Students Supported by Medical Technology: Making the Transition From School to Adult Life

Transition planning for young adults with disabilities has been identified as a critical element if students are to successfully move from the safety-net of high school into adult life. Focusing on transition has become a priority for two disciplines: education and medicine. Yet, despite the importance these two fields have placed on it, few studies have addressed the transition planning issues specifically related to students with disabilities supported by medical technology. This research employed longitudinal interview techniques to gather information regarding the transition experiences of family members and students supported by medical technology. Three major themes emerged: (a) future expectations of students and parents; (b) implementation of transition planning; and (c) participation and involvement in transition planning. The unexpected factor of a student's level of cognitive impairment appeared to impact several of the findings. Overall, results of this study indicated that the majority of students supported by medical technology appeared to be receiving minimal planning during transition. The findings are discussed in terms of implications both for planning for the transition from school to adult life as well as the transition to adult health care systems.     

Interpersonal Sources of Conflict in Young People with and without Mild to Moderate Intellectual Disabilities at Transition from Adolescence to Adulthood

Background Interpersonal conflict is a source of stress and contributes to poor mental health in people with mild to moderate intellectual disabilities. Understanding the contexts in which conflict typically occurs can better equip services to help people with such difficulties. However, existing studies into the contexts of conflict have included participants with wide‐ranging ages and may not reflect the experiences of young adults in particular. Materials and Methods Twenty‐six young adults (16–20 years) with intellectual disabilities and 20 non‐disabled young adults completed a semi‐structured interview about a recent experience of interpersonal conflict. Participants were asked to describe their beliefs and feelings about the event and their subsequent response. Results Participants with intellectual disabilities were more likely to encounter conflict with strangers or peers outside their friendship group and to describe incidents of aggression than non‐disabled participants. They were also more likely to characterize the other person globally as ‘bad’ and to perceive the other’s actions as being personally directed at them. Young women with intellectual disabilities were less likely to describe responding aggressively to incidents. Conclusions Findings suggest that young adults with intellectual disabilities are often the target of overt aggression from those outside their inner social sphere, while their non‐disabled peers are more likely to experience conflict with people close to them. Young adults with intellectual disabilities may also be more likely to feel victimized by interpersonal conflict. Implications of these findings and limitations of the study are discussed.     

Medical Student Perceptions of the Learning Environment in Medical School Change as Students Transition to Clinical Training in Undergraduate Medical School

Phenomenon: The learning environment is the physical, social, and psychological context in which a student learns. A supportive learning environment contributes to student well-being and enhances student empathy, professionalism, and academic success, whereas an unsupportive learning environment may lead to burnout, exhaustion, and cynicism. Student perceptions of the medical school learning environment may change over time and be associated with students' year of training and may differ significantly depending on the student's gender or race/ethnicity. Understanding the changes in perceptions of the learning environment related to student characteristics and year of training could inform interventions that facilitate positive experiences in undergraduate medical education. Approach: The Medical School Learning Environment Survey (MSLES) was administered to 4,262 students who matriculated at one of 23 U.S. and Canadian medical schools in 2010 and 2011. Students completed the survey at the end of each year of medical school as part of a battery of surveys in the Learning Environment Study. A mixed-effects longitudinal model, t tests, Cohen's d effect size, and analysis of variance assessed the relationship between MSLES score, year of training, and demographic variables. Findings: After controlling for gender, race/ethnicity, and school, students reported worsening perceptions toward the medical school learning environment, with the worst perceptions in the 3rd year of medical school as students begin their clinical experiences, and some recovery in the 4th year after Match Day. The drop in MSLES scores associated with the transition to the clinical learning environment (?0.26 point drop in addition to yearly change, effect size = 0.52, p < .0001) is more than 3 times greater than the drop between the 1st and 2nd year (0.07 points, effect size = 0.14, p < .0001). The largest declines were from items related to work–life balance and informal student relationships. There was some, but not complete, recovery in perceptions of the medical school learning environment in the 4th year. Insights: Perceptions of the medical school learning environment worsen as students continue through medical school, with a stronger decline in perception scores as students' transition to the clinical learning environment. Students reported the greatest drop in finding time for outside activities and students helping one another in the 3rd year. Perceptions differed based on gender and race/ethnicity. Future studies should investigate the specific features of medical schools that contribute most significantly to student perceptions of the medical school learning environment, both positive and negative, to pinpoint potential interventions and improvements.     

Emergency Medicine Career Change: Associations with Performances in Medical School and in the First Postgraduate Year and with Indebtedness

Objective: Emergency medicine has been identified as the specialty that has gained the most young physicians who have changed their careers. To identify factors that may have contributed to such career changes, the authors compared the characteristics of three groups of physicians trained at their medical school: those who chose and stayed in emergency medicine, those who migrated into emergency medicine from other specialties, and those who moved out of emergency medicine.
Methods: A prospective longitudinal study was conducted. The sample consisted of physicians who chose emergency medicine as their careers at graduation and stayed in the specialty ( n = 24), those who migrated from other specialties into emergency medicine ( n = 51), and those who moved out of emergency medicine ( n = 10). This sample was obtained from a total of 2,173 graduates of Jefferson Medical College between 1978 and 1987. The three groups of physicians were compared according to their academic performances both during medical school and after graduation. The dependent variables were freshman and sophomore grade point averages (GPAs), written clinical examination scores, scores on National Board of Medical Examiners examination (Parts I, II, and III), and residency program directors' ratings. Age and indebtedness at medical school graduation and board certification status also were examined.
Results: Those physicians who stayed in emergency medicine and those who migrated from other specialties into emergency medicine had similar measures of academic performance, but both of these groups had higher academic performance measures and higher board certification rates than did the physicians who moved out of emergency medicine. Those who stayed in emergency medicine had the highest mean debt in the senior year of medical school.
Conclusions: High academic performance and high indebtedness are factors associated with choosing or staying in the specialty of emergency medicine.     

Spelling on the Fly: Investigating a Pentop Computer to Improve the Spelling Skills of Three Elementary Students with Disabilities

The purpose of this study was to examine the effects of a pentop computer and accompanying spelling software on the spelling accuracy and academic engagement behavior in three elementary students with disabilities who were served in a resource room setting. Using a multiple baseline across students single subject research design, researchers determined student use of the pentop computer—the FLYPen?—and its spelling software may serve as an equivalent intervention to traditional spelling instruction. While academic engagement performance increased considerably for students when using the FLYPen?, results indicated little to no improvement over traditional instruction in spelling accuracy. Implications and suggestions for future research are presented.     

Access to Secondary Healthcare for People with Intellectual Disabilities: A Review of the Literature

Background There is growing evidence that people with intellectual disabilities have greater healthcare needs than the general population and that these needs are often unmet. Recently, increasing attention has been drawn to poor care received by people with intellectual disabilities when admitted to hospital. Method A literature search was conducted to identify studies on experiences of secondary healthcare for people with intellectual disabilities. Studies were published between January 1990 and March 2008. Results Thirteen studies were identified. Important influences on the experience of hospital care were: individual factors; the carer’s role; the attitudes, knowledge and communicative style of health staff; and the physical environment. A range of recommendations and initiatives have been developed to improve hospital care. Conclusion More research is needed, given that so few studies are published in this area. Initiatives to improve access to secondary healthcare need to be evaluated to inform the development of services.     

Teaching Translational Research to Medical Students: The New York University School of Medicine's Master's of Science in Clinical Investigation Dual‐Degree Program

To develop the next generation of translational investigators, New York University School of Medicine (NYUSOM) and the NYU‐NYC Health and Hospitals Corporation Clinical and Translational Science Institute (NYU‐HHC CTSI) developed the Master''s of Science in Clinical Investigation dual‐degree (MD/MSCI) program. This 5‐year program dedicates 1 year to coursework and biomedical research, followed by a medical school/research overlap year, to prepare students for academic research careers. This paper details the MD/MSCI program''s curriculum and approach to mentorship, describes the research/professional interests of students, and reports student productivity. In the first 4 years of the program (2010–2014) 20 students were matriculated; 7 (35%) were women, and 12 (60%) research projects were in surgical specialties. To date, 14 students have applied to residency, and half pursued surgical residency programs. Our students have produced 68 accepted abstracts, 15 abstracts in submission, 38 accepted papers, and 24 papers in submission. Despite the time‐limited nature of this program, additional training in research design and implementation has promoted a high level of productivity. We conclude that dual‐degree training in medicine and translational research is feasible for medical students and allows for meaningful participation in valuable projects. Follow‐up is warranted to evaluate the academic trajectory of these students.     

The Effects of Self-Regulation Strategies on Goal Attainment for Students with Developmental Disabilities in General Education Classrooms

Self-regulation and other student-directed learning strategies have the potential to benefit students with developmental disabilities and mental retardation in general education classrooms. However, to date, there is little information about use of such strategies in general education classrooms, particularly at the secondary education level. This study examined the effect of a self-regulation multicomponent process (antecedent cue regulation or self-monitoring with self-evaluation and self-reinforcement) with 3 students with developmental disabilities in typical classrooms. Use of the self-regulation strategies improved adaptive behaviors related to class participation or decreased problem behaviors for all students. Also, teachers working with students indicated that they had exceeded their expectations for achieving goals related to the target behaviors. The potential for use of self-regulation strategies to promote successful inclusion is discussed.     

The Action Research Program: Experiential Learning in Systems-Based Practice for First-Year Medical Students

Problem: Systems-based practice focuses on the organization, financing, and delivery of medical services. The American Association of Medical Colleges has recommended that systems-based practice be incorporated into medical schools’ curricula. However, experiential learning in systems-based practice, including practical strategies to improve the quality and efficiency of clinical care, is often absent from or inconsistently included in medical education. Intervention: A multidisciplinary clinician and nonclinician faculty team partnered with a cardiology outpatient clinic to design a 9-month clerkship for 1st-year medical students focused on systems-based practice, delivery of clinical care, and strategies to improve the quality and efficiency of clinical operations. The clerkship was called the Action Research Program. In 2013–2014, 8 trainees participated in educational seminars, research activities, and 9-week clinic rotations. A qualitative process and outcome evaluation drew on interviews with students, clinic staff, and supervising physicians, as well as students’ detailed field notes. Context: The Action Research Program was developed and implemented at the University of California, San Francisco, an academic medical center in the United States. All educational activities took place at the university's medical school and at the medical center's cardiology outpatient clinic. Outcome: Students reported and demonstrated increased understanding of how care delivery systems work, improved clinical skills, growing confidence in interactions with patients, and appreciation for patients’ experiences. Clinicians reported increased efficiency at the clinic level and improved performance and job satisfaction among medical assistants as a result of their unprecedented mentoring role with students. Some clinicians felt burdened when students shadowed them and asked questions during interactions with patients. Most student-led improvement projects were not fully implemented. Lessons Learned: The Action Research Program is a small pilot project that demonstrates an innovative pairing of experiential and didactic training in systems-based practice. Lessons learned include the need for dedicated time and faculty support for students’ improvement projects, which were the least successful aspect of the program. We recommend that future projects aiming to combine clinical training and quality improvement projects designate distinct blocks of time for trainees to pursue each of these activities independently. In 2014–2015, the University of California, San Francisco School of Medicine incorporated key features of the Action Research Program into the standard curriculum, with plans to build upon this foundation in future curricular innovations.     

Care Management Arrangements in Services for People with Intellectual Disabilities: Results of a National Study

Background Care management is the formal mechanism for linking people with intellectual disabilities with public services but little is known about these arrangements. This paper present findings from a national survey. Materials and Methods The questionnaire covered aspects of care management arrangements and was specific to services for people with intellectual disabilities. They were sent to all social services departments in England. Results The response rate was 81%. Variations were found in organizational arrangements, the performance of key care management tasks, and the degree of differentiation in approach according to need. Local authorities also differed in arrangements for person centred planning. Conclusions Further review of the relative efficiency and effectiveness of different care management approaches is needed to inform policy development and promote consistency in services for people with intellectual disabilities.     

Consumer‐Directed Goal Planning in the Delivery of Assistive Technology Services for People who are Ageing with Intellectual Disabilities

Background A consumer‐directed service‐delivery approach to assistive technology and environmental modification intervention was examined with people who were ageing with intellectual disabilities. Material and Methods The intervention was based on a collaborative approach involving consumers, their social supports and service deliverers. Thirty individuals were randomly selected to receive the intervention from a sample of 75 community‐dwelling adults. Outcomes related to consumers’ and significant others’ perceptions of performance and satisfaction with goal attainment were assessed and the consumer‐directed goal planning process examined. Results Participants in the intervention group reported significantly higher levels of performance and satisfaction related to goals identified at baseline than participants in the control group. Two broad categories of goals were addressed during the intervention – basic self‐care goals and participation/environmental/systems level goals. A 98% direct agreement rate between consumer‐identified goals and goals addressed by service deliverers was found during the intervention. Of the environmental strategies employed during the intervention, assistive devices and systems level advocacy and action were the two most frequently used across goals. Conclusion Results provide evidence in favour of a consumer‐directed approach to assistive technology and environmental modification service delivery for consumers who are ageing with intellectual disabilities.     

Preparing nurse scientists for health services and policy research: Five-year outcomes of interprofessional postdoctoral training in the National Clinician Scholars Program

BackgroundThe National Clinician Scholars Program (NCSP) is an interprofessional postdoctoral fellowship for physicians and nurses with a PhD. or DNP focused on health services research, policy, and leadership.PurposeTo evaluate 5-year outcomes of nurse postdoctoral scholars in the NCSP.MethodsWe describe the 5-year outcomes of nurse fellows and graduates from six NCSP sites (positions, number of peer-reviewed publications, citations, and h-index).ConclusionThere were 53 nurses in the sample (34 alumni, 19 fellows). Approximately half (47%, n = 16) of alumni had tenure-track faculty positions and had bibliometric performance indicators (such as h-indices) 2 to 4 times greater than those previously reported for assistant professors in nursing schools nationally. NCSP nurse scholars and alumni also had an impact on community partnerships, health equity, and health policyDiscussionThis study highlights the potential of interprofessional postdoctoral fellowships such as the NCSP to prepare nurse scientists for health care leadership roles.     

Resources,Staff Beliefs and Organizational Culture: Factors in the Use of Information and Communication Technology for Adults with Intellectual Disabilities

Background Access to, and the use of, information and communication technology (ICT) is increasingly becoming a vital component of mainstream life. First‐order (e.g. time and money) and second‐order factors (e.g. beliefs of staff members) affect the use of ICT in different contexts. It is timely to investigate what these factors may be in the context of service provision for adults with intellectual disabilities given the role ICT could play in facilitating communication and access to information and opportunities as suggested in Valuing People. Method Taking a qualitative approach, nine day service sites within one organization were visited over a period of 6 months to observe ICT‐related practice and seek the views of staff members working with adults with intellectual disabilities. All day services were equipped with modern ICT equipment including computers, digital cameras, Internet connections and related peripherals. Results Staff members reported time, training and budget as significant first‐order factors. Organizational culture and beliefs about the suitability of technology for older or less able service users were the striking second‐order factors mentioned. Despite similar levels of equipment, support and training, ICT use had developed in very different ways across sites. Conclusion The provision of ICT equipment and training is not sufficient to ensure their use; the beliefs of staff members and organizational culture of sites play a substantial role in how ICT is used with and by service users. Activity theory provides a useful framework for considering how first‐ and second‐order factors are related. Staff members need to be given clear information about the broader purpose of activities in day services, especially in relation to the lifelong learning agenda, in order to see the relevance and usefulness of ICT resources for all service users.     

Outcomes and Costs of Residential Services for Adults with Intellectual Disabilities in Taiwan: A Comparative Evaluation

Background The disability policy in Taiwan has traditionally emphasized residential care in large institutions and, more recently, medium‐sized group homes. This paper compares the relative costs, services provided and outcomes between the traditional institutions, medium‐sized group homes and new small‐scale community living units that were launched in 2004 in Taiwan. Materials and Methods Cross‐sectional analysis was used to investigate the three current residential service models. A total of 248 participants with intellectual disabilities were interviewed, including all residents from the existing 25 small residential units and purposively sampled respondents from the other two residential models. Results Outcomes for the Taiwanese participants were consistent with the existing literature on deinstitutionalization from Western societies. Small homes provided better subjective and objective quality of life than both medium‐sized community‐based units and traditional institutions. Conclusion Participants living in small residential homes experienced better outcomes at lower cost than persons living in medium‐sized group homes or institutions.     

Participation in science and engineering laboratories for students with physical disabilities: survey development and psychometrics

Abstract

Purpose: The purpose of this study is to address the development of the Full Participation Science and Engineering Accessibility (FPSEA) self-report survey that gathers experiences from students with physical disabilities (SwD-P) using a postsecondary laboratory and to evaluate the survey’s stability.

Methods: Survey items were generated from an extensive literature review and recommendations articulated by experts. Think-aloud sessions and content validity index (CVI) were used to determine survey content validity and help finalize survey items. Individuals with physical disabilities (n?=?20) who have taken a postsecondary science or engineering laboratory course completed the survey and took it again 10–14 days apart. The test–retest reliability was assessed using Spearman Rho coefficients for Likert-scale items, Chi-square and Fisher’s exact test for the dichotomous items. Missing data completely at random (MCAR) test was computed before reliability data analysis.

Results: Each sub-item passed the MCAR test, indicating that the data are missing completely at random and can be imputed to perform the analysis. Reliability analysis was completed on 20 individuals. The FPSEA had good content reliability: the item-level CVI of items kept ranged from 0.86 to 1. The scale-level CVI was 0.94. Stability was demonstrated with adequate Spearman correlation ranged from 0.56 to 0.86.

Conclusions: No previous survey had been developed linking SwD-P and the postsecondary science and engineering (S&E) laboratory setting prior to this work. Overall, FPSEA is reliable and stable for reporting the barriers and facilitators to use S&E laboratories from the SwD-P’s perspective.

• Implications for rehabilitation

• The barriers students with disabilities encounter in S&E laboratory environments are largely unknown.

• The FPSEA survey may help identify barriers and facilitators to using S&E laboratories for SwD-P.

• The FPSEA Survey allows former and current SwD-P to share their experiences using a postsecondary S&E instructional laboratory.

     

脑性瘫痪儿童辅助技术产品的进展：功能特征与典型产品

脑瘫儿童辅助技术产品品种丰富,功能繁多,涉及姿势、移动、沟通、教育、生涯发展等方面。功能精准与功能整合正成为体位保持、移动辅助技术产品的发展趋向;辅助沟通装置形成多个技术系列的产品;在教育、社会技能以及职业生涯等领域的辅助技术中,具有各种功能的软件是其重要组成部分;计算机信息技术、开关技术在脑瘫辅助技术领域的大量应用,为该领域带来了革命性的变化。