Introduction to Disability and Antiableist Health Care: A Pilot, Student-Led Module for Preclinical Medical Students

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.

Teaching Future Physician Assistants to Provide ADEPT-CARE to Disabled Patients: A Novel Application of Disability Curriculum

INTRODUCTION

Physician assistant (PA) students will be certain to provide care to patients with disabilities in their future careers. However, there is a dearth of literature on disability-related education in PA training. This curriculum sought to fill this need. The specific aims of this study were to (1) evaluate the implementation of a 3-part disability-focused education curriculum in PA education, (2) assess changes in PA students' self-perceived confidence and attitudes toward patients with disabilities, and (3) assess students' attitudes toward ADEPT-CARE.

METHODS

A 3-part disability curriculum was implemented into the first-year PA curriculum at a single Mid-Atlantic institution. Students could voluntarily complete pre and post-surveys which assessed their self-perceived confidence and attitudes toward people with disabilities, perception of the curriculum, and attitudes toward ADEPT-CARE and disability health.

RESULTS

Thirty students participated in the study, with a 100% survey response rate. Nearly all participants agreed or strongly agreed that this curriculum enhanced their medical education (n = 28, 96.6%, frequency missing n = 1). After curriculum completion, there was a statistically significant improvement in participants' confidence in their ability to assess patients with disability (46.7%-93.3%, P < 0.001), ability to provide the same quality of care to patients with disability as those without disability (80.0%-96.7%, P = 0.025), and perception of quality of life of persons with disabilities (P = 0.030).

DISCUSSION

This curriculum was well received by PA students and improved their attitudes toward patients with disabilities, thereby fulfilling a critical need for PA educators.

Student-Led Workshop on Disability Advocacy

ABSTRACT

Medical students can be powerful advocates for and in partnership with the disability community, yet opportunities for targeted advocacy training are sparse. In February 2023, a medical student-led workshop on disability advocacy for trainees took place at the Association of Academic Physiatrists' Annual Conference. The aims of this session were for trainees to (1) identify existing gaps in disability education at their institution and in policy around disability-related issues; (2) improve perceived ability to engage in disability-related education and policy-based advocacy; and (3) apply an intersectional lens to identify opportunities for intersectionality in disability advocacy. Pre- and post-session responses were anonymously submitted via Qualtrics. Of 31 pre-survey respondents, 18 responded to the post-survey, and 12 were identified as having matching unique identifiers. After the workshop, participants overall were more likely to report being very/somewhat confident about their ability to identify gaps in disability education at their institution (75.0% vs 100.0%, p = 0.011), policy around disability-related issues (41.7% vs 100.0%, p < 0.006), and opportunities for intersectionality in disability advocacy (33.3% vs 91.7%, p < 0.015). Participants were more likely to report being very/somewhat confident in engaging in education-based advocacy (58.3% vs 100.0%, p = 0.006), policy-based advocacy (16.7% vs 91.7%, p < 0.002) and intersectional disability advocacy (41.7% vs 91.7%, p < 0.006). All attendees strongly/somewhat agreed with the statements "I hope that this session will continue in future years" and "I think that other trainees would benefit from a similar course." This session was shown to effectively meet the intended goals of the program.

Aspiring to Disability Consciousness in Health Professions Training

Lack of disability-competent health care contributes to inequitable health outcomes for the largest minoritized population in the world: persons with disabilities. Health care professionals hold implicit and explicit bias against disabled people and report receiving inadequate disability training. While disability competence establishes a baseline standard of care, health professional educators must prepare a disability conscious workforce by challenging ableist assumptions and promoting holistic understanding of persons with disabilities. Future clinicians must recognize disability as an aspect of diversity, express respect for disabled patients, and demonstrate flexibility about how to care for disabled patients' needs. These skills are currently undervalued in medical training, specifically. This article describes how integrating disability consciousness into health professions training can improve health equity for patients with disabilities.

Barriers to Disclosure of Disability and Request for Accommodations Among First-Year Resident Physicians in the US

Importance

Ensuring access to accommodations is critical for resident physicians and their patients. Studies show that a large proportion of medical trainees with disabilities do not request needed accommodations; however, drivers of nonrequests are unknown.

Objective

To assess the frequency of accommodation requests among first-year resident physicians (ie, interns) with disabilities and to identify possible drivers of nonrequest for needed accommodations.

Design, Setting, and Participants

As part of the Intern Health Study, a longitudinal cohort study of first-year resident physicians, residents at 86 surgical and nonsurgical residency programs in 64 US institutions provided demographic and training characteristics 2 months prior to matriculation (April-May 2021). At the end of their intern year (June 2022), participants completed a new survey with questions about disability-related information, including disability status, disability type, whether they received accommodations, and if not, reasons for nonaccommodation. Poststratification and attrition weights were used to estimate the frequency of accommodation requests and reasons for not requesting accommodations. Interns reporting at least 1 disability were included in the analysis.

Main Outcomes and Measures

Prevalence of reported disabilities, residency specialties distribution, frequency of accommodation requests, and reasons for nonaccommodation among resident physicians with disabilities.

Results

Among the 1486 resident physicians who completed the baseline survey, 799 (53.8%) replied to the disability questions. Of those, 94 interns (11.8%; weighted number, 173 [11.9%]) reported at least 1 disability and were included in the present study (weighted numbers, 91 [52.6%] men, 82 [47.4%] women, mean [SD] age, 28.6 [3.0] years). Among interns with reported disability and need for accommodations (83 of 173 [48.0%]), more than half (42 [50.6%]) did not request them. The most frequently reported reasons for not requesting needed accommodations were fear of stigma or bias (25 [59.5%]), lack of a clear institutional process for requesting accommodations (10 [23.8%]), and lack of documentation (5 [11.9%]).

Conclusions and Relevance

Program directors should investigate cultural and structural factors within their programs that contribute to an environment where residents do not feel safe or supported in disclosing disability and requesting accommodation and review their disability policies for clarity.

ADEPT-CARE: A Pilot, Student-Led Initiative to Improve Care for Persons with Disabilities via a Novel Teaching Tool

BACKGROUND

Over one-quarter of United States adults live with a disability. Despite persistent ableism, defined as discrimination and prejudice against people with disabilities, in healthcare, disability-focused training remains largely absent from medical education.

OBJECTIVE

The aim of this study was to pilot and evaluate a novel teaching mnemonic (ADEPT-CARE) for performing a comprehensive history and physical exam for disabled patients.

METHODS

In Spring 2022, first-year medical students at a suburban Mid-Atlantic institution could electively participate in a learning module that included ADEPT-CARE. Surveys were administered to students before and following exposure to the ADEPT-CARE protocol.

RESULTS

Of 142 eligible students, 33 and 21 completed the pre- and post-surveys, respectively. The ADEPT-CARE protocol made sense to 95.2% of students. All (100%) students reported that they will use the ADEPT-CARE protocol in the assessment of patients with disabilities. Students were more likely to agree or strongly agree that they had a consistent approach or strategy in mind when assessing a patient with a disability after exposure to ADEPT-CARE (85.7% vs. 39.4%, respectively, p = 0.002). There was no statistically significant difference in students' perceived confidence in their ability to assess a patient with a disability after curriculum completion compared to before (85.7% vs. 81.8%, respectively, p = 1.0).

CONCLUSIONS

The ADEPT-CARE protocol has the potential to be an effective teaching tool by providing a framework to equitably care for disabled patients. Future research should assess whether students' self-reported increased confidence and intention to utilize ADEPT-CARE translates into the clinical setting.