Meeting Students Where They Are: Educating Students with Varying Life Experiences About the Health Care Needs of Persons with Disabilities

Purpose: Medical students enter preclinical years with varying levels of experience with individuals with disabilities. Previous experience has been shown to have a significant impact on attitudes toward this population and, hence, has the potential to impact patient care (Tervo et. al, 2002). This study examined the impact of a one-day Interclerkship on students’ self-reports regarding specific components of their attitudes, by level and type of previous disability experience. Methodology: Students met with individuals with physical or cognitive disabilities and their families in small groups to discuss their health care needs and experiences. Students also viewed a short film regarding effective methods of communication with and modifications to the clinical encounter for individuals with physical disabilities. Afternoon workshops covered a wide array of topics including assistive technology, sexuality/childbirth, mental health, community resources and bladder management. Students reported levels of experience cognitive/physical: friends, relatives, schoolmates k-12 and college. 153 (77%) students over two years completed pre-and post-Interclerkship self-assessments that rated attitudes about medical care for patients with disabilities, using a 14-item 5-point Likert scale; means were compared by paired t-test. Students also provided course feedback. Results: There was a highly significant (pConclusions: A single-day Interclerkship improved the attitudes of students’ reporting all levels and types of disability experience

Meeting Challenges in Caring for Patients with Disabilities: An Interclerkship Course

Purpose: People with disabilities use healthcare services more than those without disabilities, yet healthcare systems often fail these individuals. Understanding the needs of those with physical and cognitive disabilities is crucial in providing them with appropriate healthcare. A one-day Interclerkship introduced third-year medical students to key challenges for physicians who care for disabled patients: (1) building trust and confidence, (2) communication, (3) anticipating secondary medical conditions, (4) appropriately modifying clinical encounters, and (5) identifying appropriate community resources. Methodology: Essential elements of patient-centered care for disabled individuals were presented in plenary sessions. In small groups, students met with individuals with physical or development disabilities, their families and their community advocates, discussing healthcare and access concerns. Other workshops, taught by clinical and community experts, addressed assistive technology, parenting challenges, mental health, community resources, sexuality, and end-of-life care. Sixty-seven (69%) students completed pre-and post-Interclerkship self-assessments that rated knowledge, skills, and attitudes about medical care for disabled patients, using a 14-item 5-point Likert scale; means were compared by paired t-test. Students also provided course feedback. Results: There was a highly significant (p80% of the students agreed or strongly agreed that the Interclerkship addressed a topic essential to physician training, providing knowledge and skills not obtained elsewhere. Conclusions: A single-day Interclerkship successfully improved third year medical students self-assessed knowledge, attitudes and skills on providing appropriate medical care for disabled patient. Presented at the AAMC (Association of American Colleges) Annual Meeting, RIME (Research in Medical Education) Program, November 2006

Training physicians about caring for persons with disabilities: Nothing about us without us!

According to the World Report on Disability, physicians worldwide generally lack training about caring for persons with disabilities, thus frequently compromising their health care experiences and health outcomes. Many U.S. physicians are similarly untrained about critical aspects of providing care to persons with disabilities, perhaps contributing to disparities in their care. Recognizing these inadequacies, U.S. medical educators are beginning to develop core competencies for trainees relating to the care of patients with disabilities, including understanding patients\u27 perceptions of their quality of life and skills in providing patient-centered care. Having today\u27s physicians, even when genuinely well-intentioned, retain control over designing disability-related training programs for future doctors may miss critical issues in caring empathically and effectively for persons with disabilities. Involving persons with disabilities in identifying training needs and implementing curricula for future physicians may offer important opportunities for ensuring their competency to provide patient-centered care to persons with disabilities

Unmet needs for home and community-based services among persons with disabilities in Massachusetts

BACKGROUND: Home and community-based services (HCBS) are vital to the health and well-being of persons with disabilities. However, no previous population-based studies have examined the prevalence of unmet needs for HCBS among working-age persons with disabilities. The purpose of this report is to document the prevalence of unmet need for HCBS among a representative sample of working-age persons with disabilities in Massachusetts. METHODS: Data from the 2007 Massachusetts Survey of Unmet Needs of Adults with Disabilities were analyzed. HCBS included in-home help, case-management, information, access to medical care, physical and occupational therapy, prescription drugs, meals, assistive technology, home adaptation, transportation, need for assistance with activities of daily living and instrumental activities of daily living (IADL) services. RESULTS: The prevalence of unmet need for HCBS was high, with more than two-thirds of respondents reporting at least 1 unmet need and more than 1 in 4 respondents reporting 4 or more unmet needs. The most prevalent unmet need included the need for information for disability-related services and legal rights, need for primary, specialty, and mental health care, case management services and the unmet need for IADL services. The unmet needs for HCBS were categorized into unmet needs relating to access to information and services and those relating to in-home supports. CONCLUSIONS: The study findings support the need to broaden the scope of HCBS for working-age persons with disabilities and to implement community-based programs such as improving access to information for services and benefits and enhancing access to in-home supports

A perinatal health framework for women with physical disabilities

BACKGROUND: Studies suggest that women with disabilities experience health and health care disparities before, during, and after pregnancy. However, existing perinatal health and health care frameworks do not address the needs and barriers faced by women with physical disabilities around the time of pregnancy. A new framework that addresses perinatal disparities among women with physical disabilities is needed. OBJECTIVE: To propose a framework for examining perinatal health and health care disparities among women with physical disabilities. METHODS: We developed a perinatal health framework guided by the International Classification of Functioning, Disability and Health (ICF) and the integrated perinatal health framework by Misra et al. RESULTS: The proposed framework uses a life span perspective in a manner that directly addresses the multiple determinants specific to women with physical disabilities around the time of pregnancy. The framework is based on longitudinal and integrated perspectives that take into account women\u27s functional status and environment over their life course. CONCLUSION: The perinatal health framework for women with physical disabilities was developed to inform the way researchers and health care professionals address disparities in perinatal health and health care among women with physical disabilities

Commentary: Defining Disability in Health Care Education

According to the 2008 American Community Survey, about 12% of the population of the United States is living with one or more disabling conditions. These conditions impact lives in a variety of ways, some with more or less direct impact on an individual\u27s health and access to health care services. Although it has been 20 years since the passage of the Americans with Disabilities Act, people with disabilities still experience health disparities and a lack of access to the appropriate care. This commentary is part of a collection of articles that describe various aspects of incorporating content into the medical school curriculum to enhance the preparation of today\u27s medical students to meet the needs of people with disabilities. The authors briefly describe the scope of the problem and define the population of people with disabilities that constitutes the focus of the work described in the other articles in this collection

Teaching medical students about disability: the use of standardized patients

Standardized patients (SPs), now a mainstay of the undergraduate medical education experience, are beginning to play larger roles in helping students build competencies to better serve patients who have disabilities, in educating students about the lived experiences of persons with disabilities, and in testing students\u27 understanding of disability-related issues. In this article, the authors discuss several U.S. training programs that involve SPs who have disabilities or SPs who do not have disabilities but who portray patients who do. The authors review the goals of each program (e.g., to provide students with opportunities to gain experience with patients with disabilities), describe their commonalities (enhancing students\u27 interview skills) and differences (some programs are educational; some are evaluative), and summarize the evaluative data of each. The authors also explore the benefits and challenges of working with SPs with disabilities and of working with SPs without disabilities. Finally, they consider the practical issues (e.g., recruiting SPs) of developing and implementing such programs

Prevalence and risk factors for postpartum depression symptoms among women with disabilities

The adverse consequences of postpartum depression on the health of the mother and her child are well documented. However, there is little information on postpartum depression among mothers with disabilities. This study examines the patterns of depression and depressive symptoms before, during and after pregnancy and the association between depression before and during pregnancy and postpartum depression symptomatology (PPD) among women with and without disabilities. Data from the 2009-2011 Rhode Island Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed in 2013. Almost 30% (28.9%; 95% CI 22.8-35.8) of mothers with disabilities reported often or always feeling down, depressed or sad after childbirth compared to 10% of those without disabilities (95% CI 8.9-11.3). Compared to other women in the study, women with disabilities had a greater likelihood for PPD symptoms (RR 1.6, 95% CI 1.1-2.2) after accounting for sociodemographics, maternal characteristics related to PPD, and depression before and during pregnancy. Adjusting for other covariates, self-reported prenatal diagnosis of depression was not associated with symptoms of PPD and depression during pregnancy was marginally associated with PPD symptomatology for women with disabilities. Women with disabilities are at a greater risk of experiencing symptoms of postpartum depression than other women. Screening for PPD among new mothers with disabilities and timely referral of those with PPD diagnosis are vital to the health of mothers with disabilities and their children

Teaching health care students about disability within a cultural competency context

The training of health care providers has been identified as key to resolving the health disparities experienced by persons with disabilities. We contend that: 1) cultural competency provides a useful conceptual framework for teaching disability-related content to health professions students; 2) educational experiences can be structured to reflect the socio-cultural complexity of the \u27disability culture;\u27 3) desired competencies associated with culture can be defined with regard to professionals\u27 approach to patients with disabilities; 4) exposure to persons who have disabilities in their homes allows the student to make connections between the nuances of daily life with a disability and one\u27s health care needs; 5) the framework allows the disability culture to be integrated with other cultural contexts, including race and ethnicity; and 6) the framework acknowledges the potential impact of providers\u27 conscious or unconscious recognition of their potential membership in the disability culture on their approach to patients with disabilities