Caring for Patients with Disabilities: A Curriculum for Medical Students

1
Caring for Patients with DisabilitiesA
Curriculum for Medical Students

• Presentation to NYU SOM Curriculum Committee
• June 2, 2005

2
Disabilities Curriculum Planning Group

• Felice Aull, PhD
• Julie Chase, PhD
• Alex Moroz, MD
• Dara Richardson-Heron, MD
• David Stevens, MD

3
Needs Assessment The US

• "Closing the Gap A National Blueprint to Improve
  the Health of Persons with Mental Retardation -
  Surgeon General Report highlighting disparities
  in health care for individuals with developmental
  disabilities (2002).
• "Healthy People 2010" found that people with
  neurodevelopmental disabilities are not receiving
  quality health care (Office of Disease Prevention
  and Health Promotion and U.S. Department of
  Health and Human Services).

4
Needs Assessment NYU

• 300 third and fourth year medical students at NYU
  surveyed by e-mail
• 86 students (29) responded to a 10-questions
  survey
• Results presented at the Association of Academic
  Physiatrists annual meeting this year
• Wong, F., Moroz, A. Experience with disability,
  perception of disability and its importance in
  medical education and interest in PMR a survey
  of medical students.American Journal of Physical
  Medicine and Rehabilitation, March 2005

5
(No Transcript)
6
(No Transcript)
7
Results
8
Current Teaching at NYU SOM

• PPS Patient Narrative Unit
• A small percentage of students interview
  hospitalized rehabilitation patients at Rusk
  Institute
• PPS Site Visit
• Students learn about community resources/organizat
  ions
• Literature, Arts and Medicine elective
• Examine how society constructs and views
  disability, and how impairment is experienced in
  our culture
• Rehabilitation Medicine elective
• 2 or 4 weeks at Rusk Institute and Bellevue
  Clinics focusing on physical disabilities

9
Current Teaching at NYU SOM

• Limitations
• No Explicit Curriculum
• Not Experienced by All Students

10
Whats Been Done Elsewhere? World Institute on
Disability Curriculum

• Workshop facilitators guide
• Video Access to Medical Care Adults with
  Physical Disabilities
• Workshop handouts
• Cases for discussion with stimulus questions
• Online resource guide, Bibliography
• Downloadable guides on disability
• Evaluation form
• Treating Adults with Physical Disabilities
  Access and Communication. A Training Curriculum
  for Medical Professionals on Improving the
  Quality of care for People with Disabilities

11
Goals for a Disabilities Curriculum at NYU

• Students will
• 1. Understand and empathize with the experience
  of disabled patients
• 2. Acquire basic knowledge of medical, legal, and
  societal aspects of disability
• 3. Learn to provide care that is patient-centered
  and respectful of both a patients abilities and
  disabilities, and to collaborate in helping
  patients maximize their function and well-being

12
Specific Objectives Attitudes

• Students will demonstrate competence in
• 1. Respect- focus on the person, not impairment
• 2. Commitment to Patient Empowerment
• bend the system to suit the person
• promote patient self-efficacy

13
Objectives Knowledge

• 1. Definitions impairment, disability,
  handicap
• 2. Legal/Public Policy Issues
• Americans with Disabilities Act
• Entitlements and finances
• 3. Patient/Caregiver Experience
• Sense of self, family dynamics, etc.
• 4. Role of physicians and rehabilitation team

14
Objectives Skills

• 1. Assessment
• Physical characteristics of patients disability
• Functional impact
• 2. Development of Therapeutic Relationship
• Listening- active and reflective
• Partnership- acknowledge and act on patients
  inventiveness and expertise in their particular
  disability
• 3. Creation of an interdisciplinary plan of care

15
Proposed CurriculumFirst Year Students

• Summary (5 hours total)
• 1. Sensitivity/Simulation Exercises (30 minutes)
• 2. Lecture - Overview of Disabilities(1 hour)
• 3. Patient Narrative Session (90 minutes)
• 4. Online Exercise (1 hour)

16
Student Assessment

• Attendance
• Narrative essay
• Online Quiz (multiple choice)

17
Proposed CurriculumSecond-Fourth Year Students

• Second Year
• Skills building seminar
• OSCE
• Third Fourth Year
• Advocacy paper to be related to their
  professional development portfolio.

18
Curriculum Assessment

• Pre and Post Curriculum Survey
• Attitudes
• Knowledge
• Online Course Evaluation