Reflective impressions of a precepted clinical experience caring for people with disabilities

Reducing barriers through education: A scoping review calling for structured disability curricula in surgical training programs

BACKGROUND

Patients with disabilities face widespread barriers to accessing surgical care given inaccessible health systems, resulting in poor clinical outcomes and perpetuation of health inequities. One barrier is the lack of education, and therefore awareness, among trainees/providers, of the need for reasonable accommodations for surgical patients with disabilities.

METHODS

We conducted a scoping review of the literature on the current state of disabilities curricula in medical education and graduate residency curriculum.

RESULTS

While the literature does demonstrate a causal link between reasonable accommodation training and positive patient-provider relationships and improved clinical outcomes, in practice, disability-focused curricula are rare and often limited in time and to awareness-based didactic courses in medical education and surgical training.

CONCLUSIONS

The absence of structured curricula to educate on anti-ableism and care for patients with disabilities promotes a system of structural "ableism." Expanding disability curricula for medical students and trainees may be an opportunity to intervene and promote better surgical care for all patients.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Structured observation and informant report assessments in intellectual disability: Reflections of qualified and student speech-language pathologists

PURPOSE

The purpose of this study was to explore the perspectives of qualified and student speech-language pathologists (SLPs) on the clinical utility of informant report and observation tools following a 1-day workshop using a decision tree.

METHOD

Each participant group (qualified [n = 4] or student SLP [n = 8]) attended a 1-day workshop where they engaged with informant report and structured observation tools using video case studies. Each workshop concluded in a focus group conducted by an independent researcher. NVivo 12 software supported inductive coding and subsequent thematic analysis of transcribed data.

RESULT

Thematic analysis revealed that participants' perceptions of tools' clinical utility could be conceptualised as three themes (a) tool characteristics, (b) external clinical work demands, and (c) clinician preparedness.

CONCLUSION

Participants' views on the utility of informant report and structured observation were influenced by tensions between their desires, the realities of clinical practice, and their own capabilities. This has implications for workforce development in the field in providing clinician guidance, training, and support.

Intellectual disabilities teaching for medical students: a scoping review

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.

A systematic review of intellectual and developmental disability curriculum in international pre-graduate health professional education

BACKGROUND

Despite the increasing global population of individuals with intellectual and developmental disabilities (IDD), this population remains especially vulnerable to health disparities through several factors such as a lack of access to sufficient medical care and poor determinants of health. To add, numerous studies have shown that healthcare professionals are still insufficiently prepared to support this population of patients. This review synthesizes the literature on current pre-graduate IDD training programs across healthcare professions with the goal of informing the creation of evidence-based curricula.

METHODS

Four major databases were searched for current pre-graduate IDD training interventions for healthcare professionals. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis flow diagram and the Best Evidence Medical Educations systematic review guide were used to frame our collection and analysis.

RESULTS

Of the 8601 studies screened, 32 studies were identified, with most studies involving medical students (50%). Of note, 35% of studies were interprofessional. Most interventions utilized multiple pedagogical methods with a majority including clinical experiences (63%) followed by theoretical teaching (59%). Kirkpatrick levels showed 9% were level 0, 6% were level 1, 31% were level 2A, 31% were level 2B, 19% were level 3, 3% were level 4A, and none were level 4B.

CONCLUSIONS

There is a paucity of formally evaluated studies in pre-graduate health professional IDD education. As well, there are a lack of longitudinal learning opportunities and integration into formal curriculum. Strengths identified were the use of multimodal approaches to teaching, including interprofessional approaches to optimize team competencies.

Transformative care for people with disabilities: Empowering senior nursing students with competency based clinical education-A qualitative study of the impact

BACKGROUND

People with disabilities (PWD) constitute 26 % of the U.S. population yet no nursing schools have compulsory clinical education specific to PWD. Inadequate education and negative attitudes lead to lack of preparedness for working with PWD. To meet the needs of this highly underserved population, nursing students need training and experience in the care of PWD.

OBJECTIVE

The objective of this paper is to report three themes from the qualitative evaluation of two immersive clinical experiences with PWD for undergraduate nursing students designed to evaluate competencies for working with PWD.

DESIGN

Curriculum evaluation using qualitative methods.

METHODOLOGY

During and after the clinical experience, qualitative data (reflection papers, debriefing responses, and group interviews) were collected with a volunteer sample of senior nursing student participants of the clinical experiences with PWD. Thematic analysis was used to identify changes in students' attitudes, perceived competence, and motivation for working with PWD.

FINDINGS

Three major themes are reported in this paper: A positive shift in perspective of PWD (attitudes), impact of the experience on students' practice with PWD (comfort, confidence, awareness and motivation), and revelations from the experience (attitudes and resource awareness).

CONCLUSIONS

A comprehensive immersive clinical experience caring for PWD provides a real-world laboratory with important experiential learning activities that help students acquire and apply knowledge about the healthcare needs of PWD. Reflection activities facilitate synthesis of that knowledge. Results from this study suggest that this clinical experience can transform students' attitudes toward PWD, enhance their clinical skills, and motivate them to consider a nursing career with this highly under-served population.

Planting the Seeds of Collaboration: A Pilot for School/Clinic Partnerships During Pediatric Clerkship

Although pediatricians and family physicians often refer children to early intervention (EI) and provide support and information to families, medical school training that provides information about special education policy and procedures is often limited. We piloted a program whereby medical students, during their pediatric clerkship, observed school classrooms that included young children with disabilities. Visit impact was measured through assessments of perceived competency and a written reflection. Students showed perceived competency growth across all areas measured. Written reflections demonstrated understanding of special education practices and collaborative opportunities. These findings suggest that incorporating experiential learning through facilitated school visits is a way to enhance the learning experience of medical students on topics essential to supporting children with disabilities and their families.

Cocurricular Clinical Opportunity: Addressing Student Attitudes, Knowledge, and Skills With Disability Education

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.].

Healthcare inequities among adults with developmental disability: An integrative review with implications for nursing education

AIM

This integrative review synthesized research on the healthcare inequities experienced by adults with developmental disability in the United States and discussed implications for nursing education.

BACKGROUND

Individuals with developmental disability are living longer with chronic comorbidities and experience healthcare inequities.

METHOD

Application of inclusion criteria to database and ancestry searches resulted in 26 articles that were assessed for quality and analyzed thematically.

RESULTS

Three categories of inequity were identified: knowledge deficits, communication challenges and poor quality of care. Knowledge deficits and communication challenges can lead to frustration, errors and unmet needs. Poor quality of care encompasses the decreased availability and access to services, limited health promotion participation and higher rates of hospitalizations and complications for adults with developmental disability.

CONCLUSION

Healthcare inequities may be reduced by targeting patient and provider knowledge. Inclusion of developmental disability content and clinical experiences in nursing education may improve care and reduce inequities for this underserved population.

Disability Attitudes of Nursing Students: A Curriculum Intervention

ABSTRACT

People with disabilities (PWD) have reported that health care workers' negative attitudes are among the most significant barriers to accessing health care services. PWD constitute one quarter of the population, yet the curriculum for PWD is inconsistent. This study describes a curriculum intervention allowing student interaction with a panel of PWD to change nursing student attitudes. Surveys were administered before and after the intervention. Our pilot study did not reveal a significant change in attitudes, which suggests that more exposure to PWD and education may be needed.

'I was scared at first, but not anymore': interpersonal contact and attitudes toward people with intellectual and developmental disabilities among Korean American adolescents and young adults

The purpose of this qualitative study is to explore experiences of naturalistic interpersonal contact with persons with intellectual and developmental disabilities (IDD) and attitudes toward persons with IDD among Korean American adolescents and young adults. In interviews with 12 Korean American high school and college students, Korean American participants reported six common themes regarding their experiences of interpersonal contact with persons with IDD: 1) affective attitude, 2) behavioral attitude, 3) cognitive attitude, 4) communication with persons with IDD, 5) moments of having a positive attitude, and 6) comparisons of attitudes in the United States and Korea. Recommendations for research and practical implications are discussed.

Self-other overlap: A unique predictor of willingness to work with people with disability as part of one's career

BACKGROUND

People with disability (PWD) often rely on others, both for direct support and for the creation of enabling environments to meet their needs. This need makes it crucial for professionals to be willing to work with PWD, and for people to pursue careers that focus on supporting PWD.

OBJECTIVES

To explore self-other overlap as a unique predictor of willingness to work with PWD as part of one's career, using three studies.

METHODS

Studies 1 and 2 used cross-sectional surveys of college undergraduates to explore: 1. whether an association between self-other overlap and willingness to work with PWD exists, and 2. whether self-other overlap is a unique predictor, controlling for attitudes and empathy. Study 3 investigated whether self-other overlap is associated with the groups with whom the students indicated they want (and do not want) to work as part of their career.

RESULTS

Across the three studies, self-other overlap was uniquely associated with students' willingness to work with PWD as part of one's profession, even when controlling for attitudes and empathy.

CONCLUSIONS

Self-other overlap may be an important additional factor to take into consideration when developing interventions targeted toward promoting working with PWD.

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

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