Newswise — Atlanta — There is considerable evidence to suggest that medical school curricula is lacking in education around treating people with physical disabilities. In a new study, presented this week at the Association of Academic Physiatrists Annual Meeting in Atlanta, researchers implement a new curriculum on this topic early in medical training and evaluate the learning of medical students experiencing this curriculum.
“Caring for patients with disabilities – particularly spinal cord injuries – is not a routine part of medical school training,” explains Adam Stein, MD; chairman and professor, Department of Physical Medicine and Rehabilitation; Zucker School of Medicine at Hofstra Northwell and co-investigator in the study. “However, 17 percent of Americans are disabled, and there are 17,000 new cases of spinal cord injury in the United States each year. Clearly there is a need for this type of training, which is why we initiated the study.”
To address this, Dr. Stein’s team developed an interactive curriculum for medical students and tested it during a two-hour session with 98 second-year medical students. The session began with a framing talk given by a physiatrist – a physician who manages conditions involving the nervous and musculoskeletal systems with a focus on function and restoring quality of life. This talk provided student participants with a background on the challenges of providing medical care for people with spinal cord injury and shared the stories of people who have sustained spinal cord injuries. After this initial talk, the students participated in small group discussions with spinal cord injury patients in which they acquired a medical history as if the patients were presenting to initiate care with a new provider. Finally, the students’ knowledge of, and attitudes around, treating people with disabilities was assessed through a standardized patient encounter, essay questions, and post-session survey.
The patient encounters showed 99 percent of student participants projected respect toward patients with disabilities in a post encounter assessment, and 69 percent projected empathy (the ability to understand and share the feelings of another person).
“The patient’s love the session,” Dr. Stein shares about patient feedback. “They enjoy the activity and they often bring humorous anecdotes from their experiences. Further, they appreciate that this curriculum may help produce physicians with enhanced ability to treat people with disabling conditions.”
The student participants’ general knowledge bladder, bowel, sexuality and skin health was assessed. While only 36 percent of participants demonstrated adequate knowledge of skin health, their knowledge of bowel, bladder and sexual function was higher (69, 72 and 94 percent, respectively).
Finally, Dr. Stein’s team tested knowledge around basic activities of daily living (e.g., feeding, grooming, bathing, dressing oneself, using the restroom, etc.) and the more complex instrumental activities of daily living (e.g., managing medication, shopping, cooking, arranging transportation, managing finances, etc.), which are essential for independent living. Student participants addressed these 73 and 85 percent of the time, respectively. Eighty-three percent of the participants included conversations around the patient’s caregivers as well. On written questions around these topics 64 percent of student participants scored a 75 percent or higher.
“Disability often creates a special set of medical susceptibilities and challenges that need to be understood and evoked by healthcare providers in order to provide optimal care to an increasingly large part of the population,” explains Dr. Stein. “Disability education must be included in medical training in the same way that women’s health has been included.”
To ensure this, Dr. Stein’s team been successfully implementing this in medical student training for the past six years – making modifications over time based on feedback from both medical student and patient participants.
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The Association of Academic Physiatrists (AAP) is the only academic association dedicated to the specialty of physiatry. The AAP is an organization of leading physicians, researchers, in-training physiatrists, and others involved or interested in mentorship, leadership, and discovery in physiatry. The AAP holds an Annual Meeting, produces a leading medical journal in rehabilitation, AJPM&R, and leads a variety of programs and activities that support and enhance academic physiatry. To learn more about the Association and field of physiatry, visit physiatry.org and follow us on Twitter using @AAPhysiatrists. To learn more about the AAP's 2018 Annual Meeting, visit physiatry.org/2018.
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