A curriculum on care for people with disabilities: Effects on medical student self-reported attitudes and comfort level

BackgroundEarly, frequent encounters with people with disabilities may improve medical students' knowledge, attitudes and skills regarding their care. We developed and implemented a longitudinal four-year curriculum addressing caring for people with disabilities.Objectives/hypothesisTo test differences in mean scores between intervention and control groups on individual post-survey items regarding attitudes toward people with disabilities, and to conduct exploratory procedures to examine individual factors that may account for group differences.MethodsStudents at two U.S. medical schools, one with the new curriculum, and one with no specific disabilities curriculum, were surveyed in Year 1 of medical school, prior to curriculum introduction, and again at the end of Year 3, using a validated 30-item instrument measuring medical students' self-reported attitudes and comfort toward people with disabilities. We compared mean item ratings between the two groups using χ² and ANOVA. Principal components analysis was then used to construct linear composite variables that were then regressed on potential predictors of attitudes and comfort level.ResultsThe intervention led to significant or near-significant improvement in several factors. However, male students in the intervention group, particularly those who encountered people with disabilities in a clinical context, had a tendency to more frequently agree with negative statements (β = .628, p = .005).ConclusionsExposure of medical students to a longitudinal curriculum for caring for people with disabilities led to significant improvement in several factors related to comfort and attitudes. The gender-related reinforcement of some negative attitudes merits further investigation and caution when implementing the curriculum in the future.     

Teaching sex education improves medical students' confidence in dealing with sexual health issues

Medical students at the University of Edinburgh in Scotland can volunteer to participate in an undergraduate options project that gives them the opportunity to provide sex education for secondary school (high school) pupils. Using a questionnaire presenting a set of fictional case histories, we assessed medical students' theoretical confidence at dealing with sexual health consultations. Students who had participated in delivering peer-led sex education felt significantly more confident at discussing sexual health issues with patients of all age groups (p = 0.001) than students who had not participated in the project. All students felt more comfortable seeing patients of the same gender as themselves but more than half felt that their training left them generally ill-equipped to handle sexual health consultations.     

15～59岁肢体残疾人群致残原因研究

目的 了解15～59岁肢体残疾人群的致残原因现状及近20年来该人群主要致残原因的变化.方法 对1987年和2006年两次全国残疾人抽样调查结果 中15～59岁肢体残疾人群致残原因的调查数据进行流行病学特征分析和比较.结果 2006年我国15～59岁肢体残疾人群的主要致残原因类别为疾病因素、伤害因素、先天性疾病及发育障碍和其他因素,致残率分别为0.720%、0.595%、0.224%和0.186%.其他外伤所致肢体残疾的致残率最高,为0.296%.与1987年调查结果 相比,疾病因素、伤害因素、先天性疾病及发育障碍的致残率均显著上升.2006年我国15～59岁肢体残疾人群的前五位致残原因分别是:其他外伤、脊髓灰质炎、骨关节病、脑血管疾病以及工伤;1987年前五位致残原因分别是:其他外伤、小儿麻痹、其他原因、不明原因和血管性疾病.结论 疾病因素和伤害因素是我国15～59岁肢体残疾人群的主要致残原因类别,其他外伤因素致残率最高;骨关节病和脑血管疾病逐渐成为我国15～59岁肢体残疾人群的主要致残原因.     

First year allopathic medical student attitudes about vaccination and vaccine hesitancy

First year medical students at an allopathic medical school regional campus were asked to complete a 10-question survey at both the beginning and the conclusion of a required course on immunology, hematology and oncology. The survey was designed to solicit student attitudes about vaccination and the students’ level of comfort with and exposure to vaccine hesitant patients. Surveys were administered to five consecutive classes from 2013 to 2017. Total response rate for completion of both surveys was 58.0% (178/307). Pre- and post-course surveys were administered to assess whether curricular experiences altered the students’ perceptions about vaccinations and their ability to counsel vaccine hesitant patients. Curricular elements were presented in several different formats aimed at increasing student knowledge about vaccinations and student capacity to work with vaccine hesitant patients and families (problem-based learning, didactic lecture and interactive panel discussion). In the pre-survey, the majority of students reported having already encountered people who decline vaccinations (78.8%). Additionally, in the pre-survey the majority of medical students expressed strong support for vaccination (99.6% agreed with the statement that Vaccinations are a great public health accomplishment) and strong disagreement with both of the assertions that childhood vaccines cause autism and vaccine preservatives cause adverse health effects. In response to questions about comfort level while talking with patients about vaccine choices, baseline responses demonstrated a moderately high level of comfort. Post-course surveys revealed a statistically significant increase in student-rated comfort level in talking with patients about vaccine choices (pre-survey 79.2% report comfort versus post 97.8%; p < 0.001). Though this study is limited to student self-reporting, survey responses suggest that targeted curricular elements can improve medical student confidence in counseling patients about vaccinations. Future curricular elements designed to directly observe student performance could provide verification of counseling skill acquisition.     

Routine identification of patients with disabilities in primary care: A mixed-methods study

BackgroundPeople with disabilities experience barriers to receiving healthcare and often have worse health outcomes, but data on disability is rarely routinely collected in a standardized way.ObjectiveThis study examined how patients responded to being asked about disabilities as part of a routine, self-administered sociodemographic survey.MethodsWe conducted a mixed-methods study in a multi-site primary care organization. We compared the characteristics of people who responded to a question about disabilities to those who did not respond using logistic regression. We also compared survey responses to data available in medical charts. In-depth interviews were conducted with a sample of patients following survey completion.ResultsOver 28 months, 15,221 patients were offered the survey and 14,247 (93.6%) responded to at least one question. Of these, 11,275 (79.1%) patients answered the question about disabilities. Older patients, patients who rented their home, and non-White patients were less likely to respond to the question. When comparing survey responses to data from medical charts we identified discrepancies. Patients interviewed reported they had difficulty judging what constituted a disability. Stigma related to mental illness and substance use led them to avoid disclosing those conditions.ConclusionsDirectly asking patients whether they have a disability may be challenging given confusion about what constitutes a disability and stigma associated with certain disabilities. Future research should examine whether asking about barriers faced in accessing health services could adequately identify patients with disabilities and also be used to identify tangible actions an organization could take to lower barriers to care.     

Understanding medical students' attitudes towards and experiences with persons with disabilities and disability education

BackgroundIn the United States, approximately one quarter of individuals are living with disabilities and receiving healthcare services. The undergraduate medical school curriculum provides an opportunity to improve the attitudes and skills of physicians working with persons with disabilities (PWD).Objective/hypothesisThe purpose of this study was to gain an understanding about fourth-year medical students’ self-reported attitudes towards and experiences with PWD and disability education. We hypothesized that medical students would recall having education about disabilities, would be able to identify a pivotal disability education experience, and would report being less comfortable working with PWD than persons without disabilities.MethodsThis mixed methods observational study was conducted via an online survey distributed to medical students during Winter 2020/2021. It contained an adapted instrument and a few short answer questions.ResultsOur survey had 44 respondents, a 28% response rate. Though 98% of students reported receiving disability education during one or more courses, 80% felt their disability education during medical school has been inadequate. Additionally, 64% reported having an influential learning experience involving PWD. Despite their attitudes, education, and experiences, respondents reported feeling less comfortable obtaining a history, performing a physical exam, and establishing a differential diagnosis when working with PWD.ConclusionsThis study highlights the need for continued development of disability curricula, which likely extends beyond the studied institution. Additional educational elements could be added to humanities sessions, as well as other courses and clerkships.     

Contraceptive knowledge and use among women with intellectual,physical, or sensory disabilities: A systematic review

Background

Women spend most of their reproductive years avoiding pregnancy. However, we know little about contraceptive knowledge and use among women with disabilities, or about strategies to improve contraceptive knowledge and decision-making in this population.

医学生与非医学生性健康教育需求比较研究

目的了解医学生与非医学生性健康教育的需求,为医学院校开展青春期性健康教育提供依据和指导。方法采用自编问卷,对广州某医科大学400名医学生与非医学生的性健康知识获取途径、教育需求、避孕及性病和艾滋病预防知识进行调查。结果医学生和非医学生获取性健康知识的主要途径相似,主要是书籍杂志（69．0％、70．0％）、互联网（32．0％、49．0％）、同学朋友（31．0％、37．O％）和电影电视（24．0％、39．0％）,而老师只分别占5．0％和19．0％;他们对避孕知识的了解均相当有限,知道安全套用法的非医学男生明显多于医学男生;大部分医学生和非医学生认为自己非常需要接受性健康教育。结论医学生与非医学生主要靠书籍杂志和互联网等获取性健康知识,均希望接受系统、专业的性健康教育,非医学生需求更大。     

某省级医院医学进修生教育教学效果情况分析

找出影响医学进修生教育教学效果的一些因素.从一家省级医院2001～2005年来接收的进修生中采取系统随机抽样的方法抽取639名进行问卷调查,就其教学效果情况进行统计分析.根据分析结果,找出了进修生的年龄、学历、资金来源等几种因素,并提出加强医学进修生教育教学效果的一些建议与措施,以期培养合格的基层医学人才.     

Adaptive parenting strategies used by mothers with physical disabilities caring for infants and toddlers

There is a paucity of information concerning adaptive parenting strategies utilised by mothers with physical disabilities, particularly during early motherhood. The purpose of this study is to describe the adaptive strategies used by mothers with physical disabilities during early motherhood. This qualitative study included semi‐structured telephone interviews between January and March 2014 with US mothers with a range of physical disabilities who had a baby within the past 10 years (N = 25). Interviews were audio‐recorded, professionally transcribed, and coded using content analysis. Analysis revealed five broad themes indicating important adaptive parenting strategies for mothers with physical disabilities caring for infants and toddlers: They are as follows: (a) acquiring or modifying baby‐care equipment, (b) adapting the home environment, (c) accessing information and supports, (d) developing communication strategies to facilitate safety, and (e) receiving assistance from others. This study indicates that mothers with physical disabilities employ a variety of adaptive strategies during early motherhood. The findings from the study suggest the need for more availability of supports and equipment for mothers with physical disabilities as well as information for prospective mothers with disabilities. In addition, healthcare and social work professionals must receive training about adaptive parenting strategies.     

Continuity of primary care and prenatal care adequacy among women with disabilities in Ontario: A population-based cohort study

BackgroundWomen with disabilities experience elevated risks for pregnancy complications and report barriers accessing prenatal care. Emerging evidence highlights the significant role primary care providers play in promoting preventive services like prenatal care.ObjectiveTo examine the relationship between continuity of primary care (COC) and prenatal care adequacy among women with disabilities.MethodsWe conducted a population-based study using health administrative data in Ontario, Canada. The study population included 15- to 49-year-old women with physical (n = 106,555), sensory (n = 32,194), intellectual/developmental (n = 1515), and multiple (n = 6543) disabilities who had a singleton livebirth or stillbirth in 2003–2017 and ≥ 3 primary care visits < 2 years before conception. COC was measured using the Usual Provider of Care Index. Nominal logistic regression was used to compute adjusted odds ratios (aOR) for prenatal care adequacy, measured using the Revised-Graduated Prenatal Care Utilization Index, for women with low versus moderate/high COC, controlling for other social and medical characteristics.ResultsWomen with disabilities with low COC, versus those with moderate/high COC, had increased odds of no (aOR 1.42, 95% CI 1.29–1.56), inadequate (aOR 1.19, 95% CI 1.16–1.23), and intensive prenatal care (aOR 1.22, 95% CI 1.19–1.25) versus adequate. In additional analyses, women with low COC and no/inadequate prenatal care were the most socially disadvantaged among the cohort, and those with low COC and intensive prenatal care had the greatest medical need.ConclusionImproving primary care access for women with disabilities, particularly those experiencing social disadvantage, could lead to better prenatal care access.     

An assessment of priority and educational value in a medical curriculum

A randomly selected group of teachers, students, first-year graduates (junior doctors in the first year of postgraduate training after their final medical school examination), general practitioners and specialists responded to a postal questionnaire designed to assess their views on the priorities in medical curriculum and the educational value attributed to its content. Comparisons were made among the five participating groups and the outcome of the assessment was compared with the existing curriculum.     

Improving capacity to care for patients with intellectual and developmental disabilities: The value of an experiential learning model for family medicine residents

BackgroundPatients with intellectual and developmental disabilities (IDD) are more likely to experience poor health outcomes and family physicians receive inadequate training to provide appropriate care to this patient group. Little prior research has studied how to effectively train family physicians to care for patients with IDD.ObjectiveThe aim of this pilot study was to assess the value of adding an experiential component to didactic education strategies to improve family medicine resident perceived comfort, skills and knowledge related to caring for patients with IDD.MethodsStructured education programs for residents were implemented at three primary care practices in Ontario, Canada. Two practices received didactic information only (didactic-only group); one received didactic information and an experiential training model including clinical interactions and a written reflection on that experience (didactic plus experiential group). In this separate-sample pre-post design, residents were invited to complete a brief anonymous survey prior to and following the training assessing their perceived comfort, skills and knowledge related to patients with IDD.ResultsAt baseline, there were no significant differences between the two groups of residents. At follow up, the experiential group reported significantly higher levels of comfort, skills, and knowledge compared to baseline for most items assessed, while in the didactic-only group most items showed little or no improvement.ConclusionThis pilot study suggests that providing residents the opportunity to participate in clinical encounters with patients with IDD, as well as a structured process to reflect on such encounters, results in greater benefit than didactic training alone.     

Impact of enjoyment on physical activity and health among children with disabilities in schools

Background

Enjoyment in school-based physical activity (PA) programs, such as recess or physical education may be important for promoting children's health, but there is a lack of evidence explaining how enjoyment affects health in children with disabilities.

新冠肺炎疫情防控常态化阶段某医科大学医学生知信行现状调查

目的了解新型冠状病毒肺炎(COVID-19)疫情防控常态化阶段医学生COVID-19知信行现状,为高校开展COVID-19防控工作提供参考。方法采用分层整群随机抽样方法,于2020年4—5月从某医科大学随机抽取不同专业、不同年级合计84个班级全部学生,采用结构式自编问卷进行线上调查。结果共回收有效问卷2 245份,其中临床医学、预防医学、护理学、临床药学和卫生检验与检疫专业学生分别为805人(35.8%)、435人(19.4%)、667人(29.7%)、132人(5.9%)和206人(9.2%)。COVID-19知识综合得分为(9.42±1.47)分,知晓率为91.2%。不同专业、年级、年龄和家庭人均年收入的学生COVID-19知识综合得分差异均有统计学意义(P<0.05或P<0.01);Logistic回归分析结果显示,年级是医学生COVID-19知晓情况的影响因素(P<0.05)。获取COVID-19知识的主要途径是微博、微信等社交平台(87.5%)和电视广播(82.1%)。学生关注COVID-19疫情态度持有率为96.1%,积极预防COVID-19态度持有率为99.7%,仅10.0%的学生感到恐惧焦虑。消毒、洗手和戴口罩等健康行为增加的医学生分别占73.1%、83.8%和90.7%,46.3%的医学生减少了体育锻炼健康行为。结论医学生COVID-19知信行情况良好,年级是医学生COVID-19知晓情况的影响因素。高校与相关部门应根据学生不同特征开展健康教育,提高健康素养,降低校园感染风险。     

标准化病人在医学教育和卫生保健研究中的应用进展

标准化病人(SP)作为许多国家医学教育的标准组成部分,是为医学生和医生提供宝贵临床技能培训和评估机会的专业人员。作者综述了SP在卫生保健领域的应用,并分析了相关优缺点。建议在我国继续深入SP的相关研究,加快建立SP在医学教育和卫生体系应用的正式制度,以提高医疗质量。     

The limits of tutors' comfort zones with four integrated knowledge themes in a problem-based undergraduate medical curriculum (Interview study)

PURPOSE: To explore how a cohort of problem-based learning (PBL) tutors (with diverse medical and other content expertise) conceptualised their students' integrated learning agenda, particularly for content less familiar to the vast majority, such as public health elements. SETTING: Problem-based undergraduate medical curriculum, The University of Liverpool, in its first-ever year. PARTICIPANTS: Foundation PBL tutors for Year 1 students, Semester 1. METHOD: A cross-sectional, semistructured telephone interview study was undertaken during spring 1997, with open-ended questions about Semester 1 experience of the four main themes. Qualitative data were analysed inductively and iteratively for emerging patterns and instances. RESULTS: All 34 tutors responded. Of these, 26/34 (76%) were male and 23 (68%) were medically qualified. Towards the end of each approximately (median) 20-minute interview, reflecting on the curriculum themes, tutors mostly identified with the basic/clinical science theme (Structure and Function). Almost half articulated a clear division (implicitly or explicitly 'fact' versus 'non-fact') between it and the 'other three' themes of behavioural science, population science, and ethicolegal aspects of professional practice, respectively. Only 14/34 (41%) of tutors (including both public health doctors) outlined the public health-based theme adequately without disclosing confusion, antagonism/indifference or difficulties/uncertainty. CONCLUSION: This study provides baseline qualitative insights about new PBL tutors' insecurities when facilitating student discussion across integrated content. Given the difficulties of recruiting suitable educators into this role and potential resource limitations, staff retention and development strategies still must confront the reality of PBL tutors' bemusement when they are placed outwith their usual comfort zones.