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Reflective Impressions of a Precepted Clinical Experience Caring for People With Disabilities Renee Karl, Denise McGuigan, Matthew L. Withiam-Leitch, Elie A. Akl, and Andrew B. Symons

Abstract There is evidence that early and frequent encounters with people with disabilities can innprove tnedical students' knowledge, skills, and attitudes about disability. As part of a 4-year integrated curriculum in caring for patients with disabilities, third-year medical students (n = 144) in a Family Medicine clerkship participated in a day-long precepted clinical experience at a medical facility serving people with disabilities, predominantly developmental disabilities, where they met patients and worked with clinicians. At the conclusion of the program, students completed a reflective survey about their experience. These data were analyzed qualitatively using a constructivist grounded-theory approach. Students' responses indicated that the experience improved their comfort levels in working with people with disabilities and increased their awareness of attitudinal factors that influence patient care. Responses also demonstrated that students achieved an awareness of technical accommodations and organizational adaptations that improve patient care. Key Words:

disability; medical students; clinical experience; patients; comfort level; perceptions

Disability is defined as a physical or mental impairment that substantially limits one or more of tbe major life activities of tbe individual (Americans Witb Disabilities Act, 1990). The surgeon general projects tbat tbe number of people living witb a disability will increase in tbe coming years as tbe "baby boom" generation ages and medical advances improve life expectancy for cbronically ill patients (United States Department of Healtb and Human Services, 2005). Tbese demograpbic trends will necessitate developing tbe capacity of the U.S. health-care system to provide comprehensive care for people with disabilities. People witb disabilities face significant barriers to accessing quality bealtb care. Despite tbe requirements of tbe Americans Witb Disabilities Act, many primary care offices do not bave equipment to meet tbe basic clinical needs of people witb disabilities (Drainoni et al., 2006). Also, people witb disabilities often bave comorbidities requiring advanced care coordination, tbougb few clinics are able to offer integrated treatment (Aday, 1993). Finally, many studies bave documented that physicians often feel uncomfortable treating people witb disabilities and underestimate

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those patients' cognitive and communicative abilities (Aulagnier et al., 2005; Drainoni et al., 2006; Jackson, 2007; McCoU et al., 2008; Tervo, Palmer, & Redinius, 2004). There is evidence that early and frequent encounters with people witb disabilities can improve medical students' knowledge and attitudes about disability, tbereby increasing their comfort level in providing care to people with disabilities (Brown, Grabam, Ricbeson, Wu, &. McDermott, 2010; Jackson, 2007; Larson McNeal, Carrotbers, & Premo, 2002; Long-Bellil et al, 2011; Rose, Kent, &. Rose, 2011; Tbistletbwaite & Ewart, 2003; Tracy & lacono, 2008). Few medical scbools, bowever, offer curricula to address tbese issues (Crotty, Finucane, & Abem, 2000; Jackson, 2007; Martin, Rowell, Reid, Marks, &. Reddibougb, 2005; Symons, McGuigan, & Akl, 2009). Tbe University at Buffalo Scbool of Medicine and Biomédical Sciences bas instituted a longitudinal curriculum tbat is integrated into all four years of tbe program. Tbe curriculum was designed to enbance medical students' knowledge, attitudes, and skills pertaining to providing patient-centered care for people witb disabilities (Symons et al., 2009). Tbis curriculum design was guided by Kolb's

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(1984) experiential-learning theory, which suggests that immediate or concrete experiences provide a basis for observations and reflections. These observations and reflections can be distilled into abstract concepts, which can be applied in other settings. In the third year, all medical students participate in a 1-day precepted clinical experience at a local medical facility that provides primary care and integrated services for people with disabilities, predominantly developmental disabilities. Healthy People 2010 (United States Department of Health and Human Services, 2000) stresses that, for purposes of improving care of people with disabilities, the similarities among people with disabilities are as important as or more important than the differences among clinical diagnostic groups. Although most student exposure was with people with developmental disabilities, the lessons learned in these interactions can be applied to caring for diverse populations of patients. The students are required to complete a survey reflecting on their experience. Understanding the students' experiences as part of this curriculum is important in evaluating early exposure to caring for people with disabilities and in helping guide future curricular development. The purpose of this study was to examine student reflections about the precepted experience in a medical facility that provides primary care and integrated services to people with disabilities, predominantly developmental disabilities.

Method Curriculum In recognition that his own medical training was deficient in exposure to caring for people with disabilities, one of the authors of this article developed and implemented a four-year curriculum in caring for people with disabilities. The curriculum is described in detail in a previous publication (Symons et al., 2009). The curriculum is integrated into existing course curricula in all four years of medical student education. Students in their first year receive a lecture on disability and society from a community agency that provides health and social services for people with disabilities. The presentation is followed by small-group encounters with people with disabilities and their families, who discuss both the positive and negative aspects of their interactions with the health-care system. Second-year students receive a presentation on

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aspects of the clinical encounter with people with disabilities. They also participate in a disabilityrelated objective structured clinical encounter, for which people with disabilities are trained to serve as standardized patients who portray a medical concern and are interviewed and examined by students in this structured setting. Third-year students in the Family Medicine clerkship spend one day in a precepted clinical experience in a facility which provides primary care and ancillary services for people with disabilities (this activity is the focus of this article). They also participate in a half-day workshop on the socioeconomic and legal context of caring for people with disabilities. During the Internal Medicine clerkship, third-year students participate in a didactic presentation on common medical concerns of people with disabilities. Fourth-year students may choose to participate in a 4-week elective on primary care for people with disabilities. The curriculum was first implemented in 2008 and remains operational.

Description of the Clinical Experience The 4-year curriculum was designed to progress from discussion (Year 1) to skills practice (Year 2) to clinical care (Years 3 and 4). During the required 6-week Family Medicine clinical clerkship, thirdyear medical students spend one day in a precepted clinical experience in one of three local medical facilities that provide primary care and integrated services for people with disabilities, predominantly developmental disabilities. The students are introduced to the facility by administrative personnel. The clinical preceptors (doctors, nurse practitioners, and physical and occupational therapists) encourage the students to communicate with patients, guide the students in examination techniques, and point out elements of care that are particularly important in caring for this patient population. Throughout the day, students observe and assist the facility's clinicians and staff. Upon completion of the clinical preceptorship, students are asked to submit their written reflections about the experience.

Data Collection A survey was designed consisting of seven openended reflective questions about the students' precepted experience at the medical, facility (Appendix). Items for the survey were developed through collaborative discussions among medical

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educators, patients, and health-care providers with experience in caring for people with disabilities. In developing the survey, we relied on empirical experience as well as literature about barriers to care for people with disabilities (Drainoni et al., 2006; Veltman, Stewart, Tardif, & Branigan, 2001). Students were asked to reflect upon the site accommodations, similarities to and differences from other precepted experiences, general thoughts about their experience, a memorable patient encounter, and helpful information for students who will go to the site in the future. The students completed the survey online using a web-based application that the medical school uses for scheduling, surveys, evaluations, and tracking student clinical activities. All survey responses were confidential and anonymous. This study was deemed exempt by our university's institutional review board, since the reflection was part of normal educational practice.

Data Analysis The data were analyzed by a team tbat included a doctoral student in antbropology with expertise in qualitative analysis, a medical educator (nonphysician) involved in the development and implementation of the curriculum, and a physician who was not directly involved in implementing the curriculum hut was familiar with working with people with disabilities. Student responses were qualitatively analyzed in duplicate using a constructivist grounded-tbeory approach (Charmaz, 2005; Crabtree &. Miller, 1999). This approach entails an itetative, systematic process of reviewing reflective responses, identifying segments representing themes, assigning codes to the specific themes, and organizing the themes into categories. The process is repeated until no new themes emerge and saturation is reached. Two investigators coded and categorized each of the reflective surveys independently. They marked in specific responses as units of data and wrote descriptive phrases in the margins to be used as codes, which they then organized into thematic categories. Saturation was reached when investigators could not independently identify any new themes. At this point, the two investigators met to review, compare, and reach consensus on the codes and themes. The physician member of the analytic team helped clarify the clinical context of the identified themes when needed.

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The comprehensive list of themes was charted in Microsoft Excel 2007 and used to track the frequency of responses. The frequency of responses was compared between reviewers and used as a preliminary method to determine if the independent reviewers were reaching similar conclusions. The comprehensive list of themes was organized into major thematic categories. Researchers then used WEFT Qualitative Data Analysis Software (Fenton, 2006) to create a thematic tree which mapped major recurring themes, subthemes, and the criteria students used to develop these themes. The software then linked themes to salient direct quotations.

Results From November 2008 through December 2009, 147 tbird-year medical students completed tbe Family Medicine clerkship. One hundred forty-four students participated in the 1-day clinical experience and completed the survey (100% response rate). Three students did not participate in the clinical experience due to cancellation by the medical facility.

General Findings The majority of third-year medical students considered this precepted experience working with people with disabilities as a valuable part of tbeir education. Tbey reported tbat the inclusion of a precepting site specifically focused on caring for people with disabilities allowed tbem to acquire experience and knowledge they would not otherwise have gained. Four themes emerged from the qualitative analysis: (1) communication strategies, (2) attitudes and comfort about disability care, (3) organizational structure of the medical facility, and (4) environmental and technological accommodations at the medical facility.

Theme 1: Overcoming Communication Barriers Students identified the need to adopt effective communication strategies as an important difference between working with patients in a disabilityspecific facility and working with patients during other clinical rotations. They felt that compiling an accurate medical history required communicative adaptation. In many cases, the patient encounters forced students to revise the way they defined and

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approacbed patient communication. As one student described a patient encounter, "Tbis patient was non-verbal but wben introduced to me, immediately offered bis band to sbake. Reminded me tbat be's able to communicate and interact, just in a unique way." Working witb patients witb cerebral palsy in tbe precepted visit made students more aware tbat even bigbly intelligent patients may bave difficulty communicating. As one student wrote: "One patient, confined to a wbeel cbair witb cerebral palsy, was going tbrougb bis swallowing tberapy session wben 1 met bim. Tbis individual's ability to communicate witb otbers despite bis severe neurological deficit surprised me. ... [T]be necessity for face to face interaction and quiet patience is absolutely imperative to treating and understanding CP (cerebral palsy)." Direct observation of clinicians in tbe bealtbcare setting belped students learn communication tecbniques. As one student responded, "1 particularly enjoyed observing tbe psycbiatrist during bis clinic session. Eacb patient visit was brief, yet be managed to give tbe patient and patient's family an opportunity to discuss tbeir concerns and goals for treatment." In a few instances, tbe direct observation allowed students to confront and reflect upon tbe negative consequences of poor communication witb people witb disabilities. Students noted tbat failure to acbieve effective communication would make it nearly impossible to provide bigb-quality care. As a result, nine students requested additional training in communication tecbniques specific to people witb disabilities.

Theme 2: Attitudes and Comfort Level Working With People With Disabilities Tbe majority of tbe respondents reported that tbe experience made tbem more comfortable witb caring for people witb disabilities. Otber students stated tbat, tbrougb prior experience, tbey were already comfortable witb tbis population. A small minority of students (2) reported negative experiences. Only one student felt tbe immersion program was not a wortbwbile addition to tbe medical education, tbougb tbe student's concerns related to logistics of off-campus travel ratber tban to tbe content of tbe curriculum. Anotber student reported an observation about a bebavioral issue tbat made tbe student feel uncomfortable and

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aware of bow cballenging providing care for people witb disabilities could be, tbougb tbis student concluded tbat tbe program was valuable. Overall, students were impressed witb tbe patients' intelligence and tenacity, and witb tbe effort tbat tbe patients put into tbeir medical care. One student commented, "I was particularly impressed witb one patient wbo I worked witb in tbe PT/OT (pbysical therapy/occupational tberapy) gymnasium. Sbe bas mild mental retardation and gained tbe babit of walking witb ber bip abducted, so sbe comes to PT to work on ber walking. Sbe was so determined and bard-working, and on top of tbat sbe was a truly caring, kind, and appreciative person. Sbe was quite an inspiration." Students bigbligbted an open mind as necessary for effective treatment of people witb disabilities and stated tbat pbysicians sbould avoid making assumptions wben treating people witb disabilities. As one student wrote, "One patient before precepting I would bave given up on ber as being non-communicating. I was taugbt to give ber enougb time and sbe will eventually respond to my questions. I'm sure bad I bypassed ber and talked solely witb tbe caregivers tbat would bave ruined tbe doctor-patient relationsbip." Anotber wrote, "We saw a patient witb spina bifida. Sbe was very upbeat and bigb functioning wben most doctors in ber past told ber tbat sbe wouldn't be. Sbe gave us some excellent tips for MD's wbo are caring for patients witb disabilities. Namely, not to talk down to tbem. Many times tbey know more tban we do." Students stated tbat people witb disabilities deserve tbe same standard of care as patients witbout disabilities, even if it requires more resources to provide tbat care. Respondents also realized tbat if a person's disability becomes a pbysician's central focus, tbe pbysician migbt attribute a symptom to tbe disability wben in fact it is a symptom of an unrelated condition. Students reported surprise wben tbey realized tbat patients witb disabilities wbo were being treated for depression were depressed for reasons attributable to causes otber tban tbeir disability.

Theme 3: Organizational Structure of the Medical Environmental Students identified scbeduling longer appointments, working witb caregivers, and taking a collaborative approacb to patient care as important organizational

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solutions when treating people with disabilities. These students recognized that effective coordination of care and provision of multiple services at one site were essential. For example, one student wrote that, at these facilities, "there were physicians who have experience treating the disabled patients, there were adjunct services like PT, OT, and speech therapy present so the patient does not have to travel to multiple locations to receive care." Such responses demonstrate a recognition that people with disabilities often require a wide range of services and that multidisciplinary care teams are an effective method for health-care delivery.

Theme 4: Environmental and Technological Accommodations at the Medical Environmental Through the precepted experience, students gained an awareness of useful technological accommodations at the medical facility. Students commented on the specialized equipment and accommodations at the facilities, including low exam tables, low counters for check-ins, lifts to transfer patients from chairs to beds, and so on. Students also commented on the accessibility of the sites, including ramps to enter the facility, automatic doors, wide hallways, and ground-floor locations. Additionally, students noted the importance of the methods of transportation to the facility.

Discussion The objectives of this study were to understand medical students' perceptions of a clinical experience in a medical facility that provides primary care and integrated services for people with disabilities, primarily developmental disabilities; to assess the impact of the clinical experience on student knowledge of disability; and to use this information to further enhance our longitudinal disabilities curriculum. Overall, third-year medical students thought the experience was valuable, and the majority of students stated that the program improved their comfort level in treating people with disabilities. Student responses indicate that students gained a more positive perception of people with disabilities and that the curriculum increased their awareness of organizational and technological accommodations. We used the reflective survey as a tool to evaluate this precepted experience in the larger context of our 4-year-long disability curriculum.

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One common theme from the student reflections was an acknowledgement that caring for people with disabilities required a change in their attitude as opposed to merely a change in medical practice. This is important, given that previous research has indicated that physician attitudes and stereotypes about people with disabilities remain a significant barrier to quality of care (Drainoni et al., 2006; Field, Jette, & Institute of Medicine, 2007). For example, clinicians will occasionally assume that patients who experience communication difficulty due to a physical disability also have a cognitive disability (Nosek, Howland, Rintala, Young, & Chanpong, 2001). It is clear that immediately following this experience, students understood the need to be open-minded and not rely on their previous assumptions and stereotypes. An additional consequence of this clerkship experience was that students were exposed to medical care that was organized in a manner consistent with the principles of the patientcentered medical home. As defined by the American College of Physicians, "In a medical home, responsibility for care and care coordination resides with the patient's personal medical provider working with a health care team. Teams form and reform according to patient needs and include specialists, midlevel providers, nurses, social workers, care managers, dieticians, pharmacists, physical and occupational therapists, family and community" (Rosenthal, 2008). Many students recognized that this model improves coordination of care because the availability of physicians and ancillary services at one site eliminates travel to multiple sites and allows for improved communication and longer appointment times. Our hope is that early exposure to the patient-centered model of care will encourage students to incorporate this model in their practice. The use of multidisciplinary care teams and enhanced care coordination is important not only for people with disabilities, but for all people with chronic conditions (Nutting et al., 2009). Though students were able to recognize the importance of these process innovations for people with disabilities, they were not asked to extrapolate these lessons to a larger patient population. As a follow-up to this learning experience, we will ask students to reflect upon how the models of care they observed would impact a broader range of patients. The study has a number of strengths. All of the students who participated in the immersion

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program completed a reflective survey. The survey was administered online to avoid interviewer and response bias. Data were reviewed in duplicate by investigators representing social-science, medical, and educational perspectives. Additionally, tbe analytic team consisted of researcbers both involved in implementation and not involved in implementation of the curriculum. This provided a good balance of familiarity witb tbe curriculum and unbiased analysis. This study has a few limitations. In order to avoid influencing students' perceptions of the program, students were not asked to complete a pre-immersion program survey. Our results indicating attitudinal change as a result of the program are drawn from the survey question asking about cbanges in comfort level and from tbe students' narrative responses. Tbis project also lacks a mecbanism to determine if attitudinal cbanges are sustained over time. However, an attitudinal survey was administered at tbe start of tbe entire curriculum (in tbe first year of medical scbool) and repeated at tbe end of the third year of medical school. Preliminary review of these data indicates significant change in student attitudes towards people with disabilities after completion of the entire curriculum, though the effect of this particular clinical experience cannot be teased out in tbat analysis. Anotber limitation of tbis study is tbat tbe precepted experience was only 1 day. Administering tbis reflective piece to students choosing to do a 4-week elective course in caring for people with disabilities migbt offer deeper insigbt into tbe role played by student exposure to tbis patient population, tbougb it is encouraging tbat even a limited experience seems to bave a profound impact on student perceptions. It would be informative to also survey students in tbeir residency and later as actual practicing pbysicians.

Implications for Education Tbis study bas a number of implications for medical-student education. As we implemented tbe curriculum, we became aware of several areas requiring additional curricular activities. This precepted experience occurred in a facility dedicated to caring for people with disabilities, predominantly developmental disabilities. Because interactions occur in a bigbly structured medical environment, tbe experience migbt be tbought to unintentionally reinforce a reified conceptualization

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of disability or the idea that people with disabilities constitute a defined, bounded, and bomogenous population easily contrasted witb tbe general population (Campbell, 2009). One goal of tbis curriculum is to train pbysicians who will be comfortable caring for people with disabilities in tbe community. Tbe logistical reality is tbat in order to provide consistent exposure for students, tbe training needs to take place in a facility dedicated to working with people with disabilities. Anecdotally, students who experienced the program approached one of the authors and related that they subsequently encountered people witb disabilities in community bospitals and doctors' offices and felt tbat tbe program bad given tbem confidence in providing care for tbese patients. Tbe social model of disability recognizes tbat disability cannot necessarily be defined solely by a medical condition but is a social construct predicated on cultural beliefs, environmental factors, and social structures (Másala & Petretto, 2008). Altbougb students are introduced to elements of tbe social model of disability in tbe first-year introductory lecture and also in tbe third-year seminar, tbis message may not translate into tbe clinical arena and we may need to do a better job of reinforcing social justice aspects of disability as well as conceptual frameworks tbat explore bow our cultural conceptions of disability impact tbe perceptions and medical treatment of people witb disabilities (Couser, 2011). For example, a few students still described patients as baving "mental retardation" (as opposed to an intellectual disability), indicating an additional need for content related to social justice and discrimination. Partially as a response to recognition of tbis concern, we bave begun to add additional venues that are not necessarily medical in order to enhance students' experience interacting with people with disabilities, sucb as an early intervention and prescbool program that provides education and recreation to children with developmental disabilities. Additionally, students indicated a need for training in clinical skills tbat are particularly important in caring for people witb disabilities, such as adapting communication techniques. Students are reminded elsewhere in the curriculum, during didactic sessions, that most of the communication and examination skills used in working with people witb disabilities are tbe very same skills tbey bave learned in providing quality, patient-centered care to people witbout disabilities. Altbougb this

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1 -day experience exposes students to adapting these skills for the challenges of clinical encounters with people with disabilities, more time is probably required to further hone these clinical skills. These skills are addressed more deeply in the 4-week elective in the fourth year, but only a subgroup of students choose to take the elective. Incorporating teaching of these skills into other clinical rotations could help address this concern; it would, however, require some faculty development to raise awareness of the need to address these issues when encountering patients with disabilities in community inpatient and outpatient settings. Students' responses indicated that the experiential program increased their awareness of the importance of attitude, communication, and other subjective factors in caring for people with disabilities. In order to avoid prompting students to give specific responses, the majority of survey questions were open ended; therefore, the fact that so many student respondents were able to identify these subjective factors is significant. Our findings' are similar to those of other published studies (Brown et al., 2010; Jackson, 2007; Larson McNeal et al., 2002; Rose et al., 2011; Thistlethwaite & Ewart, 2003; Tracy & Iacono, 2008) and make a strong case that exposing medical students to encounters with people with disabilities early in their training can improve the students' knowledge, skills, and attitudes ahout disabilities and increase their comfort level in communicating with these patients. Therefore, medical schools should consider introducing curricula to improve their students' knowledge, attitudes, and skills pertaining to people with disabilities. These curricula would benefit from experiential learning and reflective learning components. An experiential approach towards medical education can introduce students to novel treatment strategies in working with diverse patient populations. For example, an experiential-learning element could be beneficial in introducing students to group home visits as a method for management of chronic diseases. Additionally, experiential learning and participant observation can improve students' skills in cross-cultural medicine and in developing strategies to bridge linguistic and cultural communication barriers.

Implications for Research The activity described in this article is part of a 4year curriculum. A preliminary review of attitudinal

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surveys administered at the beginning of the curriculum and at its end indicate that the overall curriculum has a significant impact on student attitudes and comfort level. The role of this precepted clinical experience in the overall curricular goals needs to be determined. Although this study demonstrated that this experience working in a clinic for people with disabilities affected student attitudes, we need to determine whether the entire curriculum will influence physician practice and ultimately improve patient care.

Conclusion A 1-day precepted experience working with people with disabilities affected third-year medical students' perceptions of caring for this population. Students reflected on four themes: (1) communication strategies, (2) attitudes and comfort about disability care, (3) organizational structure of the medical facility, and (4) environmental and technological accommodations at the medical facility. This study provides support for including experiential opportunities (even brief ones) in medical school curricula for improving students' attitudes and comfort levels in caring for people with disabilities.

References Aday, L. A. (1993). Risk in America: The health and health care needs of vulnerable populations in the United States. San Francisco, CA: Jossey-Bass. Aulagnier, M., Verger, P., Ravaud, J. F., Souville, M., Lussault, P. Y., Gamier, J. P., & Paraponaris, A. (2005). General practitioners' attitudes towards patients with disabilities: The need for training and support. Disability & RehabiUtation, 27(11), 1343-1352. Brown, R., Graham, C. L., Richeson, N., Wu, J., &. McDermott, S. (2010). Evaluation of medical student performance on objective structured clinical exams with standardized patients with and without disabilities. AcadeMc Medicine, 85(11), 1766-1771. Campbell, F. K. (2009). Medical education and disability studies. The Journal of Medical Humanities, 30(4), 221-235. Charmaz, K. (2005). Grounded theory in the 21st century: A qualitative method for advancing social justice research. In N. K. Denzin & Y. S.

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Lincoln (Eds.), Handbook of qualitative research (3rd ed., pp. 507-535). Thousand Oaks, CA: SAGE. Couser, G. T. (2011). What disability studies has to offer medical education. The Journal of Medical Humanities, 32(1), 21-30. Crabtree, B. E., & Miller, W. L. (1999). Doing qualitative research. Tbousand Oaks, CA: SAGE. Crotty, M., Einucane, P., & Ahem, M. (2000). Teaching medical students about disability and rehabilitation: Methods and student feedback. Medica! Education, 34(8), 659-664. Drainoni, M., Lee-Hood, E., Tobias, C , Bachman, S., Andrew, J., & Maisels, L. (2006). Crossdisability experiences of barriers to health-care access. Joumû! of Disability PoUcy Studies, 17, 101-115. Eenton, A. (2006). WEFT QDA 1.0.1: Rubyforge [Computer software]. Eenton, A (2006) Weft QDA (version I.O.I) [computer software]. http://www.pressure.to/qda/ Retrieved from http://rubyforge.org/projects/weft-qda/ Eield, M. J., Jette, A. M., & Institute of Medicine. (2007). The future of disability in America. Washington, DC: National Academies Press. Jackson, K.' B. (2007). Knowledge and attitudes toward persons with physical disabilities of healthcare trainees (Unpublisbed master's thesis). Roosevelt University, Chicago, IL. Retrieved from http:// proquest.umi.com/pqdweb?did=1338868901&. Fmt=7&clientId=39334&RQT=309&VName =PQD Kolb, D. (1984). Experientia! learning: Experience as the source of learning and development. Englewood Cliffs, NJ: Prentice-Hall. Larson McNeal, M. A., Carrotbers, L. A., & Premo, B. (2002). Providing primary health care for people with physical disabilities: A survey of California physicians. Pomona, CA: Center for Disability Issues and the Health Profession. Retrieved from http://www.cdihp.org/products. html#ProvPrime Long-Bellil, L. M., Robey, K. L., Graham, C. L., Minihan, P. M., Smeltzer, S., &. Kahn, P. (2011). Teaching medical students about disability: Tbe use of standardized patients. Academic Medicine, 86(9), 1163-1170. Martin, H. L, Rowell, M. M., Reid, S. M., Marks, M. K., &. Reddihough, D. S. (2005). Cerebral palsy: What do medical students know and believe? Journal of Paediatrics & Child Health, 41(1-2), 43-47.

244

©AAIDD DOI: 10.1352/1934-9556-51.4.237

Másala, C , & Petretto, D. R. (2008). Erom disablement to enablement: Conceptual models of disability in the 20th century. Disability & Rehabilitation, 30(17), 1233-1244. McColl, M. A., Eorster, D., Shortt, S. E. D., Hunter, D., Dorland, J., Godwin, M., & Rosser, W. (2008). Physician experiences providing primary care to people with disabilities. Hea!£hcare Po!ic:y, 4(1), 129-147. Nosek, M., Howland, C , Rintala, D., Young, M., &. Cbanpong: G. (2001). National study of women with disabilities: Einal report. Sexuality and Disability, 19, 5-39. Nutting, P. A., Miller, W. L., Crabtree, B. E., Jaen, C. R., Stewart, E. E., & Stange, K. C. (2009). Initial lessons from the first national demonstration project on practice transformation to a patientcentered medical home. The Annais of Family Medicine, 7(3), 254-260. doi:10.1370/afm.l002 Rose, N., Kent, S., & Rose, J. (2011). Health professionals' attitudes and emotions towards working with adults with intellectual disability (ID) and mental ill health. Journal of Intellectual Disability Research (September 15). doi:10.1111/ J.1365-2788.2011.01476.X Rosenthal, T. C. (2008). The medical home: Growing evidence to support a new approach to primary care. Journal of the American Board of Family Medicine, 21(5), 427-440. 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 Medica! Education, 9, 78. Tervo, R. C , Palmer, G., & Redinius, P. (2004). Health professional student attitudes towards people with disability. Clinical Rehabilitation, 18(8), 908-915. Thistlethwaite, J. E., & Ewart, B. R. (2003). Valuing diversity: Helping medical students explore their attitudes and beliefs. Medica! Teacher, 25(3), 277-281. Tracy, J., & Iacono, T. (2008). People with developmental disabilities teaching medical students—Does it make a difference? Jouma! of Intellectual & Developmental Disability, 33(4), 345-348. United States Department of Health and Human Services. (2000). Healthy People 2010. Washington, DC: U.S. Department of Health and Human Service. United States Department of Health & Human Services. (2005). The Surgeon General's call to

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action to improve the health and Wellness of persons

with disabilities. Retrieved fi-om bttp://www. surgeongeneral.gov/library/disabilities/calltoaction/ calltoaction.pdf United States Department of Justice. (1990). Tbe Americans witb Disabilities Act 1990. Retrieved from bttp://www.ada.gov/pubs/ada. btm Veltman, A., Stewart, D. E., Tardif, G. S., &. Branigan, M. (2001). Perceptions of primary bealtbcare services among people witb pbysical disabilities—Part 1: Access issues. Medscape General Medicine, 3(2), 18.

Received 4/27/12, first decision 1/11/13; second decision 3/19/2013, accepted 3/29/13. Editor-in-Charge: Glenn Fujiura This is work was supported by the U.S. Department of Health and Hurrum Services, Health Resources and

Services Administration Pre-Doctoral Training in Primary Care Grant, Award number: D56HPI03J8 (A.B. Symons, Project Director/Principal Investigator).

Autbors: Denise McGuigan (e-mail: [email protected]). University at Buffalo Scbool of Medicine and Biomedical Sciences, Department of Family Medicine, University at Buffalo, Scbool of Medicine and Biomédical Sciences, Department of Family Medicine, 202 Färber Hall, Buffalo, NY 14214, USA; Renee Karl, Matthew L. Withiam-Leitch, Andrew B. Symons, University at Buffalo Scbool of Medicine and Biomédical Sciences, Department of Family Medicine; and Elie A. Akl, American University of Beirut, Department of Internal Medicine; University at Buffalo Scbool of Medicine and Biomédical Sciences, Department of Medicine; and McMaster University, Department of Clinical Epidemiology and Biostatistics.

Appendix Reflective Survey 1. What special accommodations (physical and/or organizational) were made at your precepting site for patients with disabilities? 2. Are there any additional accommodations that you believe may have been helpful to have? 3. In what way was this experience with patients with disabilities different from or the same as other precepting experiences? 4. Do you feel this experience will make you more comfortable, less comfortable, or have no effect on your comfort level caring for patients with disabilities in the future? Why? 5. What are your general thoughts about this precepting experience with patients with disabilities? 6. What information do you think would be helpful for students to have before they go to a precepting site for patients with disabilities? 7. If possible, please describe one patient encounter with a patient that made a particular impression on you (maintain patient anonymity).

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Reflective impressions of a precepted clinical experience caring for people with disabilities.

There is evidence that early and frequent encounters with people with disabilities can improve medical students' knowledge, skills, and attitudes abou...
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