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\u27 self-perceived confidence and attitudes toward patients with disabilities, and (3) assess students\u27 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\u27 confidence in their ability to assess patients with disability (46.7%-93.3%, P \u3c 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

The Impact of Block Ambulatory Scheduling on Internal Medicine Residencies: a Systematic Review

BackgroundOver the past decade, nearly half of internal medicine residencies have implemented block clinic scheduling; however, the effects on residency-related outcomes are unknown. The authors systematically reviewed the impact of block versus traditional ambulatory scheduling on residency-related outcomes, including (1) resident satisfaction, (2) resident-perceived conflict between inpatient and outpatient responsibilities, (3) ambulatory training time, (4) continuity of care, (5) patient satisfaction, and (6) patient health outcomes.MethodThe authors reviewed the following databases: Ovid MEDLINE, Ovid MEDLINE InProcess, EBSCO CINAHL, EBSCO ERIC, and the Cochrane Library from inception through March 2017 and included studies of residency programs comparing block to traditional scheduling with at least one outcome of interest. Two authors independently extracted data on setting, participants, schedule design, and the outcomes of interest.ResultsOf 8139 studies, 11 studies of fair to moderate methodologic quality were included in the final analysis. Overall, block scheduling was associated with marked improvements in resident satisfaction (n = 7 studies, effect size range - 0.3 to + 0.9), resident-perceived conflict between inpatient and outpatient responsibilities (n = 5, effect size range + 0.3 to + 2.6), and available ambulatory training time (n = 5). Larger improvements occurred in programs implementing short (1 week) ambulatory blocks. However, block scheduling may result in worse physician continuity (n = 4). Block scheduling had inconsistent effects on patient continuity (n = 4), satisfaction (n = 3), and health outcomes (n = 3).DiscussionAlthough block scheduling improves resident satisfaction, conflict between inpatient and outpatient responsibilities, and ambulatory training time, there may be important tradeoffs with worse care continuity

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\u27 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\u27 self-reported increased confidence and intention to utilize ADEPT-CARE translates into the clinical setting