Educating Medical Students about Disability
Disability affects nearly one in five people today, and this number is growing. Alarming health disparities exist for people with disabilities (PWD). PWD experience increased barriers to routine care in comparison to their counterparts without disabilities. This population reports poorer health outcomes, increased secondary conditions, less access to preventive health services, and a lack of Proutine managed care.
Disability specific content incorporated into medical school curriculum will ensure that students have the knowledge, skills, attitudes, and competence necessary to provide quality, effective, and compassionate care to patients with autism spectrum disorder (ASD) and other developmental disabilities. We have partnered with clinical educators to introduce disability content in the medical school curriculum at The Ohio State University.
In 2017, a partnership between Nisonger Center and the OSU College of Medicine faculty, the LSI Disability Curriculum Initiative, received funding from the National Curriculum Initiative in Developmental Medicine (NCIDM) (Special Olympics International (SOI) and the American Academy of Developmental Medicine) to provide training to medical students in the field of developmental medicine on the care of individuals with intellectual/developmental disabilities (IDD) across the lifespan. This funding has allowed us to implement curriculum enhancements to OSU College of Medicine curricula aimed at addressing gaps in medical education regarding serving patients with IDD.
1st Year Medical Students
Panel- Mobility Limitations: As a part of a Musculoskeletal Panel first year medical students are taught about physical and mobility related disabilities by Dr. Ellen Kaitz of Nationwide Children’s Hospital and The Ohio State University College of Medicine.
Patient Transfer Video: In addition, a video featuring a step by step tutorial on transfers has been added to required curriculum. The video provides instruction on alternative methods that may be necessary when performing an exam for a person with a physical or developmental disabilities.
Lecture: An OSUCOM faculty member delivers a 1-hour lecture during a required class during the first year of the medical curriculum that provides an overview to I/DD. This overview will contain basics such as: What is DD? How does it differ from ID? What are examples of I/DD? How does I/DD affect health and healthcare. What can I do to provide better care to patients with I/DD?
2nd Year Medical Students
Community Education Project: First and second year medical students participate in a longitudinal community education project in the Columbus community. Small groups of students are assigned to different community sites, including disability-related sites Down Syndrome Association of Central Ohio (DSACO), Special Olympics, and Goodwill Columbus.
Disability Documentary: A documentary on the experiences of several people with I/DD (with a particular focus on health care needs and addressing biases about people with disabilities that may prevent them from receiving necessary and quality care) will be produced. During LG, students will watch the video and discuss bias and disability. This activity will be required of every medical student at OSU.
3rd Year Medical Students
Simulated Patient Encounter: Students engage in a simulated patient encounter modeled after the Formative Observed Simulated Clinical Experiences in which OSU medical students already participate. During the experience, students meet a simulated patient who has an actual developmental and/or physical disability with the goal of gaining a social and medical history and then observes a peer interview.Students participate in small group discussions/debriefing following this experience, which are led by Dr. Jennifer Walton.
Panel- Autism Spectrum Disorder: The Nisonger Center facilitates panel discussions on the healthcare needs of children and adults with ASD. Panels are facilitated by Dr. Jennifer Walton and consists of panel members made up of people with ASD, parents and other family members. All third year medical students participate in this encounter.
4th Year Medical Students
Advanced Competency: An Interdisciplinary Advanced Competency course implements home visits, online learning and and participation in interdisciplinary clinics . The goal of this course is for students to receive training on the patient-centered model of care for children and adults with intellectual and developmental disabilities and their families. Through this elective, students collaborate as part of interprofessional teams at Nisonger Center and Nationwide Children’s Hospital. Dr. Paula Rabidoux and Dr. Allison Macerollo are coordinating this effort.
Autism Curriculum Guide Website
In an effort to help medical schools integrate content on developmental disabilites a team from Nisonger Center has developed an Autism Curriculum Guide Website aimed at teaching medical students to provide care for patients with ASD. The website provides background information about ASD, a step-by-step guide to including PWD in medical curricula, video-taped vignettes featuring interviews and physical exams with patients who have ASD and video-taped panel discussions featuring adults with ASD. This resource may be helpful to faculty, students and families alike.
The website was funded through a grant from the Health Resources and Services Administration, entitled REAL Action: Resources, Education, Alignment and Linkages.The goal of the REAL Action in Ohio grant is to bring together the collective expertise and perspectives of families, the public service system, the medical community, the university community, and service providers- ultimately, to improve information about, and access to, comprehensive, coordinated health care and related services for children with ASD and their families. For more information about this the Autism Curriculum Guide Website click here.
Core Competencies on Disability for Health Care Education
The Alliance for Disability in Health Care Education (the Alliance) and the Ohio Disability and Health Program partnered to improve the disability training that health care students receive. The purpose of this project was to develop a consensus on the disability competencies required for health care providers to provide quality care to patients with disabilities and to have them integrated into health education curricula.
The Alliance is asking for endorsements of the Core Competencies from those whose who would like to see them integrated into existing curricula for future health care providers. Endorsement is a public statement of support for this disability in health education effort.
Visit the Core Competencies website for more information!
Feedback from Medical Students
“I didn’t even realize I had such preconceived notions about ASD but the exercise helped to cement in my mind that this is a spectrum and while some interactions might be very difficult there are some very high functioning individuals that we will encounter as well so to take people as individuals instead of treating them as a representation of a disorder was enlightening. This is a lesson I will take with me in my career…”
“I was immediately surprised at her willingness to talk with the medical student interviewer and openly discuss her life. This openness to communication contradicted my preconceived notions of how autistic patients conduct themselves. As the interview unfolded, I became increasingly astounded by the depth at which she understood her disease. She was able to articulate the way her thought processes differed from most other people, and she did so in a way that I could actually understand. She went on to explain the mechanisms she had developed over the course of her life to cope with her difficulties and why they work for her. I also found it extremely interesting to hear about her childhood – how things that most people take for granted, such as language skills and assigning meaning to senses, were so absolutely foreign to her initially. Looking back on the interview and the discussion that followed, I believe the most important thing I learned was to approach each autistic-spectrum patient as an individual that has their own ways of dealing with their disease.”
“I also really appreciated the perspective the patients gave on their disorder, including the struggle they have faced within the medical community. This certainly expanded my perspective on autism, giving me greater insight into how it is expressed and how it affects the medical interview. I feel like I learned many things about autism and disabilities from this experience that will help provide me with a strong foundation for future encounters with patients with disabilities.”