The memory still sticks with Dr. Steve Williams 20 years later. As a young attending in Boston, he remembers providing care for a woman who sustained a severe spinal cord injury. When the time arrived for Dr. Williams to discharge the patient, her primary care provider instantly resisted.
Addressing the Gaps in Disability Education
Jefferson works to make medical students more comfortable caring for people with complex disabilities.
“The physician said, ‘You can’t send her back to me, I don’t know what to do,’” recalls Dr. Williams, now dean of the Jefferson College of Rehabilitation Sciences. “I began to realize that some doctors are really uncomfortable working with catastrophically injured people. They’re afraid they will hurt them more just by moving them around.”
One possible reason? Even though one-fifth of adult Americans have a disability, primary care physicians are inadequately educated in their care, Dr. Williams says.
Dr. Williams and several of his colleagues recently conducted a study surveying residents at 10 academic internal medicine and family medicine programs about their comfort in managing secondary conditions associated with physical disabilities and in coordinating these patients’ therapies and services.
Even though one-fifth of adult Americans have a disability, primary care physicians are inadequately educated in their care, research shows. A Jefferson team is working to create and advocate for more disability education across the spectrum of healthcare providers.
The results didn’t surprise him. Of the 176 respondents, few had received disability-specific education during medical school or residency (34.6% and 11.2%, respectively) and nearly all (96%) expressed interest in receiving more.
Armed with this information, Dr. Williams and colleagues at Jefferson have sought to create and advocate for more disability education across the spectrum of healthcare providers, from students to attending physicians.
“We’re thinking of all the different ways we can begin to influence disability education to make physicians more comfortable caring for people who have complex disabilities,” he says. “These patients want the same care they would get if they were able-bodied.”
Looking Toward the Future
Jefferson aims to build on components of disability education already in place, says Dr. Deborah Ziring, senior associate dean of undergraduate medical education and academic affairs for the Sidney Kimmel Medical College.
Currently, one content area in the College’s curriculum, JeffMD, is health systems science, a framework for understanding how care is delivered and how the health system can improve delivery of patient care, Dr. Ziring says. A component of that is to enhance teaching students about the structural, attitudinal and knowledge barriers that people with disabilities face when they seek care.
As a longstanding leader in rehab medicine, we have both the expertise and commitment to achieve distinction in disability care.
Medical students also hear from patients with disabilities during a panel session in their first course, she says. And in a new elective, fourth-year students spend time in a primary care outpatient clinic and rehab medicine clinic caring for patients with disabilities to enhance their knowledge and skills in this area.
“This is a work in progress for the medical school, but as a longstanding leader in rehab medicine, we have both the expertise and commitment to achieve distinction in disability care,” Dr. Ziring says.
Dr. Nethra Ankam is one of the people leading the charge. The director of undergraduate medical student education for the department of rehabilitation medicine co-authored a “call to action” for competency-based curriculum development to meet the needs of people with disabilities.
Described as a “champion of this critical content” by Dr. Ziring, Dr. Ankam is identifying ways that Jefferson can further integrate disability education into the curriculum through cases and clinical skills to build proficiencies and layer competencies.
Jefferson soon will launch a disability care concentration within the internal medicine residency program.
“We want our students to be inclusive to people with disabilities in their practices—as patients, employees and employers—and we want them to see disability as a part of the continuum of human experience,” Dr. Ankam says. “We’re all temporarily abled. We don’t want our students to look at disability as a ‘special topic’ or an ‘other.’ Through this deep dive into our curriculum, we hope that our students will be at the forefront of leading the charge to end health disparities experienced by people with disabilities.”
The literature shows medical institutions have done little to examine enhancing disability education at the undergraduate medical school level, says Dr. Michael Stillman, a general internist and assistant dean of academic affairs.
“What Dr. Ankam is doing is novel and important,” he says. “We can make Jefferson a national leader in disability education. That’s well within our grasp, and it’s an exciting opportunity. We’re poised to do something important here.”
We don’t want our students to look at disability as a 'special topic’ or an ‘other.’ Through this deep dive into our curriculum, we hope that our students will be at the forefront of leading the charge to end health disparities experienced by people with disabilities.
Beyond the undergraduate medical school curriculum analysis, Jefferson will launch a disability care concentration within the internal medicine residency program this summer. The two-year longitudinal experience will help internists—whether they want to go into primary care, hospital medicine or a subspecialty—understand how to better care for individuals with a variety of disabilities and to coordinate their care across venues and in the community.
“It’s the first of its kind in the country and has received robust support from the residency program directors,” Dr. Stillman says.
Jefferson also plans to create a one-year disability fellowship for graduates of internal medicine or family medicine residency programs, Dr. Stillman says. Engaging with inpatient and outpatient clinical services and a variety of community organizations and thought leaders, graduating fellows will be in positions to not only help care for people living with disabilities but to assist in institutions’ efforts to provide them with better and more thorough and accessible care.
After the University completes its full review and implements the changes and new programs, the team will disseminate their work to a wider audience in research papers and at national conferences, Dr. Stillman notes.
“We don’t want to be greedy about the programs we develop,” he says. “We want to put forth a generation of physicians who are better able to care for patients with disabilities.”
