Resolution: S-20-29: INCORPORATING EDUCATION OF PEOPLE WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (I/DD) INTO MEDICAL SCHOOL CURRICULUM

Forums Spring 2020 Resolution Forum Resolution: S-20-29: INCORPORATING EDUCATION OF PEOPLE WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (I/DD) INTO MEDICAL SCHOOL CURRICULUM

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      Valerie Lile
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      WHEREAS, people with disabilities make up the largest legally protected group in the country since the passage of the ADA in 1990;1 and

      WHEREAS, over a billion people live with a disability, including 54 million Americans according to  the World Report on Disability;2 and

      WHEREAS, the life expectancy of people with intellectual disabilities has increased by 200% over the  past 80 years, while the life expectancy of the general population has increased by approximately 30%;  for the first time in the course of human history, there are now more adults living with intellectual and  developmental disabilities (I/DD) than children;3 and

      WHEREAS, it has been shown that people with disabilities report seeking more healthcare than people without disabilities and have greater unmet needs.4 Patients with intellectual disabilities also encounter additional challenges in accessing healthcare compared to the general population;4 and

      WHEREAS, health promotion and preventative medical care rarely target people with disabilities;  examples range from a lower rate of cervical and breast screenings for patients to unmonitored weight  for patients with I/DD compared to non-disabled patients;4 and

      WHEREAS, communication barriers and complexity of social/medical situations for this particular population were the main reasons clinicians felt like they were not able to deliver adequate care;5 and

      WHEREAS, barriers to receiving healthcare are not only physical, but also perhaps more importantly  related to the knowledge and attitudes of healthcare providers; people with disabilities have cited negative attitudes and behaviors of healthcare providers as the most formidable barriers to accessing healthcare services;5 and

      WHEREAS, medical students, residents, and practicing physicians have demonstrated deficiencies in the most basic patient care towards common forms of disability, such as cerebral palsy and learning disabilities;5 and

      WHEREAS, given the range in exposure to clinical populations, there is no guarantee that medical students will interact with patients with disabilities in medical school;6 and

      WHEREAS, providers have reported feeling inadequate in addressing this population’s healthcare  needs due to lack of education received in prior years of schooling,4 and illnesses that are readily apparent in persons without disabilities may remain undiagnosed in individuals with I/DD;5 and

      WHEREAS, Section 5307 of the Patient Protection and Affordable Care Act states that a model  disability curriculum should be developed that addresses “cultural competency, prevention, public  health proficiency, reducing health disparities, and aptitude for working with individuals with disabilities”;2 however, only a few healthcare programs have included disability topics within their  curriculum;2 and

      WHEREAS, if disability culture and disparities are not discussed during medical training, the more traditional medical model of disability that defines a person based on their disability, is reinforced, and  the health and healthcare disparities of the populations with I/DD are perpetuated;2 and

      WHEREAS, Tufts Medical School, as well as various other allopathic schools in the United States,  have incorporated educational tools to improve medical students’ preparedness for communicating with persons with disabilities, regardless of specialties, within the curriculum;6 students reported feeling more prepared and knowledgeable about properly caring for this community after implementation of  educational tools and communication between students and people with I/DD;6 and

      WHEREAS, the Mayo Clinic pre-clinical medical school curriculum was developed to focus on healthcare disparities of and biases towards disabled communities in an effort to change the current attitudes of healthcare providers towards persons with disabilities; the majority of medical students involved in this curriculum development course responded positively and believed community involvement with patients would be helpful for future clinical work;2 and

      WHEREAS, in order to improve the quality of healthcare for people with I/DD, individual providers must expand their knowledge base and skill set; this requires professional education to be integrated with didactic and clinical training that include: direct interactions with these patients, history taking, cultural practices, diagnostic treatment, as well as counseling and supporting individuals;7 and

      WHEREAS, by instilling earlier education into the medical curriculum, along with continuing education for all levels of practice, improvements may be seen in the degree of comfort and quality of care that is delivered;8 now, therefore, be it

      RESOLVED, that SOMA supports implementation of education that promotes preparedness and competency in the proper treatment and prevention of health disparities in the I/DD population at all osteopathic medical schools; and, be it further

      RESOLVED, that SOMA lobby COCA to assess curricula of osteopathic medical schools for disability awareness and preparedness; and, be it further

      RESOLVED, that SOMA recommends, if found appropriate upon completion of the assessment, that COCA establish a standard curriculum addressing the healthcare disparities of the I/DD population in order to prepare osteopathic physicians to properly treat, support, and advocate for better health outcomes of I/DD patients.

      Explanatory Statement

      The social model of disability is explained by the Foundation for People with Learning Disabilities as, “…a civil rights approach to disability. If modern life was set up in a way that was accessible for people with disabilities then they would not be excluded or restricted. The distinction is made between ‘impairments’, which are the individual problems which may prevent people from doing something, and ‘disability’, which is the additional disadvantage bestowed by a society which treats these ‘impairments’ as abnormal, thus unnecessarily excluding these people from full participation in society. The social model of disability says that it is society which disables impaired people.” 

      References

      1. Davis, L.J. (2015). Enabling acts: the hidden story of how the Americans with Disabilities Act gave the largest U.S. minority its rights. Boston: Beacon Press.
      2. Rogers J.M., Morris M.A., Hook C.C., Havyer R.D. Introduction to disability and health for preclinical medical students: didactic and disability panel discussion. MedEdPORTAL. 2016;12:10429. https://doi.org/10.15766/mep_2374-8265.10429
      3. Curriculum-NCIDM. (n.d.). Retrieved February 2, 2020, from https://aadmd.org/page/ncidmpreamble 4. Who.int. (2020). Disability and health. Retrieved February 1, 2020, from https://www.who.int/newsroom/fact-sheets/detail/disability-and-health
      4. Symons, A. B., McGuigan, D., & Akl, E. A. (2009). A curriculum to teach medical students to care for people with disabilities: development and initial implementation. BMC medical education, 9, 78. https://doi.org/10.1186/1472-6920-9-787
      5. Minihan, P. M., Bradshaw, Y. S., Long, L. M., Altman, W., et al. (2004). Teaching about disability: involving patients with disabilities as medical educators. Disability Studies Quarterly, 24(4). doi: 10.18061/dsq.v24i4.883
      6. Office of the Surgeon General (US); National Institute of Child Health and Human Development (US); Centers for Disease Control and Prevention (US). (2002). Closing the gap: a national blueprint to improve the health of persons with mental retardation: report of the surgeon general’s conference on health disparities and mental retardation. Washington (DC): US Department of Health and Human Services. Goals and Action Steps. Retrieved January 10, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK44354/
      7. Douthitt Stief, H., & Clark, M. (2013, December 29). A survey of patients, families and providers about care of patients with intellectual disabilities. Retrieved February 2, 2020, from http://aadmd.org/articles/survey-patients-families-and-providers-about-care-patients-intellectualdisabilities
      8. Social model of disability. (2017, April 12). Retrieved February 14, 2020, from https://www.mentalhealth.org.uk/learning-disabilities/a-to-z/s/social-modeldisability

      Submitted by:

      Amreeta Jammu, OMS I—AT Still University-Kirksville College of Osteopathic Medicine
      Megan Lee, OMS I—AT Still University-Kirksville College of Osteopathic Medicine

      Action Taken:
      Date:
      Effective Time Period: Ongoing

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