA for PWPDs. Canadian health and fitness practitioners (n = 115; 81% female) completed an online survey. More specialized training and access to information about PA for PWPDs are needed. In-person training, webinars, and lived experiences of PWPDs are recommended.
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Affiliation(s)
- Jennifer Leo
- The Steadward Centre for Personal & Physical Achievement, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada
| | - Jennifer R Tomasone
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Rebecca L Bassett-Gunter
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
| | - Tara Joy Knibbe
- Abilities Centre, 55 Gordon Street, Whitby, ON L1N 0J2, Canada
| | - Amy Latimer-Cheung
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON K7L 3N6, Canada
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Project Inclusive Genetics: Exploring the impact of patient-centered counseling training on physical disability bias in the prenatal setting. PLoS One 2021; 16:e0255722. [PMID: 34352009 PMCID: PMC8341652 DOI: 10.1371/journal.pone.0255722] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 07/22/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE There is robust research examining the negative impact of racial and socioeconomic implicit bias on healthcare provider clinical decision-making. However, other under-studied important biases are likely to impact clinical care as well. The goal of this study was to explore the presence of bias against people with physical disability among a heterogeneous group of healthcare workers and trainees and to evaluate the effect of implicit association testing and an educational module on this bias. METHOD The study was composed of a one-hour web-based survey and educational module. The survey included an explicit disability bias assessment, disability Implicit Association Tests (IATs), demographic collection, and pre- and post- module clinical vignettes of prenatal patient scenarios. In addition to providing counseling to hypothetical patients, participants also indicated their personal preferences on genetic testing and termination. The educational module focused on the principles of patient-centered counseling. RESULTS The collected data reflects responses from 335 participants. Within this sample, there were both explicit and implicit biases towards individuals with physical disabilities. Prior to the IAT and educational module, when respondents were tasked with providing genetic testing recommendations, implicit biases and personal preferences for genetic testing and termination influenced respondents' clinical recommendations. Importantly, having previous professional experience with individuals with disabilities diminished biased clinical recommendations prior to the intervention. In response to the IAT and educational intervention, the effect of implicit bias and personal preferences on clinical recommendations decreased. CONCLUSIONS This study demonstrates how bias against a marginalized group exists within the medical community and that personal opinions can impact clinical counseling. Importantly, our findings suggest that there are strategies that can be easily implemented into curricula to address disability bias, including formal educational interventions and the addition of professional experiences into healthcare professional training programs.
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Ní Chianáin L, Fallis R, Johnston J, McNaughton N, Gormley G. Nothing about me without me: a scoping review of how illness experiences inform simulated participants' encounters in health profession education. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:611-616. [PMID: 35520981 PMCID: PMC8936821 DOI: 10.1136/bmjstel-2021-000886] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/28/2021] [Indexed: 11/04/2022]
Abstract
Background Person-centred simulation in health professions education requires involvement of the person with illness experience. Objective To investigated how real illness experiences inform simulated participants' (SP) portrayals in simulation education using a scoping review to map literature. Study selection Arksey and O'Malley's framework was used to search, select, chart and analyse data with the assistance of personal and public involvement. MEDLINE, Embase, CINAHL, Scopus and Web of Science databases were searched. A final consultation exercise was conducted using results. Findings 37 articles were within scope. Reporting and training of SPs are inconsistent. SPs were actors, volunteers or the person with the illness experience. Real illness experience was commonly drawn on in communication interactions. People with illness experience could be directly involved in various ways, such as through conversation with an SP, or indirectly, such as a recording of heart sounds. The impact on the learner was rarely considered. Conclusion Authentic illness experiences help create meaningful person-centred simulation education. Patients and SPs may both require support when sharing or portraying illness experience. Patients' voices profoundly enrich the educational contributions made by SPs.
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Affiliation(s)
- Linda Ní Chianáin
- Centre for Medical Education, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Richard Fallis
- Medical Library, Queen's University Belfast, Belfast, UK
| | - Jenny Johnston
- Centre for Medical Education, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Nancy McNaughton
- The Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada
- University Health Network Education Scholar, Michener Institute of Education at UHN, Toronto, Ontario, Canada
| | - Gerard Gormley
- Centre for Medical Education, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
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Havercamp SM, Barnhart WR, Robinson AC, Whalen Smith CN. What should we teach about disability? National consensus on disability competencies for health care education. Disabil Health J 2020; 14:100989. [PMID: 32952097 DOI: 10.1016/j.dhjo.2020.100989] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Health care providers are unprepared to meet the health needs of patients who have disabilities. Disability training is needed, yet there is little agreement about what should be taught. OBJECTIVE Establish a national consensus on what healthcare providers across disciplines need to know to provide quality care to patients with all types of disabilities (e.g., mobility, sensory, developmental, mental health). METHODS People with disabilities, disability advocates, family members of people with disabilities, disability and health professionals, and inter-disciplinary health educators systematically evaluated and provided feedback on a draft set of disability competencies. Based on this feedback, competencies were iteratively refined. RESULTS After two waves of feedback, six competencies, 49 sub-competencies, and 10 principles and values emerged that addressed topics such as respect, person-centered care, and awareness of physical, attitudinal, and communication health care barriers. An overwhelming majority (89%) agreed or strongly agreed that the disability competencies reflected the core understandings needed to provide quality care for patients with disabilities, were relevant across disability types (85%), and across health care disciplines (96%). Averaging evaluative feedback across competencies, participants reported that the competencies were important (98%) and clear (96%). CONCLUSIONS This consensus on what to teach is an important milestone in preparing a disability competent health care workforce. Future directions for research, training, and policy are discussed. When disability is included in health care education, the health care workforce will be prepared to deliver accessible, patient-centered, quality health care to patients with disabilities.
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Dijk SW, Duijzer EJ, Wienold M. Role of active patient involvement in undergraduate medical education: a systematic review. BMJ Open 2020; 10:e037217. [PMID: 32718925 PMCID: PMC7389514 DOI: 10.1136/bmjopen-2020-037217] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/14/2020] [Accepted: 06/15/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To identify the scope of active patient involvement in medical education, addressing the current knowledge gaps relating to rationale and motivation for involvement, recruitment and preparation, roles, learning outcomes and key procedural contributors. METHODS The authors performed a systematic search of the PubMed database of publications between 2003 and 2018. Original studies in which patients take on active roles in the development, delivery or evaluation of undergraduate medical education and written in English were eligible for inclusion. Included studies' references were searched for additional articles. Quality of papers was assessed using the Mixed Methods Appraisal Tool. RESULTS 49 articles were included in the review. Drivers for patient involvement included policy requirements and patients' own motivations to contribute to society and learning. Patients were engaged in a variety of educational settings in and outside of the hospital. The vast majority of studies describe patients taking on the role of a patient teacher and formative assessor. More recent studies suggest that patients are increasingly involved in course and curriculum development, student selection and summative assessment. The new body of empirical evidence shows the wide range of learning objectives was pursued through patient participation, including competencies as professional, communicator, collaborator, leader and health advocate, but not scholar. Measures to support sustainable patient involvement included longitudinal institutional incorporation, patient recruitment and/or training, resource support and clear commitment by faculty. The importance and advantages of patient involvement were highlighted by students, faculty and patients themselves; however, organisations must continue to consider, monitor and take steps to mitigate any potential harms to patients and students. DISCUSSION This systematic review provides new knowledge and practical insights to physicians and faculty on how to incorporate active patient involvement in their institutions and daily practice, and provides suggested action points to patient organisations wishing to engage in medical education.
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Herrmann-Werner A, Loda T, Wiesner LM, Erschens RS, Junne F, Zipfel S. Is an obesity simulation suit in an undergraduate medical communication class a valuable teaching tool? A cross-sectional proof of concept study. BMJ Open 2019; 9:e029738. [PMID: 31383708 PMCID: PMC6688692 DOI: 10.1136/bmjopen-2019-029738] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE With the growing prevalence of overweight and obesity, medical students should be prepared to engage in weight management and obesity-related communications in order to prevent patients from having stigmatising experiences. In addition, medical students should have training to reduce anti-fat prejudices. DESIGN Cross-sectional proof of concept study. SETTING University Hospital Tuebingen, Germany. PARTICIPANTS 246 participants (207 second-year medical students, 13 standardised patients (SPs) and 22 teachers) took part in the study. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the assessment of degree of reality of the encounter with the SP wearing an obesity simulation suit (OSS). The secondary outcome was the evaluation of students' awareness and prejudice against patients with obesity in a simulated role play. Additionally, a description of the advantages and disadvantages when using such a teaching tool is delivered. RESULTS The OSS contributed to a realistic perception of the patient group depicted in a role play according to students, teachers and SPs. OSS body mass index estimation by students, teachers and SPs correctly was over 30 kg/m2-thus in the range of obesity. In a selected subscale of the Anti-Fat Attitudes Test, students showed significantly stronger anti-fat stigmatisation compared with teachers and SPs. CONCLUSIONS An OSS worn by an SP is a valuable teaching tool to raise awareness about patients with obesity. It gives a realistic picture of the encounter. Stigmatisation was low in general but was especially present in the students. Further research should include intervention studies to address this issue.
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Affiliation(s)
- Anne Herrmann-Werner
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Teresa Loda
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Lisa M Wiesner
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Rebecca Sarah Erschens
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
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Bejerot S, Lindgren A, Rosén J, Bejerot E, Elwin M. Teaching psychiatry to large groups in society. BMC MEDICAL EDUCATION 2019; 19:148. [PMID: 31096962 PMCID: PMC6524333 DOI: 10.1186/s12909-019-1596-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 05/07/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND There is a need to educate a range of professionals in caring for individuals with long-term mental disability who reside within our communities. Empathy alone is insufficient. The Kognus 4-Step Education Program was developed to achieve this goal. METHOD The program consisted of independent courses, including an 18-session basic course on psychiatric disability (on-site or online), advanced courses, and highly specialized training programs (Nidotherapy/Peer Consultation). Experts lectured together with clients with psychiatric disabilities. We first report Swedish reforms in which institutionalized patients were relocated to semi-independent individual households. We then describe the design and implementation of the education program. Approximately 50% of participants who were younger than 36 years old lacked any healthcare education. The participants' backgrounds, perceptions, participation in the education program, and costs are presented. RESULTS Between 2009 and 2014, 8959 participants attended the Kognus psychiatry courses online or on-site in Stockholm (basic on-site course, n = 2111; online course, n = 4480; advanced courses, n = 2322; highly specialized programs, n = 46). A total of 73% of the participants satisfactorily attended the basic sessions on-site compared with 11% of the online participants. The developers conducted the education program for the first 3 years. Thereafter, another course provider continued the program with other types of participants. The program was perceived to be equally interesting and meaningful to participants with low and high levels of education, demonstrating the generalizability of the program. The quality of the basic and advanced courses was rated as 4.4 and 4.3, respectively, on a 5-point Likert scale. CONCLUSIONS Personnel without appropriate education who work with people with psychiatric/intellectual disabilities can be educated in large numbers. The Kognus program represents a novel and successful way of training people who have no formal education about some essentials of good mental healthcare. Moreover, the model can be easily implemented elsewhere.
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Affiliation(s)
- Susanne Bejerot
- School of Medical Sciences, Örebro University, Örebro, Sweden
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ann Lindgren
- Central Health Services in pre-schools, schools and upper secundary schools, Municipality of Norrtälje, Stockholm, Sweden
| | - Jörgen Rosén
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Eva Bejerot
- The Örebro University School of Business, Örebro, Sweden
| | - Marie Elwin
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Sabatello M. Cultivating inclusivity in precision medicine research: disability, diversity, and cultural competence. J Community Genet 2018; 10:363-373. [PMID: 30539340 DOI: 10.1007/s12687-018-0402-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 12/03/2018] [Indexed: 12/31/2022] Open
Abstract
Cultural competence is increasingly viewed as key for the inclusion of diverse populations in precision medicine research (PMR) in the USA. Precision medicine researchers and personnel are thus increasingly expected to undergo cultural competency trainings and to engage with relevant racial/ethnic communities to ensure that all research components are culturally and linguistically sensitive to these communities. However, the need for PMR enterprises to ensure competence with and understanding of disability rights, history, and needs (hereinafter disability culture competency) have not received attention. This article discusses the importance of disability inclusivity in PMR and the construct-and challenges-of disability as a cultural community. Reviewing and extrapolating from studies in healthcare settings, the article considers three interrelated issues that are likely to impact disability inclusivity in PMR: disability accessibility and accommodation; disability stigma and unconsious bias; and disability language and communication. Next, disability competency trainings that were developed in healthcare settings are surveyed and their applicability for PMR is discussed. The arguments advanced are that disability culture competency among precision medicine researchers, personnel, and oversight committees is essential to upholding the welfare and rights of human subjects with disabilities in PMR; that engagement with disability communities is imperative for this endeavor; and that such knowledge of disability culture is crucial for cultivating inclusivity of people with different (dis)abilities in PMR.
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Affiliation(s)
- Maya Sabatello
- Center for Research on Ethical, Legal & Social Implications of Psychiatric, Neurologic & Behavioral Genetics, Columbia University, New York, NY, USA. .,NY State Psychiatric Institute, 1051 Riverside Drive, Unit 122, New York, NY, 10032, USA.
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Knibbe TJ, McPherson AC, Gladstone B, Biddiss E. "It's all about incentive": Social technology as a potential facilitator for self-determined physical activity participation for young people with physical disabilities. Dev Neurorehabil 2018; 21:521-530. [PMID: 28960125 DOI: 10.1080/17518423.2017.1370501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate the perceived role of social technologies in promoting physical activity participation for young people with physical disabilities and to identify design considerations that should be addressed when creating social technologies to promote physical activity. METHOD Interactive design workshops for young people with physical disabilities aged 12-18 (n = 8) were held. Data were analyzed using interpretive thematic analysis. RESULTS Young people perceived significant benefit for social technologies to promote physical activity as they have the potential to overcome many barriers to physical activity participation. Design features recommended by the participants included (1) options for diverse interests and preferences, (2) provision of informational support, (3) support through equitable technology design, (4) incentive through competition and play, and (5) opportunities to develop community. CONCLUSIONS Social technology has potential to provide tailored, equitable opportunities for social engagement and physical activity participation for young people with physical disabilities through needs- and preference-specific design.
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Affiliation(s)
- Tara Joy Knibbe
- a Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Ontario, Canada.,b Rehabilitation Sciences Institute , University of Toronto, Toronto, Ontario, Canada
| | - Amy C McPherson
- a Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Ontario, Canada.,b Rehabilitation Sciences Institute , University of Toronto, Toronto, Ontario, Canada.,c Dalla Lana School of Public Health , University of Toronto, Toronto, Ontario, Canada
| | - Brenda Gladstone
- c Dalla Lana School of Public Health , University of Toronto, Toronto, Ontario, Canada.,d Centre for Critical Qualitative Health , University of Toronto, Toronto, Ontario, Canada
| | - Elaine Biddiss
- a Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Ontario, Canada.,b Rehabilitation Sciences Institute , University of Toronto, Toronto, Ontario, Canada.,e Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Institute of Biomaterials and Biomedical Engineering , University of Toronto, Toronto, Ontario, Canada
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Coret A, Boyd K, Hobbs K, Zazulak J, McConnell M. Patient Narratives as a Teaching Tool: A Pilot Study of First-Year Medical Students and Patient Educators Affected by Intellectual/Developmental Disabilities. TEACHING AND LEARNING IN MEDICINE 2018; 30:317-327. [PMID: 29283674 DOI: 10.1080/10401334.2017.1398653] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PROBLEM People with intellectual and developmental disabilities (IDD) face complex biopsychosocial challenges and are medically underserved. This is in part due to insufficient resources and supports but can also be attributed to a lack of adequate physician training in addressing the unique needs of this population. INTERVENTION This study aimed to introduce 1st-year medical students to the IDD population using a blended educational experience that included video narratives of and direct interactions with people affected by IDD. The goal of this intervention was to promote person-centered attitudes and communication among early medical trainees. CONTEXT The study recruited 27 first-year medical students and randomly assigned each to 1 of 2 groups. The control group received an introductory video lecture about IDD healthcare, followed by a quiz. The narrative group received the same lecture, followed by reflective discussion of videos featuring people living with IDD sharing their perspectives and stories. All students then participated in 4 simulated clinical encounters with patient educators (PEs) who have lived experiences of IDD. Focus groups were conducted with students following the simulated encounters to explore their experiences and perceptions of this blended learning activity. Moreover, secondary quantitative data were collected to assess students' performance in the clinical encounters, along with self-reports of comfort, confidence, and competence of interacting with people with IDD (pre- and postparticipation). OUTCOME All students thought that the blended educational experience was valuable and enjoyable, commenting on the importance of adaptable language and engagement of people with IDD, as well as the merits of reflecting on patient narratives. Students also discussed feelings of discomfort stemming from a lack of knowledge and previous exposure to IDD and how this discomfort might motivate them to learn more and develop their skills further. In addition, descriptive analyses revealed that students in the narrative group showed greater self-rated measures of comfort, confidence, and competence compared to control; they also had higher mean performance scores across all PE interview stations. LESSONS LEARNED PEs add a powerful real-life dimension to communication skills teaching and have been shown to be a valuable educational modality. Moreover, exposure to and reflection on video-based patient narratives are useful ways of teaching medical students about patients' lived experiences and promoting person-centered communication, both within and beyond IDD.
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Affiliation(s)
- Alon Coret
- a Arts and Science Program , McMaster University , Hamilton , Ontario , Canada
| | - Kerry Boyd
- b Department of Psychiatry and Behavioural Neuroscience , McMaster University , Hamilton , Ontario , Canada
- c Chief Clinical Officer, Bethesda Services , Thorold , Ontario , Canada
| | - Kevin Hobbs
- d Standardized Patient Program, McMaster University , Hamilton , Ontario , Canada
| | - Joyce Zazulak
- e Department of Family Medicine , McMaster University , Hamilton , Ontario , Canada
| | - Meghan McConnell
- f Program for Educational Research and Development, Faculty of Health Sciences, McMaster University, McMaster University , Hamilton , Ontario , Canada
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Sundstrom B, Szabo C, Dempsey A. "My Body. My Choice": A Qualitative Study of the Influence of Trust and Locus of Control on Postpartum Contraceptive Choice. JOURNAL OF HEALTH COMMUNICATION 2018; 23:162-169. [PMID: 29297766 DOI: 10.1080/10810730.2017.1421728] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Postpartum contraception helps reduce unintended pregnancy and space births to improve maternal and child health. This study explored women's perceptions of contraceptive choice during the postpartum period in the context of locus of control and trust in healthcare providers. Researchers conducted six focus groups with 47 women, ages 18-39, receiving postpartum care at an outpatient clinic. Techniques from grounded theory methodology provided an inductive approach to analysis. HyperRESEARCH 3.5.2 qualitative data analysis software facilitated a constant-comparative coding process to identify emergent themes. Participants expressed a preference for relationship-centered care, in which healthcare providers listened, individualized their approach to care through rapport-building, and engaged women in shared decision-making about contraceptive use through open communication, reciprocity, and mutual influence. Conflicting health messages served as barriers to uptake of effective contraception. While participants trusted their healthcare provider's advice, many women prioritized personal experience and autonomy in decisions about contraception. Providers can promote trust and relationship-centered care to optimize contraceptive uptake by listening, exploring patient beliefs and preferences about contraception and birth spacing, and tailoring their advice to individuals. Results suggest that antenatal contraceptive counseling should incorporate information about effectiveness, dispel misconceptions, and engage patients in shared decision-making.
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Affiliation(s)
- Beth Sundstrom
- a College of Charleston, Department of Communication , Charleston , SC , USA
| | - Caitlin Szabo
- b Emory University School of Medicine, Department of Gynecology and Obstetrics , Atlanta , GA , USA
| | - Angela Dempsey
- c Medical University of South Carolina, Department of Obstetrics and Gynecology , Charleston , SC , USA
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Gathercoal RO, Gathercoal KA, Seegobin W, Hadley S. Nurturing constructive change that works: a critical theory-informed model for transforming health service psychologists’ views of people with disabilities. QUALITATIVE RESEARCH IN MEDICINE & HEALTHCARE 2017. [DOI: 10.4081/qrmh.2017.6391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We have been developing and refining a disability training exercise for health service psychologists that is ever more effective at encouraging lasting change in the way students regard disabilities and the people who live with those disabilities. Although research suggests that simulation exercises tend to be ineffective at creating long-term attitude change in participants, quantitative and qualitative results indicate our exercise, composed of a simulation followed by debriefing and reflection, helps professionals better understand some of the challenges people with disabilities daily face, and how those challenges can affect their well being. We found this combination is more likely to yield long-term changes than any of these approaches alone. This paper is not principally the description of a pedagogical technique, but instead is an examination of how the combination of simulation, debriefing, and reflective journaling may challenge taken-for-granted assumptions about disabilities, e.g., that disabilities transform individuals into a different kind of human being (with either superhuman powers or as object of pity) instead of seeing these individuals as ordinary people facing extraordinary, and often society-created obstacles. One frequent call of Critical Theorists is to challenge those things we take for granted. Social and cultural structures create specific viewpoints and thus problematizing the apparent is necessary for understanding of, and emancipation from, potentially oppressive social structures. Inspired by this call to render the taken-for-granted as problematic, the exercise we describe creates inversions of performer/audience, professional/student, and scientist/researcher positions. In each of these inversions, the role of the objective observer is denied and the student is invited to engage in his or her own evaluative and potentially transformative experience. Through each of these inversions, different realities can be more readily utilized by thoughtful students to render problematic some of the dominant views about people with disabilities. To make this case, we utilize both qualitative and quantitative methods. The students’ own words, captured in their journals before and after the exercise, are examined in comparison with program goals and features. The weight of the evidence is impressive, indicating that the combination of simulation, debriefing and journaling reflection are effective at creating a space in which change of attitudes does occur.
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Yorke AM, Ruediger T, Voltenburg N. Doctor of physical therapy students’ attitudes towards people with disabilities: a descriptive study. Disabil Rehabil 2016; 39:91-97. [DOI: 10.3109/09638288.2016.1140830] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Amy M. Yorke
- Physical Therapy Department, University of Michigan-Flint, Flint, MI, USA
| | - Thomas Ruediger
- Physical Therapy Department, Trine University, Fort Wayne, IN, USA
| | - Nicole Voltenburg
- Physical Therapy Department, University of Michigan-Flint, Flint, MI, USA
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Burns M, Baylor C, Dudgeon BJ, Starks H, Yorkston K. Asking the Stakeholders: Perspectives of Individuals With Aphasia, Their Family Members, and Physicians Regarding Communication in Medical Interactions. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2015; 24:341-57. [PMID: 25760479 DOI: 10.1044/2015_ajslp-14-0051] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 02/17/2015] [Indexed: 05/15/2023]
Abstract
PURPOSE The purpose of this study was to explore the experiences of patients with aphasia, their family members, and physicians related to communication during medical interactions. METHOD Face-to-face, semistructured interviews were conducted with 18 participants—6 patients with aphasia, 6 family members involved in patient care, and 6 practicing physicians. A qualitative description approach was used to collect and summarize narratives from participants' perspectives and experiences. Participants were asked about experiences with communication during medical interactions in which the family member accompanied the patient. Interviews were audio- and/or video-recorded, transcribed, and then coded to identify main themes. RESULTS Patients and family members generally described their communication experiences as positive, yet all participants discussed challenges and frustrations. Three themes emerged: (a) patients and family members work as a team, (b) patients and family members want physicians to "just try" to communicate with the patient, and (c) physicians want to interact with patients but may not know how. CONCLUSIONS Participants discussed the need for successful accommodation, or changing how one communicates, to help facilitate the patients' increased understanding and ability to express themselves. Over- and underaccommodation with communication were commonly reported as problems. Speech-language pathologists have a role to play in helping to improve communication during medical interactions. Implications for current speech-language pathologist practice and future directions of research are discussed.
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Duggan AP, Vicini A, Allen L, Shaughnessy AF. Learning to See Beneath the Surface: A Qualitative Analysis of Family Medicine Residents' Reflections About Communication. JOURNAL OF HEALTH COMMUNICATION 2015; 20:1441-1448. [PMID: 26147857 DOI: 10.1080/10810730.2015.1018647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Patients share straightforward statements with physicians such as describing their fears about their diagnosis. Physicians need to also understanding implicit, indirect, subtle communication cues that give broader context to patients' illness experiences. This project examines physicians' written reflections that offer insight into their interpretation of both the stated and the tacit aspects of their observations about communication, their resulting responses, and their intended actions. Tufts University Family Medicine residents (N = 33) of the Tufts Family Medicine Cambridge Health Alliance completed three reflective exercises each week over the course of 1 year (756 reflective entries). An interdisciplinary research team identified communication-related concepts within the reflections. Identified themes include (a) physicians recognizing and discovering mutual interplay of their communication with and patient disclosure, (b) physicians paying attention to subtleties of patient behavior as indicative of a fuller picture of patients' lives and their coping with illness, and (c) physician images of growth and awareness about communication indicative of their potential for growth and improvement. The project extends the literature in communication and medical education by examining explicit and tacit points of reflection about communication. The project (a) allows for unpacking the multifaceted aspects of reflection and (b) bridges reflective theory and medical education with communication foundations.
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Affiliation(s)
- Ashley P Duggan
- a Communication Department , Boston College , Chestnut Hill , Massachusetts , USA
| | - Andrea Vicini
- b School of Theology and Ministry , Boston College , Chestnut Hill , Massachusetts , USA
| | - Lucas Allen
- b School of Theology and Ministry , Boston College , Chestnut Hill , Massachusetts , USA
| | - Allen F Shaughnessy
- c School of Medicine , Tufts University School of Medicine , Malden , Massachusetts , USA
- d Cambridge Health Alliance , Family Medicine , Malden , Massachusetts , USA
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Ng SL, Kinsella EA, Friesen F, Hodges B. Reclaiming a theoretical orientation to reflection in medical education research: a critical narrative review. MEDICAL EDUCATION 2015; 49:461-75. [PMID: 25924122 DOI: 10.1111/medu.12680] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/13/2014] [Accepted: 12/19/2014] [Indexed: 05/12/2023]
Abstract
CONTEXT Reflection and reflective practice have become popular topics of scholarly dialogue in medical education. This popularity has given rise to checklists, portfolios and other tools to inspire and document reflection. We argue that some of the common ways in which reflection has been applied are influenced by broader discourses of assessment and evidence, and divorced from original theories of reflection and reflective practice. METHODS This paper was developed using a critical narrative approach. First we present two theoretical lenses provided by theories of reflection. Next we present a summary of relevant literature, indexed in PubMed from 2004 to 2014, relating to the application of reflection or reflective practice to undergraduate and postgraduate medical education. We categorise these articles broadly by trends and problematise the trends relative to the two theoretical lenses of reflection. RESULTS Two relevant theoretical orientations of reflection for medical education are: (i) reflection as epistemology of practice, and (ii) reflection as critical social inquiry. Three prevalent trends in the application of reflection to medical education are: (i) utilitarian applications of reflection; (ii) a focus on the self as the object of reflection, and (iii) reflection and assessment. These trends align with dominant epistemological positions in medicine, but not with those that underpin reflection. CONCLUSIONS We argue for continued theorising of and theoretically informed applications of reflection, drawing upon epistemologies of practice and critical reflection as critical social inquiry. These directions offer medical education research broad and deep potential in theories of reflection, particularly in relation to knowledge creation within uncertain and complex situations, and challenging of dominant discourses and structures. Future work could explore how dominant epistemological positions and discourses in medicine influence theories from other disciplines when these theories are deployed in medical education.
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Affiliation(s)
- Stella L Ng
- Centre for Faculty Development, St Michael's Hospital, Toronto, Ontario, Canada; Centre for Ambulatory Care Education, Women's College Hospital, Toronto, Ontario, Canada; Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada; Wilson Centre for Research in Education, University Health Network, Toronto, Ontario, Canada
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21
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Shakespeare T, Kleine I. Educating Health Professionals about Disability: A Review of Interventions. ACTA ACUST UNITED AC 2013. [DOI: 10.11120/hsce.2013.00026] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Medical humanities, ethics, and disability -- one fellow's confession and transformation. Camb Q Healthc Ethics 2012; 21:260-6. [PMID: 22377079 DOI: 10.1017/s0963180111000764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In Confessions of a Knife, Richard Selzer gives a candid account of his life as a surgeon, divulging mistakes, regrets, impressions, and emotions in beautiful, metaphorical prose.
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Scherr CL, Mattson M. From research to self-reflection: learning about ourselves as academics through a support group's resistance to our intervention. HEALTH COMMUNICATION 2011; 27:310-313. [PMID: 22188358 DOI: 10.1080/10410236.2011.629410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Purdue University's Center for Healthcare Engineering developed a computer-assisted technology hub (CATHUB) designed to aid individuals with disabilities. Upon realizing the lack of input from the very individuals they were trying to help, Marifran approached the developers of CATHUB and offered to engage a group of amputees to aid in the design and implementation of the hub. In this essay, Courtney and Marifran recount, each from their own perspective, their experiences working with Amputees in Action as participants in their research project. Ultimately the researchers discovered their research agenda was not compatible with the amputees' needs, resulting in enlightened self-reflection by the researchers and abandonment of the research project.
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Affiliation(s)
- Courtney Lynam Scherr
- Brian Lamb School of Communication, Purdue University, West Lafayette, IN 47907-2098, USA.
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Duggan AP, Bradshaw YS, Swergold N, Altman W. When rapport building extends beyond affiliation: communication overaccommodation toward patients with disabilities. Perm J 2011; 15:23-30. [PMID: 21841921 DOI: 10.7812/tpp/11-018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Physician rapport with patients is described as a vital component of relationship-centered care, but rapport-building communication behaviors may exceed boundaries and instead indicate patronizing behavior toward patients with disabilities. This paper addresses the types of communication behaviors and contexts for interpreting when rapport building extends beyond boundaries toward patients with disabilities. METHODS Videotaped interactions between third- and fourth-year medical students (N = 142) and standardized patient educators with physical disabilities were qualitatively analyzed. RESULTS Results suggest six primary themes of exceeding expected rapport boundaries, including baby talk (ie, exaggerated nonverbal gestures and "we" language to indicate "you"), kinesic movement (ie, stiff posture and awkward handshakes), vocalics (ie, volume or pitch that interfered with the flow of conversation), relationship assumptions (ie, communicating assumptions that relationships were grounded in care-receiving), emotional divergence from patient disclosure (ie, minimizing or embellishing disability), and inconsistency with patient emotional cues (ie, responding to negative or neutral disclosure by overly accentuating positive interpretation). DISCUSSION This study suggests that communication behaviors generally described as positive, rapport-building behaviors can pose negative implications when they exceed the expected quantity or duration, when they are inconsistent with patient verbal disclosure, or when verbal and nonverbal messages are inconsistent. Identified themes serve as examples to understand when rapport building exceeds beyond affiliation and instead appears to indicate patronizing behavior toward patients with disabilities. Suggestions for interpreting communication behaviors within the context of patient disclosure and building capacity to distinguish attitudes and biases limiting communication are addressed.
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Affiliation(s)
- Ashley P Duggan
- Communication Department of Boston Collegein Chestnut Hill, MA.
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Long-Bellil LM, Robey KL, Graham CL, Minihan PM, Smeltzer SC, Kahn P. Teaching medical students about disability: the use of standardized patients. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2011; 86:1163-70. [PMID: 21785304 DOI: 10.1097/acm.0b013e318226b5dc] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Standardized patients (SPs), now a mainstay of the undergraduate medical education experience, are beginning to play larger roles in helping students build competencies to better serve patients who have disabilities, in educating students about the lived experiences of persons with disabilities, and in testing students' understanding of disability-related issues. In this article, the authors discuss several U.S. training programs that involve SPs who have disabilities or SPs who do not have disabilities but who portray patients who do. The authors review the goals of each program (e.g., to provide students with opportunities to gain experience with patients with disabilities), describe their commonalities (enhancing students' interview skills) and differences (some programs are educational; some are evaluative), and summarize the evaluative data of each. The authors also explore the benefits and challenges of working with SPs with disabilities and of working with SPs without disabilities. Finally, they consider the practical issues (e.g., recruiting SPs) of developing and implementing such programs.
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Affiliation(s)
- Linda M Long-Bellil
- Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, USA.
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Goldsmith J, Wittenberg-Lyles E, Shaunfield S, Sanchez-Reilly S. Palliative Care Communication Curriculum: What Can Students Learn From an Unfolding Case? Am J Hosp Palliat Care 2010; 28:236-41. [DOI: 10.1177/1049909110385670] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Limited attention to palliative care communication training is offered to medical students. In this work, we pursued unfolding case responses and what they indicated about student tendencies to use palliative care communication as well as what medical students can learn from their own reflective practice about palliative care. Findings showed an overwhelming trend for students to avoid palliative care communication or inclusion of topics including advance directives, place of care, family support, and dying. Instead, students relied heavily on the SPIKES protocol, communication that was strategically vague and ambiguous, and discussions that centered on specialty care and referral. In reflecting on their own case study responses, students noted an absence of direct communication about prognosis, no coordination of care, late hospice entry, and patient pain resulting from communication inefficacies. Future research should focus on the development of formal and adaptive curriculum structures to address these communication needs.
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Affiliation(s)
- Joy Goldsmith
- Department of Communication Studies, One College Avenue, Young Harris College, Young Harris, GA, USA,
| | | | - Sara Shaunfield
- Department of Communication Studies, University of North Texas, Denton, TX, USA
| | - Sandra Sanchez-Reilly
- Department of Medicine, Division of Geriatrics, Gerontology and Palliative Medicine, University of Texas Health Science Center at San Antonio, South Texas Veterans Health Care System, San Antonio, TX, USA
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Duggan A, Bradshaw YS, Altman W. How do I ask about your disability? An examination of interpersonal communication processes between medical students and patients with disabilities. JOURNAL OF HEALTH COMMUNICATION 2010; 15:334-350. [PMID: 20432112 DOI: 10.1080/10810731003686630] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Medical student behaviors were examined through digital recordings of interpersonal skills communication training framed around a brief curriculum on disability within a family medicine clerkship. This analysis focuses on interpersonal communication processes and ways medical students ask standardized patient educators about visually apparent disability (N = 142). Primary themes of asking about or avoiding disability were identified with regard to language and nonverbal communication in how medical students asked and whether they integrated chronic disability with new musculoskeletal pain complaints. Secondary themes related to timing and communication further contextualized the primary themes. Seventy-four percent of students asked about the disability. Analysis of feedback sessions immediately following the interactions revealed that more than half the students who did not ask about disability spontaneously recognized that they avoided disability language. Results suggest that some ways of asking about disability may inhibit patient disclosure and restrict relationship building. In particular, asking about disability, but then avoiding integrating disability disclosure into the treatment plan, or responding to disability-related disclosure with overly positive, infantilizing-type communication, may pose more difficult dilemmas than never asking about the disability. On the contrary, students who ignored disability altogether often also recognized they missed disability cues, thus providing a learning experience of considerable value. Underlying student attitudes and possibilities for integrating biomedical concerns with social-psychological impacts of disability are addressed.
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Affiliation(s)
- Ashley Duggan
- Communication Department, Boston College, Chestnut Hill, Massachusetts, USA.
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