1. Training Medical Students in Patient Care for People with Disabilities: A Pilot Clinical Encounter Program
Authors: Jill Crane, BA, Jessica Prokup, RN, BSN, Susan Havercamp, PhD, Allison Macerollo, MD, Karen Ratliff-Schaub, MD, A. Todd Lash, MA, Ann Robinson, BS The Ohio State University Nisonger Center, UCEDD/LEND
Background
Simulated Patients
Next Steps
Recent research indicates that individuals with intellectual and developmental disabilities (IDD) experience significant disparities in utilization of, access to, and quality of healthcare services, and that this is a pressing issue in the state of Ohio.1,2
Medical student education has been recommended to mitigate these disparities. Some additions to medical school curricula have included lectures, presentations, didactic training, and interacting with model patients.3,4,5
In recent years The Ohio State University College of Medicine (OSUCOM) has integrated a panel presentation on autism spectrum disorders into their curriculum.6
The present project expands the disability curriculum by providing medical students with an opportunity to interact with real people with disabilities (both developmental and physical) in a medical setting.
This program has been established in the OSUCOM curriculum, in the Patients Within Populations (Family Medicine/Pediatric ) ring during the 3rd year of the curriculum. An eventual goal for this encounter is to standardize it into a FOSCE or OSCE.
Our simulated patients, originally volunteers, have now been added to the same payroll as our standardized patients.
While a 4th year elective in developmental disabilities (DD) already exists at OSUCOM, we are working to expand the elective in order to accommodate more students.
26 simulated patients were recruited for the first run of the program, and 12 were recruited for the second run (5 returning from the first run).
We recruited simulated patients with developmental and/or physical disabilities, including but not limited to:
Autism spectrum disorder
Down syndrome
Intellectual disability
Cerebral palsy
Multiple sclerosis
Visual impairment
Traumatic brain injury
Simulated patients were given a brief presentation on providing constructive feedback to medical students and were provided a sheet of feedback guidelines to reference during the encounter.
Figure 2. Students answered questions about their simulated patient, for future analysis of whether type of disability influences student self-reported comfort and competence.
Results
References
Students indicated high levels of satisfaction with the simulated clinical encounter experience, both in the debriefing discussion and in survey responses.
Many students expressed that they would like more information on treating people with disabilities.
One of the most discussed topics during the group debriefing was the students’ need to change their clinical approach and how students made such changes to their communication with the simulated patient throughout the encounter.
Students in the first run of the program expressed that they would have liked to conduct another interview or observe another encounter, leading to the inclusion of a peer observation into the program. Satisfaction remained high with this addition.
Despite simulated patients receiving training on feedback, many students in both the first and second run of the program did not receive detailed feedback from their patients.
Havercamp, S. M., & Scott, H. M. (2015). National health surveillance of adults with disabilities, adults with intellectual and developmental disabilities, and adults with no disabilities. Disability and health journal, 8(2),
Prokup, J. A., Andridge, R., Havercamp, S. M., & Yang, E. A. (2017). Health care disparities of Ohioans with developmental disabilities across the lifespan. The Annals of Family Medicine, 15(5),
Minihan PM, Bradshaw YS, Long LM. Teaching about disability: involving patients with disabilities as medical educators. Disability Studies Quarterly. 2004;24(4).
Symons AB, McGuigan D, & Akl EA. A curriculum to teach medical students to care for people with disabilities: development and initial implementation. BMC Medical Education. 2009;9(78).
Woodard, L. J., Havercamp, S. M., Zwygart, K. K., & Perkins, E. A. (2012). An innovative clerkship module focused on patients with disabilities. Academic medicine, 87(4),
Havercamp, S. M., Ratliff-Schaub, K., Macho, P. N., Johnson, C. N., Bush, K. L., & Souders, H. T. (2016). Preparing Tomorrow's Doctors to Care for Patients With Autism Spectrum Disorder. Intellectual and developmental disabilities, 54(3),
Robey, K. L., Gwiazda, J., & Morse, J. (2001). Nursing students' self-attributions of skill, comfort, and approach when imagining themselves caring for persons with physical impairments due to developmental disability. Journal of Developmental and Physical Disabilities, 13(4),
Description of Program
The clinical encounters were modeled after Formative Observed Simulated Clinical Experiences (FOSCEs), which are already built into the OSUCOM curriculum and provide students with an applied, in-person setting to practice their clinical skills.
In the first run of the program, students:
Completed a pre-encounter survey
Received a brief description of their patient and their goal of collecting a social history
Engaged in a 20-minute clinical encounter with the patient
Completed the post-encounter survey
Participated in a debriefing discussion with a faculty member and other students
In the second run of the program, students completed steps 1-4, observed another student, then completed step 5, or observed another student, then completed steps 1-5.
Materials
A pre- and post-survey was administered to each student. This survey was made up of demographic questions, a modified version of an established self-report healthcare comfort and competence questionnaire, and an opportunity for students to share their thoughts on the encounter and how it might be improved.7
Figure 1. Healthcare comfort and competence questionnaire as modified for the pre-encounter survey.
Funded by the Maternal and Child Health Bureau Grant T73MC24481