Create objectives for encounter
Curricular elements that include patients with autism spectrum disorders or other disabilities can support the Liaison Committee on Medical Education (LCME) goals of cultural competence, diversity, or meeting the needs of underserved/vulnerable populations. Consider including one or more of the following objectives in your undergraduate medical education curriculum:
- Teach medical students how to care for patients with autism spectrum disorders and other developmental disabilities.
- Improve students’ understanding of and competence in providing family-centered care to underserved patients.
- Improve medical students’ attitudes and knowledge of persons from diverse cultural backgrounds including disability.
- Increase the number of physicians with skills and attitudes that welcome persons with disabilities into their practices.
- Empower individuals with developmental disabilities to become advocates for their own care.
Choose type of encounter or combination of encounters
Undergraduate medical programs address diversity in a variety of ways: didactic instruction, community service encounters, clinical clerkships, standardized patient (SP) encounters, panel discussions with patients, advocates, and family members; in addition to home visits where students interact with individuals with disabilities outside of a healthcare setting.
Lectures can be an efficient way to teach students about health and healthcare disparities, diversity, and patient care issues. Incorporating video content that features people with disabilities and their families can make lectures more engaging and impactful. Online didactic material is available and examples can supplement hands-on patient encounters. Click here for “Healthcare Access for Persons with Developmental Disabilities,” a one-hour training on health issues and barriers to health care for people with developmental disabilities (including intellectual disability, autism spectrum disorder, and cerebral palsy).
The Centers for Disease Control and Prevention’s Learn the Signs. ACT Early materials help healthcare professionals gain knowledge and skills to improve early identification, diagnosis and care of children with ASD.
In 2005 University of South Florida clinical educators implemented a disability-related course for all third-year medical students. This six-week course incorporates didactic instruction, training sessions, and clinical experiences during the primary care clerkship (Woodard, Havercamp, Zwygart, & Perkins, 2012).
Symons, McGuigan, and Akl (2009) at the University of Buffalo School of Medicine and Biomedical Sciences developed a four-year curriculum to educate medical students about disabilities. The curriculum uses several approaches such as classroom instruction, home visits and clinical experience to achieve three overarching goals: build knowledge of disabilities, improve attitudes and commitment to disability, and foster skills to provide patient-centered care.
Estimated time for encounter: 60 mintues
Including patients with disabilities in standardized patient (SP) encounters is an effective way to provide training on vulnerable populations including autism spectrum disorders (ASD) and other disabilities. Standardized patients are individuals who are specifically trained to participate in mock doctor-patient encounters. SPs are trained to recreate physical, emotional, and medical history and responses of an actual patient. These activities can improve students’ interpersonal communication skills, which are the cornerstone in patient interviewing. For SPs with disabilities, the encounter could be simply a “new patient exam”; this may be easier for volunteers with cognitive impairment that might interfere with their ability to memorize and act-out a case.
Clinical educators at the University of South Carolina created a ninety-minute workshop for third-year medical students to improve skills, awareness and clinical consideration of patients with disabilities. Persons with disabilities are used as standardized patients for this interaction (Brown, Graham, Richeson, Wu, & McDermott, 2010). Medical students are taught how to safely transfer patients from their wheelchairs to examination tables. Students are required to complete a fifteen-minute visit with a patient who has a disability including physical exam. Tufts University School of Medicine introduces medical students to the “Chris Walker case” during their third-year clerkship in Family Medicine. This case uses individuals with physical disabilities and/or blindness to portray a patient with shoulder discomfort. Students are required to perform a patient interview including medical and social history (Minihan et al., 2004).
The Ohio State University Nisonger Center, with funding from the Health Resources and Service Administration, implemented a curriculum to train third-year medical students to care for patients with autism spectrum disorders. This encounter took place during the ambulatory care clerkship and we worked closely with the Director of Ambulatory Clerkships in the College of Medicine to facilitate these encounters. One element of this innovative curriculum involved training adults with ASD to function as standardized patients in a mock interview scenario with medical students. We used this presentation to introduce adults with ASD to the standardized patient program. During each rotation, two adults with ASD were interviewed by medical students, who were encouraged to build rapport and establish a relationship with the SP in a “new patient” scenario. The clinical scenario entailed an interview, medical history, but no physical exam at the request of several volunteers with ASD. Following each encounter, we conducted a facilitated small-group discussion. Finally, students were asked to write a reflection on what they learned and the relevance of the experience to their practice as a physician.
Estimated time for encounter: 90 mintues
Students at Rutgers University Robert Wood Johnson School of Medicine visit Matheny Medical and Educational Center during their third year to learn how to interact and care for individuals with disabilities as a part of their clerkship rotation. Additionally, third-year medical students take part in a developmental disability seminar during their pediatric rotation facilitated by The Elizabeth M. Boggs Center on Developmental Disabilities.
The School of Medicine at the University of Massachusetts offers an interclerkship for third-year medical students entitled “Working with Persons with Disabilities in the Clinical Setting,” and a Population Health Clerkship for second-year medical and nursing students focused on the healthcare needs of individuals with disabilities.
Estimated time for encounter: four hours
Panels can be an effective way to expose students to a number of patient care issues from the patient or family perspective. Participants can be individuals with disabilities, parents, family members, advocates, and medical professionals. The role of the facilitator is to create a dialogue that is both informative and engaging.*
*Note: Because panel discussions are not scripted, panel members may surprise the class and moderator with what they share. For example, it is not uncommon for families with children with autism spectrum disorder to explore Complementary or Alternative Medicine. This presents an opportunity for the faculty member to discuss with the students how to respond to the family who expresses interest in treatments that are not evidence-based. This dicussion should be held before or after the panel presentation.
Ideas for panel discussion:
- Impact of diagnosis
- Misconceptions and stigmas associated with diagnosis
- Acute healthcare experiences
- Best experience with medical professional
- Worst experience with medical professional
- Medications, therapy, community services
- Transition to adult services
- Educational services
- Caregiver wellness
- Community resources for patients and families
- Healthcare financing, cost of services
The Ohio State University Nisonger Center facilitates panel discussions on the healthcare needs of children and adults with ASD. Our panels consist of a facilitator (a developmental-behavioral pediatrician) and 4-6 panel members made up of people with ASD, parents and other family members. Although previous panel participants with ASD were able to speak and respond to questions, the parents were able to offer a glimpse into life with children who are severely affected by ASD. We also added two videotaped physical exams of patients with ASD performed by a developmental-behavioral pediatrician. These exams were used to demonstrate the effectiveness of interpersonal communication, person-first language, and the benefits of a medical home approach to primary care.
Estimated time for encounter: 90 mintues
Home visits can have a profound impact on students and are effectively used by clinician educators to teach medical students continuity of care. Home visits have been used as part of geriatric clerkships to educate students on the psychosocial components of chronic illness and to improve attitudes toward vulnerable populations.
Mount Sinai Visiting Doctors Program is the largest academic-based home visit program in the nation. Third-year medical students take part in a one-week, home-based clinical rotation in the Visiting Doctors Program. Students conduct physical examinations and assessments, focusing closely on social and cultural determinants of health within the home environment (Ornstein, Hernandez, DeCherrie, & Soriano, 2011). Students at Weill Cornell Medical College participate in a half-day home visit experience as a part of their third-year primary care clerkship, where they learn the art of psychosocial histories and chronic illness care management. University of Connecticut medical students participate in a home care and health assessment program as part of their second-year experience.
Estimated time for encounter: two hours
Florida International University Herbert Wertheim College of Medicine has an innovative service-learning program through its community outreach initiative, NeighborhoodHELP. This program is considered the cornerstone of students’ medical education at Florida International University. During students’ second year they take part in their service-learning study, which includes a home visit component. Using interdisciplinary teams from public health, social work, nursing, and law, students monitor and track the health of families. Additionally, students will work with community partners and primary care physicians to develop and implement care plans for families throughout their matriculation.
Estimated time for encounter: varies
The University of California-San Francisco has created a program within The Department of Family and Community Health with the goal of improving health outcomes for individuals with developmental disabilities across the lifespan. The Office of Developmental Primary Care offers clinical services, advocacy, research and training opportunities. Their website offers a wealth of resources for self-advocates, clinicians, researchers, and trainees.