Project Description:
People with intellectual/developmental disabilities (I/DD) are an under-recognized group who suffer from health disparities. Due to advances in the medical care of children with I/DD, people with I/DD are living longer and require additional supports for themselves and their families as they age. Changes in policy over the last few decades have meant that the overwhelming majority of people with I/DD live in the community and rely on physicians in their communities for care.
Health care settings are not accessible to people with I/DD. The majority of physicians have limited knowledge regarding the health and psychosocial needs of this population, primarily due from a lack of exposure and training. Despite having higher rates of chronic disease than the neurotypical population, people with I/DD are less likely to receive preventive care and screenings. They are also less likely to be asked preventive health-related questions. The goal of the NCIDM project is to provide training to medical students in the field of developmental medicinethe care of individuals with I/DD across the lifespan.
In accordance with the principle of nothing about us without us, it is essential to include self-advocates with I/DD in these efforts. Previous contact with people with disabilities, specifically close contact, along with prior knowledge about disabilities, impact the attitudes of medical students towards people with disabilities (Sahin and Akyol, 2010). Results of a survey of UACOM-T medical students suggested students were most interested in social issues surrounding disability in the medical context, and wanted to learn from people with disabilities and their families (Kennedy et al, 2017).
Introducing new material into medical school curricula has a number of barriers, including curriculum crowding. This generally limits the addition of a stand-alone course in disability medicine to elective time. While electives are an important part of the strategy to enhance medical student education, the addition of disability medicine topics to the required portion of the curriculum increases the level of education among medical students more broadly.
Opportunities for topics in disability medicine occur throughout the four-year medical curriculum. Integration of new curricular topics in an integrated fashion across the medical school curriculum has proven to be effective in nutrition education at the UACOM-T (Taren et al, 2001) and elsewhere (Ball et al, 2014).
The investigators propose to implement sustainable curricular changes at the Univserisyt of Arizona College of Medicine Tucson,, guided by the NCIDM Medical Student Goals and Objectives, in the preclinical and clinical curriculum of the University of Arizona College of Medicine-Tucson. A primary component of these enhancements is a partnership with self-advocates and with Special Olympics Arizona. The goals are to increase knowledge of developmental medicine, enhance comfort with caring for and working with people with I/DD, and improve attitudes toward I/DD.
The structure of the UACOM-T curriculum provides many opportunities for this type of curricular enhancement. The curriculum is an integrated progressive curriculum that takes a holistic view of the human body and of medical knowledge. Clinical training begins early in the educational program, and basic science lessons continue during the clinical years. The pre-clerkship phase is 18 months long and is comprised of eight basic sciences core courses which integrate basic science and clinical learning around specific systems or topics, and two longitudinal courses: Doctor & Patient/Societies and Clinical Reasoning. The next 12 months includes seven core clerkship courses as well as Intersessions (which provide an opportunity to reintegrate basic science with new clinical learning), and Transition to Clerkships. The final 14 months of the clinical curriculum includes time for electives in addition to five required courses. Finally, Pathways in Health and Medicine is a longitudinal social science course with educational goals that are met longitudinally through the entire four-year curriculum.
The investigators will use five strategies/activities to enhance curricular content in disability medicine in the curriculum. They include:
1) Introducing special considerations for people with I/DD to first year medical students in the physical examination and medical interview portions in the Doctor and Patient curriculum
2) Increasing the number of self-advocates working with small inter-professional groups in a required inter-professional teaching activity in disability for first year medical students
3) Introducing a small group training lab with self-advocates acting as standardized patients that provides feedback to second year medical students
4) Introducing positive video introductions (FRAME) to people with specific disabilities to second year medical students
5) Designing and implementing a fourth-year medical school elective in disability medicine
