Competency-Based Curriculum Development to Meet the Needs of People With Disabilities: A Call to Action

Abstract

People with disabilities constitute 22.2% of the population in the United States, and virtually all physicians have people with disabilities in their clinical practice across a wide range of diagnostic groups. However, studies demonstrate that people with disabilities are inadequately served by the health care system, leading to high costs and poor outcomes. The authors argue that one cause of this discrepancy is that medical students receive limited training in the care of people with disabilities and may therefore not be able to adequately meet the competencies that underlie the Core Entrustable Professional Activities for Entering Residency. To address these gaps, the authors present practical examples of integrating concepts of disability into the curriculum with minimal additional time requirements. A comprehensive disability curriculum is suggested to include active classroom learning, clinical, and community-based experiences. At institutions that do not have a comprehensive curriculum, the authors recommend adding disability-related knowledge and skill acquisition to existing curricula through modifications to current case-based learning, simulated patients, and objective structured clinical examinations. To facilitate curriculum development, they recommend that the World Health Organization International Classification of Functioning, Disability, and Health be used as a tool to build disability concepts into active learning. The goal of these recommended curricular changes is to enhance student performance in the clinical management of people with disabilities and to better train all future physicians in the care of this population.

COVID-19 and the need for disability conscious medical education, training, and practice

“…When generalizing this data to all American medical schools, the authors suggest that potentially no more than 23% have disability-focused training [46]. Among these schools, varying degrees of disability-related training have been implemented, including hands-on experiences with standardized patients, simulation exercises, panel discussions with patients with disabilities, and didactic approaches to highlight disability-related issues [46][47][48][49]. Of note, no standardized curriculum has been widely adopted.…”

“…Of disability curricula that have been proposed [8,[46][47][48][49][50][51][52][53], several follow the Bloom's taxonomy framework used widely throughout healthcare education, propos-ing instruction based on three educational outcomes: knowledge, skills, and attitudes [49,[51][52][53]. "Knowledge" and "skills" related to disability are largely addressed in cultural competence training, often alongside but discrete from issues related to race, gender, and class [49].…”

Emergency Medicine Resident Education on Caring for Patients With Disabilities: A Call to Action

“…Using a multimodal form of education including didactic sessions to introduce basic concepts (example: health disparities, cultural competency vs. humility, othering) and definitions (example, different types of disabilities and their respective accommodations), implicit bias testing, hands-on simulation scenarios, research opportunities, and community-based experiences allows for full integration. 67,68 We also suggest modification of some of the core ACGME EM milestones to reflect the integration of diversity and inclusion curricula, specifically incorporating milestones that evaluate residents on care of the patient with a disability. Examples of the original ACGME milestones can be seen in Figures 3A through 3C, 69 followed by suggested language modification.…”

“…In undergraduate medical education, it has been demonstrated that incorporating individuals from the community with disabilities into training on caring for patients with disabilities had a positive effect on the self-reported comfort levels of young learners in caring for these patients. 37,68 Additionally, the incorporation of narratives from the "expert by experience" has the potential to positively influence one's perspective of those with disabilities. 70 Outside of the field of medicine, research has shown that learning from a person with a disability is more beneficial not only to others with disabilities, but also to those without disabilities.…”

“…Inclusion of education regarding patients with disabilities requires integration into existing EM didactic curriculum, the core competencies, and the evaluation system. Using a multimodal form of education including didactic sessions to introduce basic concepts (example: health disparities, cultural competency vs. humility, othering) and definitions (example, different types of disabilities and their respective accommodations), implicit bias testing, hands‐on simulation scenarios, research opportunities, and community‐based experiences allows for full integration 67,68 …”