TEACHING FUNCTIONING,DISABILITY AND REHABILITATION TO FIRST YEAR MEDICAL STUDENTS

BackgroundMany patients have disabilities; it is therefore essential that medical education includes comprehensive teaching on disability and rehabilitation. In 2006, Hannover Medical School implemented an introductory course in the curriculum for medical students, on how to communicate with persons with disability and on the need for rehabilitation. The course, entitled “Introduction to medicine”, has the main goals of teaching the strategy and systematic approach of medicine to solving patients’ problems.MethodsThis paper describes the content, methods and outcomes of 1 of the 4 main themes of the “Introduction to medicine” course; the theme “Pain and disability”, which is covered in the second week of the course.ResultsEvaluation of the “Pain and disability” module found that students’ ratings for the category “patient involvement” were very high (93%), whereas their ratings for the category “examination of student knowledge” were low. The overall rating of the module was “good” (10.8 out of 15 points), but not “very good”.CONCLUSIONThe concept of the “Pain and disability” module is feasible and successful, even though it is scheduled early in the first year of the curriculum and approximately 350 students participate. Factors related to this success are: a mixture of teaching knowledge, supporting students’ understanding, and applying communication and physical examination skills.LAY ABSTRACTAs every medical doctor will be confronted with persons with disabilities, medical students should learn about disability and rehabilitation topics. Within a comprehensive concept of teaching disability and rehabilitation topics, in Hannover Medical School, a propaedeutic teaching course has been implemented to sensitize the students to how to communicate with persons with disability and to raise awareness about the need for rehabilitation.The survey of the students showed good acceptance of the new course, and the involvement of patients in the lessons was especially appreciated.Key words: teaching, medical school, persons with disabilities, undergraduate medical training, pain, disability, rehabilitation

Disability is defined as the interaction of a person with a health condition and/or impairment and the environment (1, 2). This definition of disability includes persons with congenital conditions (e.g. cerebral palsy, spina bifida, chromosomal aberrations, etc.) and those with acquired impairments (e.g. traumatic brain injury, spinal cord injury, limb amputation, etc.). The definition also includes persons with chronic diseases, cancer, infectious diseases, and others who may experience disability related to a disease and its consequences (e.g. loss of physical performance, need for oxygen, diabetic feet, etc.). In addition, mental health disorders and learning disabilities often result in disability. For medical doctors, and other professions in medicine, education on functioning, disability and rehabilitation must be addressed in the undergraduate curriculum, since:

• in practice, all medical doctors will treat patients with disabilities;
• many persons with disabilities, including those with chronic health conditions, require rehabilitation, including assistive devices;
• in long-term care persons with disabilities may have specific health needs that are treated by medical doctors
• communication with persons with disabilities may be challenging and result in uncertainty and communication barriers on both sides, reducing the quality of medical treatment.

Medical students should therefore learn about the main factors causing disabilities, based on theoretical models, as early as possible in their education, and become competent in communicating with persons with disabilities and creating an appropriate atmosphere during conversation and examination.Rehabilitation is one of 4 main health strategies, together with preventive, curative and supportive strategies (3–5). It is the strategy that “based on the World Health Organization’s (WHO’s) integrative model of human functioning and disability applies and integrates biomedical and engineering approaches to optimize a person’s capacity. This strategy build on and strengthen the resources of the person approaches which provide a facilitating environment. It should help to develop a person’s performance in the interaction with their environment with the goal to enable people with health conditions experiencing or likely to experience disability to achieve and maintain optimal functioning in interaction with the environment” (6). Thus, it is crucial that all physicians understand the principles of rehabilitation, the indications and contraindications for rehabilitation, rehabilitation interventions, and complex rehabilitation concepts. Based on federal regulations in Germany rehabilitation is taught together with physical medicine and naturopathy in a so-called cross-sectional field. However, the content and the academic leadership of this field in German medical faculties is very diverse (7, 8). Currently, the bodies responsible are updating the content of the curriculum (with rehabilitation as an independent field of learning in the course examination) and introducing more rehabilitation topics into the catalogue of learning goals (9).Hannover Medical School has implemented a teaching course to impart basic knowledge about disability and rehabilitation, teach medical students to how to communicate with persons with disability, and raise awareness of the need for rehabilitation. This course is integrated into the initial teaching block on the principles of clinical work (the so-called Propädeutikum), which is delivered at the start of the first year medical student curriculum (10). The course has the following teaching/learning goals:

• provide an insight into a systematic pathway of the medical problem-solving process (“from the patient’s problems to diagnosis”), demonstrated using patient cases;
• understanding pain as symptom and/or disease;
• understanding disability and the main principles of rehabilitation;
• acquiring basic skills in clinical examination and understanding the physician’s role