Educating Medical Students about the Care of Patients with Disabilities

1. Educating Medical Students about the Care of Patients with Disabilities Kira Zwygart, MDLaurie Woodard, MD University of South Florida College of MedicineDepartment of Family Medicine Revised 3/6/08

2. Background • Major curricular reform in the 3rd and 4th years • Opportunity to insert new topics previously omitted from the curriculum • Patients with disabilities are encountered by all physicians, regardless of specialty, yet most physicians are not trained in the care of this group • The Surgeon General created a call to action to improve the health and wellness of persons with disabilities in 2005, citing the importance of training physicians

3. GOALS To encourage patient centered care that allows students to see the patient as an individual To help students understand that disability is part of life, through a concept of varying abilities rather than disease model To help students develop respectful communication and examination techniques resulting in more effective therapeutic outcomes To help students become familiar with some of the more common disabling conditions OBJECTIVES Upon completing the clerkship, students will be able to: 1. Demonstrate an adequate comfort level when interacting with patients with disabilities in the clinical setting 2. Practice and demonstrate appropriate history and physical exam techniques with standardized patients with disabilities 3. Locate and provide adequate community resources for patients with disabilities 4. Participate in service learning projects, behaving respectfully and remaining open-minded toward alternate learning activities Goals and Objectives of Curriculum

4. Module Overview • Didactic Sessions • 3 half days in 12 week clerkship • Community Sessions • 1 half day per week for 6 weeks, includes: • One home visit • One service learning experience • Film and Video • Interdisciplinary Collaboration • Online Feedback and Reflection • Required home visit reflection is posted • Online discussion about module experiences • Module Evaluation

5. Didactic Sessions • Week One • Overview of various disabilities, and specific exam and preventive care issues • Students interview and examine several model patients with disabilities, student -group wrap-up. • Week Two • Special Considerations for Special Athletes – the preparticipation exam for patients with disabilities • Panel discussion with persons and advocates from disability community • Students discuss newsworthy disability issues they found • Week Three • Sensitivity training: students acquire a disability and explore the medical school • Communication techniques for patients with speech and hearing impairments • Case discussions and wrap up.

6. Exposing Students to Community Resources • All students spend 1/2 day a week in a community setting • Experiences vary and may include: • Developmental screening for school system and classrooms • Spinal cord injury center • Group homes for people with developmental disabilities • Adult day care programs • Shriner’s Hospital • Physical Medicine Office • Recreational programs

7. Home Visits • All students are assigned to visit a patient with a disability in their home • Patients are usually members of the faculty practice • Students visit the patient in pairs • Often a medical and physical therapy visit in a pair • Students write a reflection of the visit that is posted online for other students to read and comment on. • Patients are asked for feedback about each visit

8. Service Learning • Students team teach health topics to • College aged or high school students with developmental disabilities in their classrooms • Adults with developmental disabilities at a local training center • Students assist in • Special Olympics events and other structured sports and recreational activities • Periodic Sports physicals for patients with developmental disabilities • Students reflect upon these activities and their peer activities using the online discussion board

9. Reading, Film and Video • Required reading posted online: • Medical literature about caring for patients with various disabilities • Surgeon General 2005 report • Using the arts and humanities: • e.g., 2005 film “Murderball”, essay “Carnal Acts” • Videos shown: • Communicating with patients with physical disabilities • Ten Commandments of communicating with patients with disabilities • Optional online reading and video/film • Used as makeup for missed sessions • Enrichment for students with particular interests

10. Interdisciplinary Collaboration • University • UCEDD • School of Physical therapy • School of Dance and Theater • Department of Speech and Language • Community • ADA Liaison • Division of Blind Services • Parks and Recreation Dept • Independent Living Organizations • Special Olympics • And More…

11. Evaluation and Feedback • Evaluation of student performance • Log of student activities including online communication • Questions regarding disability included in clerkship exam • Patient with disability in final OSCE type exam (in development) • Module evaluation • Student performance and feedback • Home visit patient feedback • Knowledge and attitude surveys at the beginning and end of clerkship in collaboration with UCEDD • Long term follow-up conducted by UCEDD

12. Feedback from Students • “I thought this was a wonderful experience. You can learn much more from a patient in their home than in the clinic and you are able to discuss things that you would not be able to discuss in class. I would definitely continue this experience in the future.” • “I learned about the significant social discrimination that occurs affecting people with disabilities. I learned about some of the multitude of resources available for these patients as well as some helpful hints for their medical care.” • “The model patient exercises were very revealing. I would hope that this exercise influenced my approach to patients with disabilities in the future. It was very revealing and demonstrated the importance of taking extra time with these patients.” • “What an eye-opening experience! I really enjoyed this portion of the block. Getting to see how a patient with a serious disability goes about their day-to-day activities was very educational and humbling. I really enjoyed having a chance to talk with the pt’s caregiver as well and to better understand what they go through to take care of their loved ones. Textbooks don’t provide the same emotional impact as person-to-person communication!”