We have developed a longitudinal curriculum to teach medical students to care for people with disabilities using the six-step approach of Kern, Thomas, Howard and Bass for curriculum development[22
]. The curriculum has well defined goals and objectives and employs both traditional and non-traditional teaching strategies. The implementation is planned over the four-year medical school curriculum in collaboration with a number of academic departments and specialized community-based agencies. The curriculum evaluation includes an attitudinal survey which is administered using a controlled design and is administered to participants before beginning the curriculum as well as after their participation in the curriculum.
Our curriculum received federal funding from the U.S. Department of Health and Human Services, Health Resources and Services Administration in June 2008 and is currently being implemented. Although the current first-year class will be the only class to experience the entire curriculum, we have been implementing elements of this curriculum with the current third-year class as well. Students currently in the second year of medical school will experience the activities in their third and fourth years. The second-year OSCE activity is still in its planning stages, which is why the second-year class has not participated in this activity.
Introducing new material into the medical school curriculum needs to be done with sensitivity to the perception that a new "special interest" will supplant existing elements, and excessively burden those responsible for delivering the existing curriculum. For that purpose we have secured a "buy-in" during the needs-assessment portion of the project. In the implementation phase, we are taking care not to overburden any one course or rotation with too many activities related to our curriculum. Faculty members have been very receptive and cooperative in incorporating elements of the curriculum.
Students in the first-year clinical skills course participated in the lecture presentation about the history of disabilities and society followed by small seminar group encounters with patients with disabilities and their families. The session was very informative and personal, providing an opportunity for the students to meet real-life patients with real-life struggles. As a result of the session, the students were able to examine and reflect on their own attitudes about disability. In the third year, students participating in the Internal Medicine Clerkship have been participating in the one-hour presentation on common medical concerns of patients with disabilities.
Students in the Family Medicine Clerkship have been attending a half-day seminar on the social context of caring for patients with disabilities and have been spending one day in a precepted clinical experience in a facility which provides primary care for patients with disabilities. Student reflections on their experiences have been informative. While students noted many similarities with their other clinical experiences, they also noted a number of unique aspects. For example, in relation to the specialized community-based facility, students commented that: the facility was more comprehensive and better run than other clinics; every patient had an accompanying advocate who used detailed records for the patient, making the physician's history taking easier; physical examinations were tailored to meet the individual needs; and more time was allotted for each patient. Most students indicated they would likely treat patients with disabilities in the future, having spent time in this clinic. One student stated, "before this experience, I had reservations about disabled patients, but I am now more comfortable with working with them in the future."
We believe that the major strength of this curriculum is the introduction of students to caring for patients with disabilities early in their career. By integrating the elements of the curriculum into other primary care-oriented courses and clerkships, students perceive caring for patients with disabilities as a natural part of patient care in general. Also, we feel that the lessons and experience gained in caring for patients with a particular disability will be transferable not only to patients with various disabilities, but also to fostering professionalism in the compassionate, competent care of all patients.
A highly gratifying part of developing and implementing the curriculum has been the partnerships fostered with the specialized community-based agencies caring for patients with disabilities, People Inc. and Aspire of Western New York. There is a great mutual appreciation in that we have given them access to medical students so as to instill in these young physicians the knowledge, attitudes, and skills necessary to care for their patients who have disabilities. In turn, we have appreciated their expertise and their contribution to the development and implementation of the curriculum.
The challenges involved in this curriculum are mostly related to its implementation in the field. Full implementation involves coordinating clinical experiences in the community, as well as training people from the community to come in and work with the students. Each of the agencies and groups with whom we interact has its own agenda and its own logistical and financial constraints. Clarifying these agendas and working within these constraints is essential for successful implementation of the program.