Desired Educational Outcomes of Disability-Related Training for the Generalist Physician: Knowledge, Attitudes, and Skills

Abstract

The problems adults with disabilities face obtaining quality primary care services are persistent and undermine national efforts to improve the health status of this group. Efforts to address this issue by providing disability-related training to physicians are hampered by limited information about what generalist physicians need to know to care for patients with disabilities. The authors consider the desired outcomes of disability-related training for generalists by exploring the contributions of the domains of knowledge, attitudes, and skills to patient-directed behavior and summarizing the empirical data.Because disability reflects a complex interplay among individual, interpersonal, institutional, community, and societal factors, generalist physicians can promote and protect the health of adults with disabilities by interventions at multiple levels. Thus, the authors use the social-ecological framework, an approach to health promotion that recognizes the complex relationships between individuals and their environments, to delineate the recommended knowledge, attitudes, and skills in the context of primary care. The importance of role models who demonstrate the three domains, the interactions among them, and issues in evaluation are also discussed. This clear delineation of the recommended educational outcomes of disability-related training in terms of knowledge, attitudes, and skills will support efforts to better prepare generalist physicians-in training and in practice-to care for adults with disabilities and to evaluate these training strategies.

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

“…There is a general consensus in the medical education and disability community that more attention needs to be given toward training medical students to care for people with disabilities. 9,16,29,30 Evidence indicates that substantial exposure to a marginalized group (such as people with disabilities) increases positive attitudes toward that group and may even help reverse deepseated biases toward that group. 9,31 In training medical students, this is particularly important since negative biases have been shown to adversely affect medical care of people with disabilities.…”

“…9,16,29,30 Evidence indicates that substantial exposure to a marginalized group (such as people with disabilities) increases positive attitudes toward that group and may even help reverse deepseated biases toward that group. 9,31 In training medical students, this is particularly important since negative biases have been shown to adversely affect medical care of people with disabilities. 11,12,32,33 By administering a pre-and post-attitudinal and comfort level survey, we sought to document objective quantitative effects on student attitudes by examining changes in the class which experienced the curriculum, and in a control class which did not experience the curriculum.…”

Commentary: Defining Disability in Health Care Education

“…In this context, chronic medical conditions on their own (e.g., high blood pressure, diabetes, asthma) are not discussed as disabilities, although they frequently contribute to disabling conditions. In our two articles 15,16 in this issue, we use the general definition of disability: "difficulty performing daily activities and fulfilling social roles because of physical, sensory, emotional, or cognitive impairment, often compounded by environmental barriers." 6 This definition focuses on the actual impact of disability on functioning but also acknowledges that such functioning can be compounded by, and thus also alleviated by, environmental conditions.…”

O Ensino sobre Deficiência a Estudantes de Medicina: o que Existe no Mundo?

“…Embora essa habilidade seja promovida em cursos de fisioterapia e enfermagem, isso não acontece no curso médico, apesar de sua importância para o exame do paciente nessa situação e de fácil ensino. As estratégias educacionais variaram entre as seguintes: aulas quando o objetivo era promover o conhecimento dos estudantes 29,23 ; seminários 20 ; painéis 17 ; oficinas 24,27 ; anamneses 25,30,31,32 ; visitas a serviços que atendem pessoas com deficiência 22,33 ; e vivências onde os estudantes eram desafiados a realizar atividades usando cadeiras de rodas, muletas, vendas nos olhos 14,34 . French 35 critica o uso isolado de vivências por não haver evidência de que tenham efeito positivo quer nas atitudes, quer nos comportamentos dos estudantes de Medicina, e acredita que individualizem e medicalizem a deficiência, enfocando principalmente as dificuldades, sem expor as estratégias de enfrentamento ou habilidades desenvolvidas pelas pessoas com deficiência em seu cotidiano.…”

“…Essas vivências não dariam conta dos aspectos sociais e psicológicos. As pessoas com deficiência, seus familiares ou cuidadores vêm participando de forma passiva ou ativa, isto é, apenas enquanto pacientes observados pelos estudantes nas consultas em centros de reabilitação ou outros cenários de atenção à saúde; PCDs e seus familiares ou cuidadores falando sobre como é viver com deficiência aos estudantes em sala de aula; como pacientes padronizados; como pacientes padronizados educadores, palestrantes e tutores de oficinas 30,25,24 . .…”