Transcript Document

Educating Medical Students
about the
Care of Patients with Disabilities
Kira Zwygart, MD
Laurie Woodard, MD
University of South Florida College of Medicine
Department of Family Medicine
Revised 3/6/08
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
Goals and Objectives of Curriculum
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
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
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.
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
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
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
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
Interdisciplinary Collaboration
• University
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UCEDD
School of Physical therapy
School of Dance and Theater
Department of Speech and Language
• Community
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ADA Liaison
Division of Blind Services
Parks and Recreation Dept
Independent Living Organizations
Special Olympics
And More…
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
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-today 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!”