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Sanders JS, Williams K, Thompson D, Shapiro HF. Enhancing comfort of resident physicians treating adults with intellectual and developmental disabilities by facilitating meaningful interactions. Front Med (Lausanne) 2024; 11:1264958. [PMID: 38835795 PMCID: PMC11148428 DOI: 10.3389/fmed.2024.1264958] [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: 08/18/2023] [Accepted: 03/25/2024] [Indexed: 06/06/2024] Open
Abstract
Background Many physicians feel uncomfortable caring for patients with intellectual and developmental disabilities (IDD). While some residency training programs include lecture content on IDD, few provide structured experiences with individuals with IDD. One strategy for improving comfort is "contact theory:" increasing interactions with "dissimilar" people can lead to decreased negative attitudes toward that population. Objective Evaluate the impact of an interactive session on resident physicians' comfort with adults with IDD. Methods Small groups of resident physicians and artists with IDD collaborated on art projects during the noon conference. A prospective pre-post-intervention survey, including the validated Interaction with Disabled Persons Scale (IDP), evaluated residents' comfort with patients with IDD before and after the session. Results 53 residents completed both pre- and post-conference surveys. Mean IDP scores decreased from 78.7 (10.9) to 75.8 (9.5; p < 0.01), indicating decreasing discomfort. The mean level of comfort interacting with individuals with IDD increased from uncomfortable 3.6 (1.2), before the intervention, to comfortable 4.4 (1.2) after the intervention (p = <0.01). The mean level of comfort treating individuals with IDD increased from uncomfortable 3.5 (1.1) to comfortable 4.1 (1.3) after the intervention (p < 0.01). Discussion Providing resident physicians with real-life connections with people with IDD was associated with increased comfort. If statistically significant improvements occurred after one session, future studies should evaluate if additional experiences with people with IDD could have more substantial, lasting impacts on future doctors' comfort with and willingness to care for patients with IDD.
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Affiliation(s)
- Jessica Solomon Sanders
- School of Medicine, Department of Pediatrics, Section of Developmental Pediatrics, University of Colorado, Denver, CO, United States
| | - Kathryn Williams
- Boston Children's Hospital, Institutional Centers for Clinical and Translational Research, Biostatistics and Research Design Center, Boston, MA, United States
| | - Darcy Thompson
- School of Medicine, Department of Pediatrics, Section of Nutrition, University of Colorado, Denver, CO, United States
| | - Hannah F Shapiro
- Department of Neurology, UCSF Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, United States
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Ong N, Lucien A, Long J, Weise J, Burgess A, Walton M. What do parents think about the quality and safety of care provided by hospitals to children and young people with an intellectual disability? A qualitative study using thematic analysis. Health Expect 2024; 27:e13925. [PMID: 38014873 PMCID: PMC10768875 DOI: 10.1111/hex.13925] [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: 04/30/2023] [Revised: 11/13/2023] [Accepted: 11/19/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES Children with intellectual disability experience patient safety issues resulting in poor care experiences and health outcomes. This study sought to identify patient safety issues that pertain to children aged 0-16 years with intellectual disability admitted to two tertiary state-wide children's hospitals and a children's palliative care centre; to describe and understand these factors to modify the Australian Patient Safety Education Framework to meet the particular needs for children and young people with intellectual disability. DESIGN, SETTING AND PARTICIPANTS Parents of children with intellectual disability from two paediatric hospitals and a palliative care unit participated in semi-structured interviews to elicit their experiences of their child's care in the context of patient safety. Thirteen interviews were conducted with parents from various backgrounds with children with intellectual, developmental and medical diagnoses. RESULTS Eight themes about safety in hospital care for children and young people with intellectual disability emerged from thematic analyses: Safety is not only being safe but feeling safe; Negative dismissive attitudes compromise safety, quality and care experience; Parental roles as safety advocates involve being heard, included and empowered; Need for purposeful and planned communication and care coordination to build trust and improve care; Systems, processes and environments require adjustments to prevent patient safety events; Inequity in care due to lack of resources and skills, Need for training in disability-specific safety and quality issues and Core staff attributes: Kindness, Patience, Flexibility and Responsiveness. Parents highlighted the dilemma of being dismissed when raising concerns with staff and being required to provide care with little support. Parents also reported a lack of comprehensive care coordination services. They noted limitations within the healthcare system in accommodating reasonable adjustments for a family and child-centred context. CONCLUSIONS The development of an adapted Patient Safety Education Framework for children with intellectual disability should consider ways for staff to transform attitudes and reduce bias which leads to adaptations for safer and better care. In addition, issues that apply to quality and safety for these children can be generalised to all children in the hospital. PATIENT AND PUBLIC CONTRIBUTION Parent advocates in the project advisory team were shown the questions to determine their appropriateness for the interviews.
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Affiliation(s)
- Natalie Ong
- School of Public HealthUniversity of SydneyCamperdownNew South WalesAustralia
- Child Development UnitChildren's Hospital at Westmead, Sydney Children's Hospitals NetworkWestmeadNew South WalesAustralia
| | - Abbie Lucien
- UNSW MedicineUniversity of New South WalesKensingtonNew South WalesAustralia
| | - Janet Long
- Australian Institute of Health Innovation, Faculty of Medicine and Health SciencesMacquarie UniversityMacquarie ParkNew South WalesAustralia
| | - Janelle Weise
- Department of Developmental Disability Neuropsychiatry (3DN), UNSW MedicineUniversity of New South WalesRandwickNew South WalesAustralia
| | - Annette Burgess
- Medical Education, Education Office, Sydney Medical SchoolUniversity of SydneyCamperdownNew South WalesAustralia
| | - Merrilyn Walton
- School of Public HealthUniversity of SydneyCamperdownNew South WalesAustralia
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Towson G, Daley S, Banerjee S. Intellectual disabilities teaching for medical students: a scoping review. BMC MEDICAL EDUCATION 2023; 23:818. [PMID: 37915002 PMCID: PMC10621142 DOI: 10.1186/s12909-023-04766-4] [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: 05/03/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND People with intellectual disabilities are a marginalized group whose health experiences and outcomes are poor. Lack of skill and knowledge in the healthcare workforce is a contributing factor. In England, there is a new legislative requirement for mandatory intellectual disability training to be given to the existing healthcare workforce, including doctors. There is a lack of evidence about effective models of educational delivery of such training in medical schools. We undertook a scoping review to assess the range of intellectual disabilities educational interventions and their effectiveness. METHODS We included any study from 1980 onwards which reported an educational intervention on intellectual disability, or intellectual disability and autism, for medical students from any year group. Databases searched included PUBMED, ERIC, Scopus and Web of Science as well as searches of grey literature and hand searching two journals (Medical Education and Journal of Learning Disabilities). 2,020 records were extracted, with 1,992 excluded from initial screening, and a further 12 excluded from full-text review, leaving 16 studies for inclusion. Data was extracted, quality assessed, and findings collated using narrative analysis. RESULTS We found a variety of intervention types: classroom-based teaching, simulation, placement, home visits, and panel discussions. There was substantial variation in content. Most studies involved lived experience input. Across studies, interventions had different learning outcomes which made it difficult to assess effectiveness. Overall study quality was poor, with high use of non-validated measures, making further assessment of effectiveness problematic. CONCLUSIONS There is a need for more consistency in intervention design, and higher quality evaluation of teaching in this area. Our review has drawn attention to the variety in teaching on this topic area and further research should focus on updating this review as curriculum changes are implemented over time.
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Affiliation(s)
- Georgia Towson
- Brighton and Sussex Medical School, Centre for Dementia Studies, University of Sussex, Trafford Building, Room 101, Falmer, BN1 9RY, UK
| | - Stephanie Daley
- Brighton and Sussex Medical School, Centre for Dementia Studies, University of Sussex, Trafford Building, Room 101, Falmer, BN1 9RY, UK.
| | - Sube Banerjee
- Faculty of Medicine and Health Sciences, University of Nottinham, Nottingham, UK
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Ong N, Lucien A, Long JC, Weise J, Walton M, Burgess A. What do healthcare staff think about the quality and safety of care provided to children and young people with an intellectual disability? A qualitative study using the framework method of analysis. BMJ Open 2023; 13:e071494. [PMID: 37491102 PMCID: PMC10373726 DOI: 10.1136/bmjopen-2022-071494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE To elicit patient safety issues pertaining to children and young people with intellectual disability in hospital from healthcare staff perspectives. This follows a previous paper of parent interviews of patient safety experiences of their child in hospital. DESIGN Qualitative study. SETTING We conducted semi-structured interviews and focus groups of staff of tertiary children's hospitals based on the domains of the Patient Safety Education Framework and using the framework methodology for data analysis. PARTICIPANTS There were 29 female and 7 male staff aged between 27 and 70 years from a range of departments and specialties including ancillary staff. INTERVENTION Questions based on the patient safety framework were developed from consultation with parents, researchers and clinicians exploring staff views and experiences of safety and quality care of these children in hospital. During April 2021 to May 2022, 22 interviews and 3 focus groups were conducted of staff who have had experience caring for children and young people with intellectual disability in the last 12 months in the hospital. RESULTS Key themes elicited include Definition of Safety, Need to consider additional vulnerabilities of children and young people with intellectual disability in hospital, Communication is key to safe care, Parent and family perspectives on safe care, Management challenges compromising safety and Service system gaps in preventing, identifying and managing risk. CONCLUSIONS Staff need to consider additional vulnerabilities, mitigate negative attitudes and biases towards better engagement and relationships with parents, children and young people of this population. Improvement of current systems that prevent the identification, prevention and management of risk and safety issues for this population need to be undertaken. Future developments include combining data from parent interviews, academic and grey literature in developing safety competencies in this population for training and education of staff across the health system.
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Affiliation(s)
- Natalie Ong
- Children's Hospital Westmead Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Child Development Unit, The Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Abbie Lucien
- Faculty of Medicine, School of Psychiatry, UNSW, Sydney, New South Wales, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Janelle Weise
- Department of Developmental Disability Neuropsychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Merrilyn Walton
- Office of Teaching and Learning in Medicine, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Annette Burgess
- Medical Education, Education Office, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
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Qualitative Focus Groups with Professionals of Special Education and Parents of Young Females with Intellectual Disability Exploring Experiences with Menstrual Hygiene Management and the Trigger for the Non-Therapeutic Hysterectomy in Mexico. Healthcare (Basel) 2022; 10:healthcare10091690. [PMID: 36141302 PMCID: PMC9498658 DOI: 10.3390/healthcare10091690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/23/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
How primary carers, physicians, health education professionals, and others see or understand the subject of menstruation in women with intellectual disability (ID) is rooted in the socio-cultural context and in the socio-economic structures in which all of them live. The aim of this study was to explore how parents of young females with ID and special education professionals perceive and experience menstrual hygiene management, which coping strategies are applied; and what triggers the performance of a hysterectomy. A qualitative focus group study design was conducted with 69 parents and 11 special education professionals, in 14 schools and one Down syndrome clinic, in Mexico City. Data were analysed using the method of thematic analysis. The main concern of parents was how to cope with the underlying disease. They perceived menstrual bleeding positively. Their psychological distress had to do with the reproductive health of their daughters, with their wish to avoid pregnancy, and with their fear of death and leaving their daughters alone and helpless without them. None of them favoured hysterectomy. Medical indication of hysterectomy was identified as the trigger for its performance. There is an urgent need of policy development/review on best practices for hysterectomy in the females in question.
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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.
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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.
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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)
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Amir N, Smith L, Valentine AM, Mitra M, Parish SL, Moore Simas TA. Clinician perspectives on the need for training on caring for pregnant women with intellectual and developmental disabilities. Disabil Health J 2021; 15:101262. [PMID: 35031269 PMCID: PMC8983509 DOI: 10.1016/j.dhjo.2021.101262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/27/2021] [Accepted: 12/12/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Women with intellectual and developmental disabilities (IDDs) experience disparities in obstetric care access and quality, in addition to communication gaps with healthcare providers. Many obstetric providers are untrained and uneducated about critical aspects of providing care to persons with IDDs. OBJECTIVE The study was conducted to describe obstetric clinicians' training experiences related to providing obstetric care to women with IDDs, to assess the perceived need for formalized training, and to identify recommendations for training content. METHODS This study involved qualitative individual interviews (n = 9) and one focus group (n = 8) with obstetric clinicians who self-reported experience caring for women with IDDs during pregnancy. Descriptive coding and content analysis techniques were used to develop an iterative codebook related to education and training; codes were applied to the data. Coded data were analyzed for larger themes and relationships. RESULTS Analysis revealed three main themes: 1. Need for obstetric training and education: No participant reported receiving any training in caring for pregnant women with IDDs. Participants expressed a need for formal education. 2. Recommendations for formal training: Participants noted the need for training during residency and beyond, and all healthcare staff members should be included in training. 3. Training outcomes should increase knowledge, enhance attitudes, and develop practical skills related to care for pregnant women with IDDs. CONCLUSION Results indicate a need for systematic training efforts regarding obstetric care for women with IDDs. Improved training and education may decrease health inequities and improve the quality of care, and thus pregnancy outcomes, for women with IDDs. LEVEL OF EVIDENCE VI.
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Affiliation(s)
- Nili Amir
- University of Connecticut Medical School, Department of Obstetrics and Gynecology, 200 Academic Way, Farmington, CT 06032, USA; University of Masachusetts Chan Medical School, 55 Lake Ave North Worcester, MA 01605, USA.
| | - Lauren Smith
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, USA
| | - Anne M Valentine
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, USA
| | - Monika Mitra
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, USA
| | - Susan L Parish
- Virginia Commonwealth University, College of Health Professions, 900 E. Leigh Street, Box 980233 Richmond, VA 23298, USA
| | - Tiffany A Moore Simas
- University of Massachusetts Chan Medical School/UMass Memorial Health Care Department of Obstetrics and Gynecology, Pediatrics, Psychiatry, and Population and Quantitative Health Sciences Memorial Campus, 119 Belmont Street, Jaquith Building Floor 2, Worcester, MA 01605, USA
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Caring for Adults With Autism Spectrum Disorder in the Emergency Department: Lessons Learned From Pediatric Emergency Colleagues. J Emerg Nurs 2021; 47:384-389. [PMID: 33637342 DOI: 10.1016/j.jen.2020.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 12/05/2020] [Accepted: 12/27/2020] [Indexed: 11/21/2022]
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Dambal A, Gururaj H, Aithal KR, Kalasuramath Dharwad M, Sherkhane R, Siddanagoudra S, Kanabur DR, Ahmed Mulla S. Delivering disability competencies of MCI's revised competency based curriculum at a medical university in North Karnataka. Med J Armed Forces India 2021; 77:S65-S72. [PMID: 33612934 PMCID: PMC7873704 DOI: 10.1016/j.mjafi.2020.12.029] [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: 10/15/2020] [Accepted: 12/31/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND India has ratified with the United Nations Convention on the Rights of Persons with Disabilities and has passed the Rights of People with Disabilities Act in 2016. There is need for training healthcare professionals in disability competencies as people with disabilities are many and marginalized. Disability competencies were introduced in the foundation course of revised competency based medical curriculum for Indian medical graduates by the Medical Council of India (MCI) just prior to the rollout of the programme. We intend describing our center's experience in implementing the same. METHODS FC 4.5.1 TO 4.5.8 of MCI foundation course guidelines were resource material. Eight faculty members participated. Setting was the lecture theatre. The suggested and actual teaching learning methods are compared for each competency. Notes made from delivering disability competencies, photographs, videos and reflections from students were source of data. RESULTS We used sensitizing lectures of 15 min each for FC 4.5.1, 4.5.2 and 4.5.4 [cognitive] with interesting set induction, student narratives of family members with disability, buzz groups for interaction and self-directed learning activity using mobile phones. We facilitated FC 4.5.3 and 4.5.5 [skill/affective domain] demonstrating unacceptable and acceptable disability etiquettes using standardized patients and role play. We conducted a forum theatre of the oppressed for FC 4.5.6. We introduced our learners to universal design in our campus for teaching 4.5.7. As a part of the principle of inclusivity we involved two staff members with motor disabilities for delivering FC 4.5.8 in an interview. We assessed the learners using written reflections and obtained feedback on a rating scale.
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Affiliation(s)
- Archana Dambal
- Professor (General Medicine) & Curriculum Committee Member, SDMCMS&H, Sattur, Dharwad, India
| | | | - Kiran R. Aithal
- Professor & Head (General Medicine), SDMCMS&H, Sattur, Dharwad, India
| | | | - Radhika Sherkhane
- Professor & Head (Pharmacology) & Coordinator, Medical Education Unit, SDMCMS&H, Sattur, Dharwad, India
| | - Savitri Siddanagoudra
- Professor (Physiology) & Curriculum Committee Member, SDMCMS&H, Sattur, Dharwad, India
| | - Deepak R. Kanabur
- Professor (Physiology) & Curriculum Committee Member, SDMCMS&H, Sattur, Dharwad, India
| | - Sameer Ahmed Mulla
- Associate Professor (General Surgery) & Curriculum Committee Member, SDMCMS&H, Sattur, Dharwad, India
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Lazcano-Ponce E, Angeles-Llerenas A, Rodríguez-Valentín R, Salvador-Carulla L, Domínguez-Esponda R, Astudillo-García CI, Madrigal-de León E, Katz G. Communication patterns in the doctor-patient relationship: evaluating determinants associated with low paternalism in Mexico. BMC Med Ethics 2020; 21:125. [PMID: 33302932 PMCID: PMC7731770 DOI: 10.1186/s12910-020-00566-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 12/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Paternalism/overprotection limits communication between healthcare professionals and patients and does not promote shared therapeutic decision-making. In the global north, communication patterns have been regulated to promote autonomy, whereas in the global south, they reflect the physician's personal choices. The goal of this study was to contribute to knowledge on the communication patterns used in clinical practice in Mexico and to identify the determinants that favour a doctor-patient relationship characterized by low paternalism/autonomy. METHODS A self-report study on communication patterns in a sample of 761 mental healthcare professionals in Central and Western Mexico was conducted. Multiple ordinal logistic regression models were used to analyse paternalism and associated factors. RESULTS A high prevalence (68.7% [95% CI 60.0-70.5]) of paternalism was observed among mental health professionals in Mexico. The main determinants of low paternalism/autonomy were medical specialty (OR 1.67 [95% CI 1.16-2.40]) and gender, with female physicians being more likely to explicitly share diagnoses and therapeutic strategies with patients and their families (OR 1.57 [95% CI 1.11-2.22]). A pattern of highly explicit communication was strongly associated with low paternalism/autonomy (OR 12.13 [95% CI 7.71-19.05]). Finally, a modifying effect of age strata on the association between communication pattern or specialty and low paternalism/autonomy was observed. CONCLUSIONS Among mental health professionals in Mexico, high paternalism prevailed. Gender, specialty, and a pattern of open communication were closely associated with low paternalism/autonomy. Strengthening health professionals' competencies and promoting explicit communication could contribute to the transition towards more autonomist communication in clinical practice in Mexico. The ethical implications will need to be resolved in the near future.
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Affiliation(s)
- Eduardo Lazcano-Ponce
- Population Health Research Centre, National Institute of Public Health, Cuernavaca, Morelos, Mexico.,Centre for Mental Health Research, Australian National University, Canberra, Australia
| | - Angelica Angeles-Llerenas
- Population Health Research Centre, National Institute of Public Health, Cuernavaca, Morelos, Mexico. .,Research Ethics Committee, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
| | - Rocío Rodríguez-Valentín
- Population Health Research Centre, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Australian National University, Canberra, Australia
| | | | | | - Eduardo Madrigal-de León
- Hospital Director at the National Institute of Psychiatry Ramón de La Fuente Muñiz, Mexico City, Mexico
| | - Gregorio Katz
- Department of Mental Health, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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Trollor JN, Eagleson C, Ruffell B, Tracy J, Torr JJ, Durvasula S, Iacono T, Cvejic RC, Lennox N. Has teaching about intellectual disability healthcare in Australian medical schools improved? A 20-year comparison of curricula audits. BMC MEDICAL EDUCATION 2020; 20:321. [PMID: 32958040 PMCID: PMC7507627 DOI: 10.1186/s12909-020-02235-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/09/2020] [Indexed: 05/05/2023]
Abstract
BACKGROUND People with intellectual disability (ID) have multiple and complex health needs, more frequent healthcare episodes, and experience poorer health outcomes. Research conducted two decades ago showed that medical professionals were lacking in the knowledge and skills required to address the complex needs of this patient group. The aim of the current study was to determine whether Australian undergraduate medical schools that offer ID health education content had changed the amount and nature of such teaching over this period. METHODS Identical or equivalent questionnaire items were compared across eight Australian medical schools that participated in curricula audits conducted in 1995 (referred to as T1) and 2013/14 (T2). The audits were of the nature of the ID content, methods used to teach it, and who taught it. RESULTS There was no significant difference in the number of hours of compulsory ID content offered to medical students at T2 (total = 158.3 h; median = 2.8 h per ID unit) compared with T1 (total = 171 h; median = 2.5 h). At T2 compared with T1, units with ID content taught in the area of general practice had increased (2 units; 3.6% to 7 units; 16.3%), while decreases were seen in paediatrics (22 units; 40.0% to 10 units; 23.3%) and psychiatry (10 units; 18.2% to 4 units; 9.3%). The number of schools using problem- and/or enquiry-based learning rose to six at T2 from one at T1. Inclusive teaching practices (people with ID develop or deliver content) in compulsory/elective units had increased at T2 (10 units; 23.3%) compared with T1 (6 units; 10.9%), but direct clinical contact with people with ID had decreased (29 units; 52.7% to 11 units; 25.6%). CONCLUSIONS Overall, little progress has been made to address the gaps in ID education for medical students identified from an audit conducted in 1995. Renewal of ID content in medical curricula is indicated as a key element in efforts to improve workforce capacity in this area and reduce barriers to care, with the aim of reversing the poor health outcomes currently seen for this group.
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Affiliation(s)
- Julian N. Trollor
- Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, 34 Botany Street, Sydney, NSW 2052 Australia
| | - Claire Eagleson
- Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, 34 Botany Street, Sydney, NSW 2052 Australia
| | - Beth Ruffell
- Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, 34 Botany Street, Sydney, NSW 2052 Australia
| | - Jane Tracy
- Centre for Developmental Disability Health Victoria (CDDHV), Monash Health, 122 Thomas Street, Dandenong, VIC 3175 Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168 Australia
| | - Jennifer J. Torr
- Department of Psychiatry, School of Clinical Sciences, Monash University, Monash Medical Centre, Block P, Level 3 246 Clayton Rd, Clayton, VIC 3168 Australia
| | - Seeta Durvasula
- Centre for Disability Studies, The University of Sydney School of Medicine, Faculty of Medicine and Health, Level 1, Medical Foundation Building, 92-94 Parramatta Road, Camperdown, NSW 2050 Australia
| | - Teresa Iacono
- La Trobe Rural Health School & Living with Disability Research Centre, La Trobe University, 102 Arnold Street, Bendigo, VIC 3550 Australia
| | - Rachael C. Cvejic
- Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, 34 Botany Street, Sydney, NSW 2052 Australia
| | - Nicholas Lennox
- Queensland Centre for Intellectual and Developmental Disability (QCIDD), Mater Research Institute (MRI-UQ), The University of Queensland, Level 2 Aubigny Place, Mater Hospitals, South Brisbane, QLD 4101 Australia
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13
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Soklaridis S, de Bie A, Cooper RB, McCullough K, McGovern B, Beder M, Bellissimo G, Gordon T, Berkhout S, Fefergrad M, Johnson A, Kalocsai C, Kidd S, McNaughton N, Ringsted C, Wiljer D, Agrawal S. Co-producing Psychiatric Education with Service User Educators: a Collective Autobiographical Case Study of the Meaning, Ethics, and Importance of Payment. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:159-167. [PMID: 31873923 PMCID: PMC7078174 DOI: 10.1007/s40596-019-01160-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 11/26/2019] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Co-production involves service providers and service users collaborating to design and deliver services together and is gaining attention as a means to improve provision of care. Aiming to extend this model to an educational context, the authors assembled a diverse group to develop co-produced education for psychiatry residents and medical students at the University of Toronto over several years. The authors describe the dynamics involved in co-producing psychiatric education as experienced in their work. METHODS A collaborative autobiographical case study approach provides a snapshot of the collective experiences of working to write a manuscript about paying service users for their contributions to co-produced education. Data were collected from two in-person meetings, personal communications, emails, and online comments to capture the fullest possible range of perspectives from the group about payment. RESULTS The juxtaposition of the vision for an inclusive process against the budgetary constraints that the authors faced led them to reflect deeply on the many meanings of paying service user educators for their contributions to academic initiatives. These reflections revealed that payment had implications at personal, organizational, and social levels. CONCLUSION Paying mental health service user educators for their contributions is an ethical imperative for the authors. However, unless payment is accompanied by other forms of demonstrating respect, it aligns with organizational structures and practices, and it is connected to a larger goal of achieving social justice, the role of service users as legitimate knowers and educators and ultimately their impact on learners will be limited.
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Affiliation(s)
| | | | | | | | - Brenda McGovern
- , 1353 Danforth Ave, suite #2, Toronto, M4J 1N1, Ontario, Canada
| | - Michaela Beder
- University of Toronto, Toronto, ON, Canada
- Unity Health Toronto, Toronto, ON, Canada
| | - Gail Bellissimo
- , 2548 Strathmore Crescent, Mississauga, L5M 5L1, Ontario, Canada
| | - Tucker Gordon
- The Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | | | - Andrew Johnson
- The Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Csilla Kalocsai
- The Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sean Kidd
- The Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | | | | | - Sacha Agrawal
- The Centre for Addiction and Mental Health, Toronto, ON, Canada
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