in Medical Education Danbi Lee PhD OTD OTRL Department of rehabilitation medicine amp disability studies program University Of Washington Acknowledgement University of Washington Center for Health Workforce Studies ID: 1034243
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1. Disability Competency Training in Medical Education Danbi Lee, PhD, OTD, OTR/LDepartment of rehabilitation medicine & disability studies programUniversity Of Washington
2. AcknowledgementUniversity of Washington Center for Health Workforce StudiesHealth Workforce Research Center for Health Equity funded by the Health Resources and Services Administration (HRSA) Research TeamSamantha Pollack, MHSTracy Mroz, PhD, OTR/L Bianca Frogner, PhDSusan Skillman, MS
3. BackgroundPeople with disabilities experience persistent disparities in health status and health care. One of the barriers is the lack of training among health care providers addressing negative attitudes towards disability and the wide range of health care needs of people with disabilities.Disability competency training is not a priority in medical education because it is not required for medical school accreditation or licensure in the U.S.
4. Background: Disability Core Competencies“Core Competencies on Disability for Health Care Education” established by the Alliance for Disability for Health Care EducationSix core competencies and 49 sub-competencies Contextual and conceptual frameworks on disabilityProfessionalism and patient-centered careLegal obligations and responsibilities for caring for patients with disabilitiesTeams and systems-based practiceClinical assessmentClinical care over the Lifespan and during Transitions
5. Research AimsTo explore the extent to which medical education addresses the Disability Core Competencies and how the competencies are addressed.To understand facilitators and barriers to integrating disability competency training into medical education.
6. Online survey 23 questions on Disability Core Competencies addressed in curriculum, specific learning activities, and facilitators and barriers to integration of disability competency training.Distributed to all allopathic and osteopathic medical schools in the U.S. (n=196) between February – June 2020Qualitative interviews 30-minute semi-structured individual interviewsConvenience (volunteers) and purposeful samplingMethods: Data CollectionExplanatory mixed methods design
7. Methods: Data AnalysisQuantitative data: Descriptive analysisOpen-ended questions: Coded and categorizedQualitative interviews: Thematic analysis
8. Participants14 survey respondentsCharacteristics of medical programs Count (%)Degree typeMD11 (78.6) DO3 (21.4)Census region South7 (50.0) Midwest 3 (21.4) Northeast2 (14.3) West2 (14.3)Cohort size100+ students 11 (78.6) 75-99 students 2 (14.3) 50-74 students1 (7.1)Institution typePublic10 (71.4) Private4 (28.6)5 interview participants Characteristics of medical programsCountDegree typeMD5Census regionWest2Midwest 1Northeast1South1Cohort size100+ students475-99 students1Institution typePublic4Private1
9. Disability Core Competencies AddressedMany of the Core Competencies were addressed in the curriculum Majority of schools (n=11) addressed five to all six Core Competencies. Disability Core Competencies addressed through learning activities (n=14) Count (%)Contextual and conceptual frameworks on disability13 (92.9)Teams and systems-based practice13 (92.9)Professionalism and patient-centered care12 (85.7)Clinical assessment11 (78.6)Clinical care over the lifespan and during transitions9 (64.3)Legal obligations and responsibilities7 (50)Number of Disability Core Competencies addressed by schoolsCount (%) Six Disability Core Competencies6 (42.9%)Five Disability Core Competencies5 (35.7%)Four Disability Core Competencies1 (0.07%)One Disability Core Competency2 (14.3%)
10. Learning Activities Addressing Core CompetenciesLength: mostly single 45- to 90-minute sessionsFormat: A mix of lectures, case studies, panel discussions, small group discussions, encounters with people with disabilities or standardized patients, community engagementMost learning activities were required and completed during the first two years of medical education“I think a better way to get more disability into the curriculum would be to put more examples of people with disabilities...peppered throughout... [T]here's nothing in the third and fourth year where people necessarily come together to think back on what they learned in the first two years…So it's completely hit or miss what they get.”
11. Learning Activities Addressing Core CompetenciesContent:Ableism and implicit bias, and lived experiences of people with disabilities, disability etiquette in clinical settingDisability competency training yet within the medical model Medical model Social model“I would love to have more of the faculty appreciate disability…as an identity, instead of as a negative health outcome…. they’re subject to the same social determinants of health as people in other minority populations.”
12. Learning Activities Addressing Core CompetenciesInvolvement of individuals with disabilities: People with disabilities, when involved in the training, were primarily involved as panelists or patients. Involvement of people with disabilities in disability competency training (n=12) Count (%)Sharing experience/ knowledge in panels or lectures (as "peer experts") 9 (75.0)Interacting with students as patients (e.g., lab, role-play, interview) 7 (58.3)Involved as planning/ advisory members (as "peer educators")4 (33.3)Instructor identifies as someone with a disability 4 (33.3)Not directly involved 3 (25.0)
13. FactorsCount (%)Facilitators Faculty champion11 (84.6)Support of academic leadership8 (61.5)Partnership with community-based disabilities organizations7 (53.8)Student advocacy/champion5 (38.5)Faculty with a disability3 (23.1)Past or current student(s) with a disability2 (15.4)Medical school staff (non-faculty) with a disability1 (7.7)Barriers Lack of time in current curriculum to add new content10 (90.9)Inadequate resources (e.g., funding, time to restructure curriculum)5 (45.5)Lack of faculty to teach disability-related content2 (18.2)Lack of learning materials for curriculum development (e.g. readings, video sources)2 (18.2)Lack of relationships with community-based disability organizations1 (9.1)Facilitators and Barriers to Integrating Disability Competency Training
14. Influence of curricular structure and time Limited curriculum time due to competing requirements“finding a foothold in the curriculum is huge. It’s really hard. You fight for your 2 hours.” Weaving disability content into other threads of diversity, health equity, and social determinants of health. “I was able to make the case that disability is totally appropriate in the context [of understanding social determinants of health]…”Obtaining a grant to develop disability content and “to get a foot in the door”
15. Need for a champion and resources Vital role of a champion to help integrate disability competency training“I have so much respect for what they [champions] are able to do and the blood and tears and sweat that they put into making changes at their institution. But, it’s not sustainable, and it’s not scalable…[A]s soon as the champion retires, there’s like a sell-by date on the content and the curriculum. It just cannot withstand the forces of the demands on the curriculum.”Importance of institutional support and resources
16. DiscussionLimitations: Low response rate, potential response bias, no saturation. There were few opportunities for students to gain in-depth understanding of disability and the care people with disabilities need. Given limited time in the curriculum, medical curricular could benefit from multiple opportunities for scaffolding that are integrated into cases and discussions around diversity.
17. DiscussionPrograms needed a faculty champion to push disability competency training into part of the curriculum due to competing curricular content.Accreditation level requirements would help integrate disability competency training in schools where champions or resources are not present and where curriculum time can be difficult to negotiate.
18. ResourcesCore Competencies on Disability for Health Care Educationhttps://nisonger.osu.edu/wp-content/uploads/2019/08/post-consensus-Core-Competencies-on-Disability_8.5.19.pdf Ankam NS, Bosques G, Sauter C, et al. Competency-Based Curriculum Development to Meet the Needs of People With Disabilities: A Call to Action. Academic Medicine. 2019;94(6):781-788. doi:10.1097/ACM.0000000000002686Iezzoni LI, Long-Bellil LM. Training physicians about caring for persons with disabilities: “Nothing about us without us!” Disability and Health Journal. 2012;5(3):136-139. doi:10.1016/j.dhjo.2012.03.003