1
|
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
|
2
|
Robinson K, Jamison J. Teaching Physician Assistant Students to Care for People With Intellectual and Developmental Disabilities. J Physician Assist Educ 2024; 35:201-205. [PMID: 38684093 DOI: 10.1097/jpa.0000000000000582] [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: 05/02/2024]
Abstract
ABSTRACT The purposes of this educational activity were to instill in students a greater empathy for patients with intellectual developmental disabilities, give students a better understanding of how to obtain a medical history for patients with communication limitations, teach students practical tips for obtaining a medical history and physical examination to increase competence in their future practice, and to build a relationship with a local organization that serves people with intellectual disabilities. An experiential learning activity was added to the curriculum of two courses for first-year PA students to accomplish these goals. The course instructors engaged in several planning meetings with a local residential facility for people with intellectual disabilities, including choosing patients that the students would assess. The students made 3 visits to the facility. The visits included interactive lectures by a physical therapist, occupational therapist, nurse practitioner, medical doctor, and dentist. Two of the facility involved patient visits at designated homes on campus. The students then wrote comprehensive visit notes with patient identifying information removed and submitted them for grading. Students expressed feeling better prepared to assess people with intellectual disabilities and having an increased appreciation for obtaining quality medical histories. The partner facility also reported they received positive feedback from staff participants and indicated they would like to continue this partnership.
Collapse
Affiliation(s)
- Kathy Robinson
- Kathy Robinson, DHSc, MPAS, PA-C, is an associate professor, Hardin-Simmons University Abilene, Texas
- Jenni Jamison, MS, MPAS, PA-C, is an assistant professor, Hardin-Simmons University, Abilene, Texas
| | - Jenni Jamison
- Kathy Robinson, DHSc, MPAS, PA-C, is an associate professor, Hardin-Simmons University Abilene, Texas
- Jenni Jamison, MS, MPAS, PA-C, is an assistant professor, Hardin-Simmons University, Abilene, Texas
| |
Collapse
|
3
|
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
|
4
|
Mpofu J, Sefotho MM. Challenges of competency-based curriculum in teaching learners with learning disabilities. Afr J Disabil 2024; 13:1268. [PMID: 38628957 PMCID: PMC11019064 DOI: 10.4102/ajod.v13i0.1268] [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: 06/14/2023] [Accepted: 12/19/2023] [Indexed: 04/19/2024] Open
Abstract
Background Zimbabwean government adopted competency-based curriculum in 2017 as a measure to prepare learners for life and work in an indigenised economy and increasingly globalised and competitive environment. The government also sought to ensure that learners develop skills necessary for lifelong learning in line with the emerging opportunities. Objectives The purpose of this study was to explore challenges faced by teachers in the implementation of competency-based curriculum to learners with learning disabilities in Mhangura of Makonde District in Zimbabwe. Methods A constructivist lived experience perspective underpinned this research, in which a single case study was used to interact with participants on challenges faced by teachers in the implementation of competency-based curriculum to learners with learning disabilities. Purposive sampling was used to select nine participants (five males and four females). Data were collected through face-to-face interviews and transcribed verbatim. Four themes emerged from the thematic analysis of data sources. Results Results indicated that participants were facing several challenges in implementing competency-based curriculum to learners with learning disabilities. Among the cited challenges were negative attitudes towards learners with learning disabilities, poor teacher preparation, lack of resources and poor collaboration. Conclusion The study concluded that the objectives of competency-based curriculum are noble to learners, but its implementation is not inclusive. Contribution The study findings will assist in identifying areas that need to be improved and need strengthening. The education policy makers in the country will have a better understanding of challenges faced by teachers in the implementation of competency-based curriculum in Zimbabwe.
Collapse
Affiliation(s)
- Jabulani Mpofu
- Department of Educational Psychology, Faculty of Education, University of Johannesburg, Johannesburg, South Africa
- Department of Disability Studies, Faculty of Applied Social Sciences, Zimbabwe Open University, Harare, Zimbabwe
| | - Maximus M. Sefotho
- Department of Educational Psychology, Faculty of Education, University of Johannesburg, Johannesburg, South Africa
- Division of Disability Studies, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
5
|
Tolchin DW, Ankam NS, Rydberg L. Twelve tips for including disability education in undergraduate medical education. MEDICAL TEACHER 2024:1-8. [PMID: 38386799 DOI: 10.1080/0142159x.2024.2317913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
Disability is a large and growing minority population worldwide. People with disabilities continue to experience health and healthcare disparities. Despite multiple calls to action to provide disability education within undergraduate medical education as a strategy to mitigate ongoing inequities, robust disability education is not routinely provided across medical schools. This article provides twelve tips that any medical school faculty can utilize to integrate meaningful disability education within existing core medical education.
Collapse
Affiliation(s)
- Dorothy W Tolchin
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spauling Rehabilitation Hospital, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, MassGeneral Brigham, Boston, Massachusetts, USA
| | - Nethra S Ankam
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Leslie Rydberg
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
6
|
Isaacson A, Coleman J, Fok K, Tolchin DW. Creating an anti-ableist learning environment: Development of a novel disability-related microaggressions session for medical and dental students and mixed methods analysis of impact on learning and empowerment. Disabil Health J 2024:101584. [PMID: 38272777 DOI: 10.1016/j.dhjo.2024.101584] [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: 10/05/2023] [Revised: 12/31/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Disability-related microaggressions are unique among microaggressions in the assumptions they reflect and the verbal and non-verbal forms they take. They impact patients and providers alike. Yet, medical and dental students are not routinely educated about disability-related microaggressions. A medical school student-faculty team harnessed Kern's six-step curriculum design process to co-produce a novel 90-min educational intervention centered on recognizing and responding to disability-related microaggressions. The session was piloted in February 2022 as a required element of the school's mandatory professional development training for first-year medical and dental students. OBJECTIVE This mixed-methods study examined session impact on student-reported learning pertinent to addressing and mitigating disability-related microaggressions. METHODS Voluntary surveys were distributed to all first-year students to capture pre-/post-session self-assessment of knowledge, skills, and comfort, as well as post-session reflection on lessons learned. Quantitative data was analyzed using summary statistics, unpaired t-tests, and Mann Whitney U tests; qualitative data was analyzed using a hybrid inductive-deductive approach. RESULTS Survey response rate was 61 % (100/164) pre-session and 25 % (41/164) post-session. Post-session, there was significantly increased student agreement with statements addressing microaggressions knowledge, comfort teaching others, and strategies to support disability-sensitive workplaces. Post-session narrative reflections revealed learning within five themes: nature of microaggressions, identifying microaggressions, preventing microaggressions, responding to microaggressions, and medical student empowerment. Ninety-three percent of post-session respondents (38/41) agreed the session empowered them to actively contribute to anti-ableist learning environments. CONCLUSIONS The pilot educational intervention provides a promising strategy to foster anti-ableism and advocacy among first-year medical/dental students. While limited by low response rate, small sample size, participant self-selection for survey participation, and unlinked individual pre- and post-session responses, mixed methods analysis suggests the session had a positive impact on student action-oriented knowledge and empowerment.
Collapse
Affiliation(s)
| | | | - King Fok
- Harvard Medical School, 25 Shattuck St, Boston, MA, USA 02115
| | - Dorothy W Tolchin
- Harvard Medical School, 25 Shattuck St, Boston, MA, USA 02115; Spaulding Rehabilitation Hospital, 300 First Ave., Charlestown, MA, USA 02129; Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA 02114.
| |
Collapse
|
7
|
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
|
8
|
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
|
9
|
May P, El-Mallakh RS. Historical Perspective Regarding Health Care of Adults with Neurodevelopmental Disorders. South Med J 2023; 116:964-966. [PMID: 38051172 DOI: 10.14423/smj.0000000000001629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
|
10
|
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
|
11
|
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
|
12
|
Seymour R, Scher C, Frasso R, Truong S, Ziring D, Ankam N. Exposing the disability-related hidden curriculum in case-based learning: A qualitative study. Disabil Health J 2023; 16:101483. [PMID: 37344272 DOI: 10.1016/j.dhjo.2023.101483] [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: 03/15/2023] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND People with disabilities face significant health disparities. Studies show that healthcare professionals harbor negative attitudes towards disability, compromising the quality of care. These attitudes, in unwritten, unofficial, and even unintended ways can be passed from providers to learners in the medical education setting. OBJECTIVE Using a Critical Disability Studies (CDS) paradigm, the authors uncovered the disability-related hidden curriculum within Case-Based Learning (CBL) and proposed guidelines for promoting a disability-conscious medical education that resists ableism. METHODS The study team conducted a qualitative analysis of all CBL cases from the pre-clerkship curriculum (n = 53) at Sidney Kimmel Medical College. The authors employed a directed content analysis approach to develop a codebook based on case examination, literature review, and CDS concepts. Two researchers coded all cases and assessed intercoder reliability. The results informed the development of an explanatory model. RESULTS Only four of 53 cases overtly mentioned disability, none of which defined disability according to CDS. Coding did not identify content challenging stereotypical views of disability. Additionally, two cases included content fueling negative attitudes of disability. CONCLUSION By inadequately addressing disability from a CDS perspective, harmful assumptions of disability may go unchallenged, driving a hidden curriculum within CBL. This phenomenon leaves medical students ill-prepared to care for people with disabilities and creates physicians ill-equipped to teach the next generation. Since many health professions utilize CBL to educate students, these cases provide an untapped opportunity to resist ableism and better prepare students to address the negative attitudes driving health disparities experienced by people with disabilities.
Collapse
Affiliation(s)
- Rory Seymour
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Carly Scher
- University College Dublin School of Medicine, Dublin, Ireland
| | - Rosemary Frasso
- College of Population Health at Thomas Jefferson University, Philadelphia, PA, USA; Asano-Gonnella Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Susan Truong
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Deborah Ziring
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Nethra Ankam
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
| |
Collapse
|
13
|
Adams EJ, Schroth S, Kaundinya T. Student-driven disability advocacy and education within the health professions: pilot survey results from a single-day virtual conference. JOURNAL OF COMMUNICATION IN HEALTHCARE 2023; 16:255-259. [PMID: 37140055 DOI: 10.1080/17538068.2023.2208836] [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: 05/05/2023]
Abstract
BACKGROUND Health professional programs can promote equitable healthcare delivery but few programs include disability in these efforts. Limited opportunities exist for health professional students to engage with disability education within the classroom or beyond. The Disability Advocacy Coalition in Medicine (DAC Med) is a national interprofessional student-led organization which hosted a virtual conference for health professional students in October 2021. We describe the impact of this single-day virtual conference on learning and the current state of disability education across health professional programs. METHODS This cross-sectional study utilized a 17-item post-conference survey. A 5-point Likert scale-based survey was distributed to conference registrants. Survey parameters included background in disability advocacy, curricular exposure to disability, and impact of the conference. RESULTS Twenty-four conference attendees completed the survey. Participants were enrolled in audiology, genetic counseling, medical, medical scientist, nursing, prosthetics and orthotics, public health, and 'other' health programs. Most participants (58.3%) reported not having a strong background in disability advocacy before the conference, with 26.1% indicating they learned about ableism in their program's curriculum. Almost all students (91.6%) attended the conference to learn how to be a better advocate for patients and peers with disabilities, and 95.8% reported that the conference provided this knowledge. Eighty-eight percent of participants agreed that they acquired additional resources to better care for patients with disabilities. CONCLUSIONS Few health professional students learn about disability in their curriculum. Single-day virtual, interactive conferences are effective in providing advocacy resources and empowering students to employ them.
Collapse
Affiliation(s)
- Elizabeth J Adams
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Samantha Schroth
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Trisha Kaundinya
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
14
|
Salinger MR, Feltz B, Chan SH, Gosline A, Davila C, Mitchell S, Iezzoni LI. Impairment and Disability Identity and Perceptions of Trust, Respect, and Fairness. JAMA HEALTH FORUM 2023; 4:e233180. [PMID: 37738065 PMCID: PMC10517379 DOI: 10.1001/jamahealthforum.2023.3180] [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: 04/12/2023] [Accepted: 07/27/2023] [Indexed: 09/23/2023] Open
Abstract
Importance Most studies use impaired functioning alone to specify populations with disabilities. However, some people with functional impairments do not identify as disabled. With functional status-based definitions, studies have shown disparate care quality for people with disabilities. Objective To examine whether impairment and disability identity have different associations with perceived health care experiences and explore factors associated with disability identification. Design, Setting, and Participants This cross-sectional study used a nationally representative survey of US adults conducted from April 20 through May 31, 2021, and analyzed between June 1 and August 31, 2022. Survey participants were 1822 English- or Spanish-speaking adults responding either online or via telephone. Exposures Using 8 survey questions, participants were grouped according to presence of impairment and disability identity. Main Outcomes and Measures Likert scale measures of trust, respect, and fairness (henceforth, procedural justice measures) were dichotomized. Sociodemographic characteristics and rates of procedural justice responses were compared across groups. Multivariable logistic regressions adjusting for baseline characteristics were performed to (1) estimate associations of impairment and disability identity with perceptions of procedural justice and (2) explore factors associated with disability identification. Analyses applied survey weights. Results Of 6126 individuals invited to participate, 1854 (30.3%) completed the survey. Thirty-two were excluded due to unreportable gender, for a final analytic sample of 1822 participants. Participants with impairments (n = 816; mean [SD] age, 48.1 [17.0] years; 51.2% women, 48.8% men) had worse perceptions on 7 of 10 procedural justice measures (crude) compared with those without impairments (n = 1006; mean [SD] age, 49.6 [18.1] years, 55.1% female, 44.9% male). Among respondents with impairments, those who did (n = 340) vs did not (n = 476) identify as disabled gave better ratings for clinician communication efforts (a lot of effort, 38.8% vs 31.0%) and having health goals understood (understood very or fairly well, 77.2% vs 70.1%) but gave worse ratings for respect (almost never felt inferior or talked down to, 66.1% vs 59.1%). Disability identification was associated with more reports of unfair treatment (31.0% vs 22.4%; adjusted odds ratio, 1.65; 95% CI, 1.12-2.42) and of being unafraid to ask questions or disagree (50.5% vs 40.1%; adjusted odds ratio, 1.51; 95% CI, 1.04-20.19). Income and employment were associated with disability identification. Conclusions and Relevance In this cross-sectional survey study of US adults, health care perceptions differed between groups defined by impairment status and disability identity. These findings suggest that, alongside functional measures, health systems should capture disability identity to better address disparities for people with impairments.
Collapse
Affiliation(s)
- Maggie R. Salinger
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Brian Feltz
- 3D Research Partners LLC, Harvard, Massachusetts
- Flowetik, Boston, Massachusetts
| | - Stephanie H. Chan
- Massachusetts Coalition for Serious Illness Care, Boston, Massachusetts
- Blue Cross Blue Shield of Massachusetts, Boston, Massachusetts
| | - Anna Gosline
- Massachusetts Coalition for Serious Illness Care, Boston, Massachusetts
- Blue Cross Blue Shield of Massachusetts, Boston, Massachusetts
| | - Carine Davila
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Suzanne Mitchell
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Lisa I. Iezzoni
- Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
15
|
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.
Collapse
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)
| | | | | |
Collapse
|
16
|
Ceravolo MG, Gimigliano F, Lains J. Editorial: Pursuing quality education in Physical and Rehabilitation Medicine. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1242522. [PMID: 37546580 PMCID: PMC10402734 DOI: 10.3389/fresc.2023.1242522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Maria Gabriella Ceravolo
- Department of Experimental and Clinical Medicine, Politecnica Delle Marche University, Ancona, Italy
| | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Jorge Lains
- Physical Medicine and Rehabilitation, Centro de Medicina de Reabilitação da Região Centro - Rovisco Pais, Tocha, Portugal
- Faculty of Medicine, University Coimbra, Coimbra, Portugal
| |
Collapse
|
17
|
Ali A, Nguyen J, Dennett L, Goez H, Rashid M. A scoping review for designing a disability curriculum and its impact for medical students. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:75-86. [PMID: 37465749 PMCID: PMC10351622 DOI: 10.36834/cmej.74411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Background There is an increasing need for a standardized undergraduate disability curriculum for medical students to better equip students with the proper training, knowledge, and skills to provide holistic care for individuals with disabilities. Objectives The aim of this scoping review was to better understand and analyze the current body of literature focusing on best practice for including disability curricula and its impact on undergraduate medical students. Results Three major components for designing a disability curriculum for undergraduate medical students were obtained from our analysis. The components were: (1) effective teaching strategies, (2) competencies required for disability curriculum, and (3) impact of disability curriculum on medical students. Conclusions Current literature revealed that exposing medical students to a disability curriculum impacted their overall perceptions about people with disabilities. This allowed them to develop a sense of understanding towards patients with disabilities during their clinical encounters. The effectiveness of a disability curriculum is dependent on the extent to which these interventions are incorporated into undergraduate medical education.
Collapse
Affiliation(s)
- Abdinasir Ali
- Faculty of science, University of Alberta, Alberta, Canada
| | - Julie Nguyen
- Department of Paediatrics, University of Alberta, Alberta, Canada
| | - Liz Dennett
- Scott Health Sciences Library, University of Alberta, Alberta, Canada
| | - Helly Goez
- Department of Pediatrics, University of Ottawa
| | | |
Collapse
|
18
|
Hotez E, Rava J, Russ S, Ware A, Halfon N. Using a life course health development framework to combat stigma-related health disparities for individuals with intellectual and/or developmental disability (I/DD). Curr Probl Pediatr Adolesc Health Care 2023; 53:101433. [PMID: 37867057 DOI: 10.1016/j.cppeds.2023.101433] [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: 10/24/2023]
Abstract
In the U.S., 1 in 6 children has an intellectual and/or developmental disability (I/DD). This population experiences a multitude of negative health outcomes across the life course, relative to the general population. Stigma-the social devaluation of individuals with certain characteristics, identities, or statuses within interpersonal, educational, healthcare, and policy contexts-is a potentially preventable contributor to health disparities. To date, existing approaches for addressing and preventing stigma are limited to discrete and siloed interventions that often fail to address the lifelong, cumulative impacts of the specific types of stigma experienced by the I/DD population. In the current paper, we describe three elements of Life Course Health Development (LCHD)-a novel translational framework that draws on evidence from biology, sociology, epidemiology, and psychology-that healthcare providers can use to prevent stigma-related health disparities and improve outcomes for individuals with I//DDs. We discuss the utility of targeting prevention to sensitive periods; prioritizing interventions for the most damaging types of stigmas; and leveraging supports from multiple service systems and sectors. By incorporating evidence from life course science into efforts to address stigma-related health disparities, providers can more effectively and strategically prevent and combat stigma-related health disparities for the I/DD population in childhood and across the life course.
Collapse
Affiliation(s)
- Emily Hotez
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, 911 Broxton Ave, Los Angeles, CA, 90095, United States; University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States.
| | - Julianna Rava
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, 911 Broxton Ave, Los Angeles, CA, 90095, United States; University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States
| | - Shirley Russ
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, 911 Broxton Ave, Los Angeles, CA, 90095, United States; University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States
| | - Allysa Ware
- Family Voices, 110 Hartwell Avenue, Lexington, MA, 02421, United States
| | - Neal Halfon
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, United States; Department of Public Policy, UCLA Luskin School of Public Affairs, Los Angeles, CA, United States
| |
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
|
Going Virtual: A Virtual Summer Physical Medicine and Rehabilitation Externship Experience for Medical Students. Am J Phys Med Rehabil 2023; 102:71-74. [PMID: 36228184 DOI: 10.1097/phm.0000000000002109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
ABSTRACT Opportunities for early medical student exposure to the field of physical medicine and rehabilitation (PM&R) are desirable for promoting the field as a career choice and are useful for introducing students to the care of people with disabilities. The COVID-19 pandemic disrupted medical education and caused the cancellation of many in-person clinical programs, including the Medical Student Summer Clinical Externship in PM&R supported by the Association of Academic Physiatrists. This article describes the process by which an in-person summer clinical externship program was effectively converted into a Virtual PM&R Experience using a combination of independent assignments and small-group sessions. A total of 87 medical students completed the Virtual PM&R Experience over two summers. The participants of the program met the program learning objectives, including enhancing their understanding of physiatry as a career and recognizing the medical and social issues that affect persons with disability.
Collapse
|
21
|
Ankam NS, Seymour R, Scher C, Truong S, Ziring D, Frasso R. Exploring How Case-Based Learning Addresses Disability. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:S152. [PMID: 37838884 DOI: 10.1097/acm.0000000000004824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Nethra S Ankam
- Author affiliations: N.S. Ankam, R. Seymour, S. Truong, D. Ziring, Sidney Kimmel Medical College at Thomas Jefferson University; C. Scher, University College Dublin, School of Medicine; R. Frasso, College of Population Health at Thomas Jefferson University
| | | | | | | | | | | |
Collapse
|
22
|
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
|
23
|
Guo MZ, Allen J, Sakumoto M, Pahwa A, Santhosh L. Reimagining Undergraduate Medical Education in a Post-COVID-19 Landscape. J Gen Intern Med 2022; 37:2297-2301. [PMID: 35710661 PMCID: PMC9202962 DOI: 10.1007/s11606-022-07503-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 03/23/2022] [Indexed: 12/01/2022]
Abstract
Online education due to the COVID-19 pandemic caused many medical schools to increasingly employ asynchronous and virtual learning that favored student independence and flexibility. At the same time, the COVID-19 pandemic highlighted existing shortcomings of the healthcare field in providing for marginalized and underserved communities. This perspective piece details the authors' opinions as medical students and medical educators on how to leverage the aspects of pandemic medical education to train physicians who can better address these needs.
Collapse
Affiliation(s)
- Matthew Z Guo
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jawara Allen
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Matthew Sakumoto
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Amit Pahwa
- Department of Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lekshmi Santhosh
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA.
| |
Collapse
|
24
|
Kim S, Fry A, Kim DH, Kezar LB. Retrospective Study on the Effect of the Timing of Exposure on Confidence Level in Applying to Physical Medicine and Rehabilitation Residency Programs. Am J Phys Med Rehabil 2022; 101:S51-S56. [PMID: 33990487 DOI: 10.1097/phm.0000000000001786] [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: 11/25/2022]
Abstract
ABSTRACT Residency specialty choice, a complex decision-making process, is often influenced by confidence level built upon knowledge, experience, and fit with the specialty. Despite the need for physiatrists with population growth, especially people with disability and older patients, limited growth in the number of residency positions and delayed exposure to the field of physical medicine and rehabilitation potentially contribute to a lack of confidence in pursuing physical medicine and rehabilitation. Early introduction to a specialty has been shown to impact specialty selection. Thus, this study aims to explore the impact of timing of exposure to physiatry on the confidence level of physical medicine and rehabilitation residents in their specialty choice. A survey for current physical medicine and rehabilitation residents was developed and distributed to residency program directors with a request to forward it to all residents. The response rate was low at 13%; however, the results provide a window into the experience of today's medical and premedical students. Interestingly, of the 175 respondents, a similar number reported first exposure to physiatry during third year and before medical school. In addition, earlier exposure was associated with higher confidence levels in specialty choice, the most powerful factor being the exposure to the specialty before starting medical school or during the preclinical years in medical school. These findings highlight opportunities to improve the physiatry workforce by providing earlier exposure to the specialty, even before medical school. Based on the results of the survey and ongoing discussions among medical students, residents, and faculty leaders, the authors review current recruitment efforts and new ideas.
Collapse
Affiliation(s)
- Soojin Kim
- From the Utah Healthcare Institute/St. Mark's Family Medicine Residency Program, Millcreek, Utah (SK); Beaumont Health PM&R Residency Program, Taylor, Michigan (AF); Department of Health Care Administration, Idaho State University College of Business, Pocatello, Idaho (DHK); and Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama (LBK)
| | | | | | | |
Collapse
|
25
|
Grewal H, Kim S, Katz NB, Case CM, Pingenot E, Chung YK, Chukwuma V, Mayer RS. Evaluation of the Association of Academic Physiatrists Medical Student Summer Clinical Externship. Am J Phys Med Rehabil 2022; 101:693-697. [PMID: 35034055 DOI: 10.1097/phm.0000000000001948] [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: 11/27/2022]
Abstract
ABSTRACT The Medical Student Summer Clinical Externship is an 8-wk program hosted by the Association of Academic Physiatrists and offered to first year medical students. Various institutions sponsor participants and provide clinical exposure and mentorship opportunities to promote interest in the field. The program has had more than 100 medical student participants. Students were asked to complete a preparticipation and postparticipation survey. Results revealed a statistically significant increase in interest in physiatry and participants' scores for comfort and experience level in obtaining a history of present illness, general physical examination, and managing developmental, musculoskeletal, and neurologic disabilities. The Medical Student Summer Clinical Externship program provides an opportunity for mentorship and exposure to various subspecialties that likely reinforces student interest in those who are predisposed to physiatry. Students' increased comfort level in treating patients with developmental, musculoskeletal, and neurologic disabilities may lead to improvements in the quality of and access to care received by these populations. All participants gain an increased awareness of the scope of practice of physiatry that will hopefully lead to the increased integration of physical medicine and rehabilitation into the care plans and as a standard of care for patients who might greatly benefit.
Collapse
Affiliation(s)
- Harmandeep Grewal
- From the Kaweah Health, Visalia, California (HG); St Mark's Hospital, Salt Lake City, Utah (SK); Department of Internal Medicine, Mount Auburn Hospital, Cambridge, Massachusetts (NBK); Creighton University School of Medicine, Omaha, Nebraska (CMC); Kansas City University of Medicine and Biosciences College of Osteopathic Medicine, Kansas City, Missouri (EP); State University of New York Upstate Medical University, Syracuse, New York (YKC); Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee (VC); and Johns Hopkins University School of Medicine, Baltimore, Maryland (RSM)
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Comparative effects of disability education on attitudes, knowledge and skills of baccalaureate nursing students. Nurse Educ Pract 2022; 61:103330. [DOI: 10.1016/j.nepr.2022.103330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 02/03/2022] [Accepted: 03/09/2022] [Indexed: 11/22/2022]
|
27
|
Evaluation of Disability Education and Emergency Preparedness Curricula of Physician Assistant Programs. Disaster Med Public Health Prep 2022; 17:e122. [PMID: 35416144 DOI: 10.1017/dmp.2022.31] [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] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this pilot study was to evaluate whether physician assistant (PA) programs in the Midwest integrate both disabilities and emergency preparedness education into 1 curriculum. METHODS A convenience sample was utilized to survey program directors and deans of PA programs. Emails were obtained from the Physician Assistant Education Association. A 26, closed-ended question Qualtrics survey was based on an original study by Tanenhaus et al. RESULTS Out of 43 accredited physician assistant programs surveyed, 9 programs replied (21%), and 1 program did not complete the survey. Six of the 10 programs (66%) responded that their program provided lectures specific to emergency preparedness. All 9 programs responded they do not offer a graduate-level track or concentration in emergency/disaster preparedness, and they do not offer a dual degree or a multidisciplinary program that highlights emergency/disaster preparedness. CONCLUSIONS This study was conducted to bring awareness to physician assistant students' education regarding disabilities and emergency preparedness. As public health crises continue to arise, such as coronavirus disease (COVID-19), it is critical to have appropriately trained health care professionals. The study revealed that most programs lack a graduate-level track or concentrations, dual degrees, or extracurricular opportunities related to disabilities and emergency and disaster preparedness.
Collapse
|
28
|
Golden RN, Petty EM. Learners With Disabilities: An Important Component of Diversity, Equity, and Inclusion in Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:328-330. [PMID: 34732654 DOI: 10.1097/acm.0000000000004496] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The population of people with physical or sensory disabilities is growing, yet they are underrepresented in the medical and other health professions. At the same time, there is a clear need to enhance didactic curricular content and clinical training experiences that explicitly address the full scope of medical needs that individuals with disabilities have. These gaps represent missed opportunities to advance the health of an important, underserved, and growing population. Based on the authors' experience, the inclusion of people with physical or sensory disabilities in medical education greatly enhances the education of all learners and the professional development of faculty and staff, providing invaluable perspectives on the significant abilities of individuals with diverse physical or sensory disabilities. There are additional efforts and costs associated with the education of a medical student who is blind, is deaf, uses a wheelchair, or has another disability. But based on the authors' experience, it is clear that the societal return on investment is enormous, and the costs associated with a failure to embrace full inclusivity are much greater. Medical education institutions should recognize the population of people with disabilities as a vital component of their commitment to diversity, equity, and inclusion and strive to provide inclusive education for learners with disabilities.
Collapse
Affiliation(s)
- Robert N Golden
- R.N. Golden is dean, School of Medicine and Public Health, and vice chancellor for medical affairs, University of Wisconsin-Madison, Madison, Wisconsin
| | - Elizabeth M Petty
- E.M. Petty is senior associate dean for academic affairs, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| |
Collapse
|
29
|
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]
|
30
|
Rotenberg S, Gatta DR, Wahedi A, Loo R, McFadden E, Ryan S. Disability Training for Health Workers: A Global Evidence Synthesis. Disabil Health J 2022; 15:101260. [DOI: 10.1016/j.dhjo.2021.101260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/16/2021] [Accepted: 12/03/2021] [Indexed: 11/03/2022]
|
31
|
Bosques G, Ankam NS, Kasi R, Rydberg L, Sauter C, Therattil M, Tolchin DW. Now Is the Time: A Primer on How to Be a Disability Education Champion in Your Medical School. Am J Phys Med Rehabil 2022; 101:89-96. [PMID: 33496438 DOI: 10.1097/phm.0000000000001703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT One in four noninstitutionalized adults in the United States lives with a disability. People with disabilities have frequent interactions with the medical community and the healthcare system yet experience disparities in access and outcomes. The Association of American Medical Colleges has included disability in its definition of diversity as one of the aspects of patient care that may affect health equity. However, training in the lived experience of disability is not always included in medical education. Physiatrists make excellent disability champions in medical schools, given their training and experience in the care of individuals with disabilities. Here, we describe strategies for physiatrists to increase disability education in medical schools and an overview of standards and tools (Liaison Committee on Medical Education standards; Commission on Osteopathic College Accreditation standards; International Classification of Functioning, Disability and Health language; and the Core Competencies on Disability for Health Care Education published by the Alliance for Disability in Health Care Education) physiatrists can use to facilitate interactions with medical school educational leadership. Specific examples are provided along with a framework to guide the development of disability champions in medical schools.
Collapse
Affiliation(s)
- Glendaliz Bosques
- From the Department of Physical Medicine and Rehabilitation, McGovern Medical School at University of Texas Health Sciences Center at Houston, Shriners Hospital for Children in Houston, TIRR Memorial Hermann Hospital, Houston, Texas (GB); Department of Rehabilitation Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania (NSA); Rush Medical College at Rush University Medical Center, Chicago, Illinois (RK); Northwestern University Feinberg School of Medicine and Shirley Ryan Ability Lab, Chicago, Illinois (LR); Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin (CS); Drexel University College of Medicine, Philadelphia, Pennsylvania (MT); and Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Boston, Massachusetts (DWT)
| | | | | | | | | | | | | |
Collapse
|
32
|
Chardavoyne PC, Henry AM, Forté KS. Understanding Medical Students' Attitudes Towards and Experiences with Persons with Disabilities and Disability Education. Disabil Health J 2022; 15:101267. [DOI: 10.1016/j.dhjo.2021.101267] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 12/07/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022]
|
33
|
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
|
34
|
Edwards AP. Cocurricular Clinical Opportunity: Addressing Student Attitudes, Knowledge, and Skills With Disability Education. J Nurs Educ 2021; 60:637-641. [PMID: 34723735 DOI: 10.3928/01484834-20210913-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Multiple organizations have urged inclusion of disability content in health care professional's education and training. Few nursing schools in the United States have adopted dedicated disability curricula nor studied its impact on attitudes, knowledge, and skills of disability education. Evidence suggests that inadequate education contributes to health care disparities and unmet needs of people with disabilities. METHOD A 2-hour cocurricular clinical experience was developed, using established competencies, and offered to senior nursing students. Students participated in multimodal experiences, with an emphasis on clinical exposure in various facilities serving children and adults with disabilities. RESULTS Five cohorts of students (N = 34) participated in the fellowship. Data illustrate the strong need to continue and require the curricula. CONCLUSION Faculty should develop disability education secondary to population prevalence and in accordance with the American Association of Colleges of Nursing's essential competencies. [J Nurs Educ. 2021;60(11):637-641.].
Collapse
|
35
|
Annaswamy TM, Chandan P, Houtrow AJ. Health care for people with disabilities: Need for systemic change. PM R 2021; 13:1193-1195. [PMID: 34029454 DOI: 10.1002/pmrj.12647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Thiru M Annaswamy
- Department of PM&R, UT Southwestern Medical Center, PM&R Service, VA North Texas Health Care System, Dallas, Texas, USA
| | - Priya Chandan
- Division of Physical Medicine & Rehabilitation, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Amy J Houtrow
- Division of Pediatric Rehab Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
36
|
Sapp RW, Sebok-Syer SS, Gisondi MA, Rotoli JM, Backster A, McClure Poffenberger C. The Prevalence of Disability Health Training and Residents With Disabilities in Emergency Medicine Residency Programs. AEM EDUCATION AND TRAINING 2021; 5:e10511. [PMID: 33898914 PMCID: PMC8053000 DOI: 10.1002/aet2.10511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 05/17/2023]
Abstract
OBJECTIVES Individuals with disabilities experience significant health care disparities due to a multitude of barriers to effective care, which include a lack of adequate physician training on this topic and negative attitudes of physicians. This results in disparities through inadequate physical examination and diagnostic testing, withholding or inferior treatment, and neglecting preventative care. While much has been published about disability education in undergraduate medical education, little is known about the current state of disability education in emergency medicine (EM) residency programs. METHODS In 2019, a total of 237 EM residency program directors (PDs) in the United States were surveyed about the actual and desired number of hours of disability health instruction, perceived barriers to disability health education, prevalence of residents and faculty with disabilities, and confidence in providing accommodations to residents with disabilities. RESULTS A total of 104 surveys were completed (104/237, 43.9% response rate); 43% of respondents included disability-specific content in their residency curricula for an average of 1.5 total hours annually, in contrast to average desired hours of 4.16 hours. Reported barriers to disability health education included lack of time and lack of faculty expertise. A minority of residency programs have faculty members (13.5%) or residents (26%) with disabilities. The prevalence of EM residents with disabilities was 4.02%. Programs with residents with disabilities reported more hours devoted to disability curricula (5 hours vs 1.54 hours, p = 0.017) and increased confidence in providing workplace accommodations for certain disabilities including mobility disability (p = 0.002), chronic health conditions (p = 0.022), and psychological disabilities (p = 0.018). CONCLUSIONS A minority of EM PDs in our study included disability health content in their residency curricula. The presence of faculty and residents with disabilities is associated with positive effects on training programs, including a greater number of hours devoted to disability health education and greater confidence in accommodating learners with disabilities. To reduce health care disparities for patients with disabilities, we recommend that a dedicated disability health curriculum be integrated into all aspects of the EM residency curriculum, including lectures, journal clubs, and simulations and include direct interaction with individuals with disabilities. We further recommend that disability be recognized as an aspect of diversity when hiring faculty and recruiting residents to EM programs, to address this training gap and to promote a diverse and inclusive learning environment.
Collapse
Affiliation(s)
| | - Stefanie S Sebok-Syer
- Department of Emergency Medicine Stanford University School of Medicine Stanford CA USA
| | - Michael A Gisondi
- Department of Emergency Medicine Stanford University School of Medicine Stanford CA USA
| | - Jason M Rotoli
- Department of Emergency Medicine University of Rochester Medical Center Rochester NY USA
| | - Anika Backster
- Department of Emergency Medicine Emergency Neurosciences Emory University Atlanta GA USA
| | | |
Collapse
|
37
|
Scholten I, Barradell S, Bickford J, Moran M. Twelve tips for teaching the International Classification of Functioning, Disability and Health with a view to enhancing a biopsychosocial approach to care. MEDICAL TEACHER 2021; 43:293-299. [PMID: 32645280 DOI: 10.1080/0142159x.2020.1789082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The World Health Organization International Classification of Functioning, Disability and Health has the power to shape professional behaviour and positively influence all aspects of health and social care practice. The visual depiction of the ICF framework belies the complexity of this multifaceted classification and coding system which students and practitioners can find challenging to grasp. This guide offers twelve integrated practical tips to help health and social care educators embed the ICF throughout the curriculum with a view to supporting student learning and ultimately interprofessional and inclusive practice.
Collapse
Affiliation(s)
| | - Sarah Barradell
- Department of Health Professions, Swinburne University of Technology, Hawthorn, Australia
| | - Jane Bickford
- Speech Pathology, Flinders University, Adelaide, Australia
| | - Monica Moran
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, Australia
- Occupational Therapy, Central Queensland University, Rockhampton, Australia
| |
Collapse
|
38
|
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
|
39
|
Bosques G, Philip K, Francisco GE. Integration of Chronic Disability Management in a Medical Student Curriculum. Am J Phys Med Rehabil 2021; 100:S30-S33. [PMID: 32932360 DOI: 10.1097/phm.0000000000001590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Increasing exposure to the needs of patients with chronic disability is important in fostering confidence and comfort in disability knowledge and management among medical students and residents of all disciplines. The 2013 Association of American Medical Colleges Graduation Survey of graduating medical students revealed that 33% expressed inadequate exposure to disability management and rehabilitative care. To address this, a 3- to 4-wk rehabilitation elective course was modified to include lectures, media-based reflections, and a hands-on wheelchair experience. Responses and reflections from students from November 2015 to February 2019 were analyzed to assess the impact of the intervention on medical student knowledge and clinical practice using a disability pretest and posttest design. Preintervention data revealed limited knowledge of terminology in disability health that improved greatly in the postelective assessment. Medical students also gained knowledge on disability laws, available resources, and improved identification of appropriate accommodations to limit barriers to care. Moreover, this novel, interdisciplinary rehabilitation elective experience increased medical student knowledge and exposure of disability management. Incorporating these changes into the medical school curriculum will be invaluable in training future physicians to close the gap in access to care for persons with disabilities.
Collapse
Affiliation(s)
- Glendaliz Bosques
- From the Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center (UTHealth) McGovern Medical School, Houston, Texas (GB, KP, GEF); Pediatric Rehabilitation Program, Shriners Hospital for Children, Houston, Texas (GB); Pediatric Rehabilitation Medicine, TIRR Memorial Hermann Hospital, Houston, Texas (GB); Pediatric Rehabilitation Program, Children's Memorial Hermann Hospital, Houston, Texas (GB); and NeuroRecovery Research Center, TIRR Memorial Hermann, Houston, Texas (GEF)
| | | | | |
Collapse
|
40
|
Nassim JS, Watson AJ, Tan JK. Achieving Equitable Care for People With Disabilities. JAMA Dermatol 2020; 156:1173-1175. [DOI: 10.1001/jamadermatol.2020.3955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Janelle S. Nassim
- Harvard Medical School, Boston, Massachusetts
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Dermatology, Massachusetts General Hospital, Boston
| | - Alice J. Watson
- Harvard Medical School, Boston, Massachusetts
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jennifer K. Tan
- Harvard Medical School, Boston, Massachusetts
- Department of Dermatology, Massachusetts General Hospital, Boston
- Boston Health Care for the Homeless Program, Boston, Massachusetts
| |
Collapse
|
41
|
Stillman MD, Ankam N, Mallow M, Capron M, Williams S. A survey of internal and family medicine residents: Assessment of disability-specific education and knowledge. Disabil Health J 2020; 14:101011. [PMID: 33041247 DOI: 10.1016/j.dhjo.2020.101011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/24/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The literature suggests that primary care physicians are inadequately educated in the care of people with disabilities. No study to date has evaluated whether internal medicine (IM) and family medicine (FM) residents have received disability-specific education or their level of comfort in caring for people with physical disabilities. OBJECTIVES To assess IM and FM residents' receipt of disability-specific education during medical school and residency; to evaluate their self-reported comfort in managing secondary conditions associated with physical disabilities and in coordinating therapies and services for individuals with disabilities; to gauge their interest in receiving disability-specific education. METHODS An on-line survey distributed to residents at a convenience sample of ten academic IM and FM residency programs in the northeastern United States. Participants (n = 176) were asked about their socio-demographic and training-specific characteristics and their self-assessed ability to manage secondary conditions associated with physical disabilities and coordinate care and services for individuals with disabilities. Chi Square tests were used to compare participant characteristics and outcomes. RESULTS Few participants had received disability-specific education during medical school or residency (34.6% and 11.2%, respectively), and nearly all (96.0%) expressed interest in receiving more. Small minorities reported feeling comfortable managing common secondary conditions or in coordinating therapies and services for individuals with disabilities. CONCLUSION Although one-fifth of adult Americans have a disability, few of our participating IM and FM residents had received disability-specific education or felt comfortable managing the care of people living with disabilities. Our results indicate a need to develop and disseminate disability-specific curricula.
Collapse
Affiliation(s)
- Michael D Stillman
- Department of Internal Medicine, Sidney Kimmel Medical College, 1100 Walnut Street, Suite 601, Philadelphia, PA, 19107, USA; Department of Rehabilitation Medicine, Sidney Kimmel Medical College, 25 South 9th Street, Philadelphia, PA, 19107, USA.
| | - Nethra Ankam
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, 25 South 9th Street, Philadelphia, PA, 19107, USA.
| | - Michael Mallow
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, 25 South 9th Street, Philadelphia, PA, 19107, USA.
| | - Maclain Capron
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, 25 South 9th Street, Philadelphia, PA, 19107, USA.
| | - Steve Williams
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, 25 South 9th Street, Philadelphia, PA, 19107, USA.
| |
Collapse
|
42
|
Rotoli J, Backster A, Sapp RW, Austin ZA, Francois C, Gurditta K, Mirus C, McClure Poffenberger C. Emergency Medicine Resident Education on Caring for Patients With Disabilities: A Call to Action. AEM EDUCATION AND TRAINING 2020; 4:450-462. [PMID: 33150294 PMCID: PMC7592824 DOI: 10.1002/aet2.10453] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 05/07/2023]
Abstract
People with disabilities constitute a marginalized population who experience significant health care disparities resulting from structural, socioeconomic, and attitudinal barriers to accessing health care. It has been reported that education on the care of marginalized groups helps to improve awareness, patient-provider rapport, and patient satisfaction. Yet, emergency medicine (EM) residency education on care for people with disabilities may be lacking. The goal of this paper is to review the current state of health care for patients with disabilities, review the current state of undergraduate and graduate medical education on the care of patients with disabilities, and provide suggestions for an improved EM residency curriculum that includes education on the care for patients with disabilities.
Collapse
|
43
|
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: 35] [Impact Index Per Article: 8.8] [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.
Collapse
|
44
|
Blauwet CA, Brashler R, Kirschner KL, Mukherjee D. Vulnerability, Interdependence, and Trust in the COVID-19 Pandemic. PM R 2020; 12:1038-1044. [PMID: 32888396 DOI: 10.1002/pmrj.12480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Cheri A Blauwet
- Department of Physical Medicine & Rehabilitation, Kelley Spaulding Rehabilitation Hospital and Harvard Medical SchoolAdaptive Sports Research Institute, Spaulding Rehabilitation Network, Boston, MA, USA
| | - Rebecca Brashler
- Assistant Professor of PM&R at Northwestern University Feinberg School of Medicine Clinical Bioethicist and Director of Global Patient Service at Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Kristi L Kirschner
- Departments of Medical Education and Neurology and Rehabilitation, University of Illinois College of Medicine and University of Illinois at Chicago, Chicago, IL, USA
| | - Debjani Mukherjee
- Division of Medical Ethics, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
45
|
Ronen GM, Kraus de Camargo O, Rosenbaum PL. How Can We Create Osler's "Great Physician"? Fundamentals for Physicians' Competency in the Twenty-first Century. MEDICAL SCIENCE EDUCATOR 2020; 30:1279-1284. [PMID: 34457790 PMCID: PMC8368653 DOI: 10.1007/s40670-020-01003-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Gabriel M. Ronen
- Faculty of Health Sciences, Department of Pediatrics, McMaster University, HSC Rm. 3A58, 1200 Main Street West, Hamilton, Ontario L8S 4K1 Canada
- CanChild Centre for Childhood Disability Research, Hamilton, Canada
| | - Olaf Kraus de Camargo
- Faculty of Health Sciences, Department of Pediatrics, McMaster University, HSC Rm. 3A58, 1200 Main Street West, Hamilton, Ontario L8S 4K1 Canada
- CanChild Centre for Childhood Disability Research, Hamilton, Canada
- Ron Joyce Children’s Health Centre, Hamilton, Canada
| | - Peter L. Rosenbaum
- Faculty of Health Sciences, Department of Pediatrics, McMaster University, HSC Rm. 3A58, 1200 Main Street West, Hamilton, Ontario L8S 4K1 Canada
- CanChild Centre for Childhood Disability Research, Hamilton, Canada
| |
Collapse
|
46
|
Peiris-John R, Jain NR, Hogan A, Ameratunga S. Educating health science students about disability: Teachers' perspectives on curricular gaps. Disabil Health J 2020; 14:100985. [PMID: 32878740 DOI: 10.1016/j.dhjo.2020.100985] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 07/30/2020] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND People living with disabilities are significantly more likely than their peers to find health professionals' skills and facilities inadequate. The 66th World Health Assembly called for better health care for people with disabilities including more inclusive health services and a stronger focus on professional training. OBJECTIVE To explore how teachers at a New Zealand university perceived the need, approaches, and systemic challenges to enhance disability education for health professionals in training. METHODS Qualitative analysis of interviews with 11 key informants teaching in population health, medicine, nursing, pharmacy, and optometry training programmes. Transcribed interview recordings were analysed using a general inductive approach. RESULTS The participants described a range of teaching approaches that they used to increase disability awareness among their students. However, these were largely ad hoc individually driven initiatives reflecting personal interests. Participants identified a critical need to develop and implement a systematic, integrated approach to enhance disability education particularly from a social justice perspective among students in health disciplines. Engaging people with lived experience of disability in teaching and course design, and senior administrative commitment were identified as necessary to address current gaps in education. CONCLUSIONS In order to develop a health professional workforce competent to respond to the needs of people with disabilities, greater attention is required at a strategic level to enhance the profile of disability education in health curricula. Meaningful engagement of people with disability and senior leadership commitment are critical components that can enable effective progression of this agenda.
Collapse
Affiliation(s)
| | - Neera R Jain
- Faculty of Education and Social Work, University of Auckland, New Zealand
| | - Amy Hogan
- Faculty of Medical & Health Sciences, University of Auckland, New Zealand
| | - Shanthi Ameratunga
- Faculty of Medical & Health Sciences, University of Auckland, New Zealand; Counties Manukau Health - Population Health Directorate, South Auckland, New Zealand
| |
Collapse
|
47
|
Bowen CN, Havercamp SM, Karpiak Bowen S, Nye G. A call to action: Preparing a disability-competent health care workforce. Disabil Health J 2020; 13:100941. [PMID: 32467076 DOI: 10.1016/j.dhjo.2020.100941] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/22/2020] [Accepted: 05/09/2020] [Indexed: 11/27/2022]
Abstract
People with disabilities make up the largest minority population in the country, yet our health care workforce is unprepared to meet their needs. Two initiatives - and the Alliance for Disability in Health Care Education's Disability Competencies and the Resources for Integrated Care Disability-Competent Care model-provide essential tools to build a health care workforce prepared to meet the health needs of people with disabilities. We note gaps in health education and continuing education curricula, document barriers to progress, and demonstrate how the two initiatives offer a clear roadmap to effect systemic change. Finally, we issue a call to action for health care education, practice, and research to ensure a health care workforce prepared to provide quality health care to people with disabilities.
Collapse
Affiliation(s)
| | - Susan M Havercamp
- Ohio State University Nisonger Center, 1581 Dodd Drive, Columbus, OH, 43210, USA.
| | - Sonya Karpiak Bowen
- Medicare-Medicaid Coordination Office, Centers for Medicare & Medicaid Services, USA
| | - Gretchen Nye
- Medicare-Medicaid Coordination Office, Centers for Medicare & Medicaid Services, USA
| |
Collapse
|
48
|
Doebrich A, Quirici M, Lunsford C. COVID-19 and the need for disability conscious medical education, training, and practice. J Pediatr Rehabil Med 2020; 13:393-404. [PMID: 33252100 DOI: 10.3233/prm-200763] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The COVID-19 era exposes what was already a crisis in the medical profession: structural racism, ageism, sexism, classism, and ableism resulting in healthcare disparities for Persons with Disabilities (PWD). Early research highlights these disparities, but we do not yet know the full impact of this pandemic on PWD. Over the last 20 years, many medical schools have attempted to develop disability competency trainings, but discrimination and inequities remain, resulting in a pervasive distrust of medicine by the disability community at large. In this commentary, we suggest that disability competency is insufficient because the healthcare disparities experienced by PWD are not simply a matter of individual biases, but structural and systemic factors requiring a culture shift in the healthcare professions. Recognizing that disability is a form of diversity that is experienced alongside other systemic disadvantages like social class, race, age, sex, gender identity, and geographic location, we explore the transformative potential of disability conscious medical education, training, and practice that draws on insights from intersectional disability justice activism. Disability conscious medicine is a novel approach, which improves upon competency programs by utilizing disability studies and the principles of disability justice to guide us in the critique of norms, traditions, and institutions to more fully promote the respect, beneficence, and justice that patients deserve.
Collapse
Affiliation(s)
- Adrienne Doebrich
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Marion Quirici
- Thompson Writing Program, Duke University, Durham, NC, USA
| | - Christopher Lunsford
- Pediatric Rehabilitation Medicine, Department of Orthopaedics and Department of Pediatrics, Duke University, Durham, NC, USA
| |
Collapse
|