Medical Students’ Perceptions, Knowledge, and Competence in Treating Neurodivergent, Disability, and Chronic Illness (NDCI) Populations: Results from a Cross-Sectional Study
Keywords:Medical schools, Medical students, Education, Medical education, Disabled persons
Background: Globally, Neurodivergent, Disability, and Chronic Illness (NDCI) populations face significant health disparities. Lack of physician knowledge about NDCI is a key mechanism underlying these disparities. The current study aimed to describe medical students’ perceptions, knowledge, and competence regarding NDCI.
Methods: A cross-sectional study was carried out using an online survey of medical students at a large public university with no NDCI-specific curriculum (n = 97; response rate = 18%). The survey asked about students’ perceptions, knowledge, and competence pertaining to NDCI populations.
Results: Most (n = 93, 96%) indicated it is important for physicians to understand the influence of NDCI on patient health and clinical encounters. Yet, only 7 (7%) and 15 (15%) reported that the NDCI curriculum in their medical school was sufficient and they felt comfortable taking care of patients with NDCI, respectively. Most (n = 87, 90%) wanted their medical school to provide additional NDCI training. Few reported high knowledge about ableism (n = 12, 12%), self-determination (n = 7, 7%), coordinating care (n = 4, 4%) and accommodations (n = 10, 10%). Few indicated high competence in cognitive, physical, social-emotional, and other NDCI types (n = 7 – 32, 7-33%). Existing knowledge often came from personal experiences or the news and media.
Conclusion: Findings demonstrated the gaps in medical education, as exemplified by medical students surveyed in one U.S. public university. Results can inform efforts to ameliorate global health disparities associated with a lack of physician knowledge about NDCI.
United Nations. Fact sheet on Persons with Disabilities.https://www.un.org/disabilities/documents/toolaction/pwdfs.pdf. Accessed April 7, 2022.
Kattari SK, Lavery A, Hasche L. Applying a social model of disability across the life span. J Hum Behav Soc Environ. 2017;27(8):865-880. doi:10.1080/10911359.2017.1344175
National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. Disability Impacts All of Us.https://www.cdc.gov/ncbddd/disabilityandhealth/infographic-disability-impacts-all.html. Published September 16, 2020. Accessed April 7, 2022.
Reichard A, Stolzle H, Fox MH. Health disparities among adults with physical disabilities or cognitive limitations compared to individuals with no disabilities in the United States. Disabil Health J. 2011;4(2):59-67. doi:10.1016/j.dhjo.2010.05.003
Vohra R, Madhavan S, Sambamoorthi U, St Peter C. Access to services, quality of care, and family impact for children with autism, other developmental disabilities, and other mental health conditions. Autism. 2014;18(7):815-826. doi:10.1177/1362361313512902
Akobirshoev I, Parish S, Mitra M, Dembo R. Impact of Medical Home on Health Care of Children With and Without Special Health Care Needs: Update from the 2016 National Survey of Children’s Health. Matern Child Health J. 2019;23(11):1500-1507. doi:10.1007/s10995-019-02774-9
Cheak-Zamora NC, Thullen M. Disparities in Quality and Access to Care for Children with Developmental Disabilities and Multiple Health Conditions. Matern Child Health J. 2017;21(1):36-44. doi:10.1007/s10995-016-2091-0
Cheak-Zamora NC, Yang X, Farmer JE, Clark M. Disparities in transition planning for youth with autism spectrum disorder. Pediatrics. 2013;131(3):447-454.
Gleason J, Ross W, Fossi A, Blonsky H, Tobias J, Stephens M. The devastating impact of Covid-19 on individuals with intellectual disabilities in the United States. NEJM Catal Innov Care Deliv. 2021;2(2).
Pelleboer-Gunnink HA, Van Oorsouw W, Van Weeghel J, Embregts P. Mainstream health professionals’ stigmatising attitudes towards people with intellectual disabilities: A systematic review. J Intellect Disabil Res. 2017;61(5):411-434.
Iezzoni LI, Rao SR, Ressalam J, et al. Physicians’ Perceptions Of People With Disability And Their Health Care: Study reports the results of a survey of physicians’ perceptions of people with disability. Health Aff (Millwood). 2021;40(2):297-306. doi:10.1377/hlthaff.2020.01452
Kuhlthau KA, Delahaye J, Erickson-Warfield M, Shui A, Crossman M, van der Weerd E. Health care transition services for youth with autism spectrum disorders: Perspectives of caregivers. Pediatrics. 2016;137(Supplement 2):S158-S166.
Ajuwon PM, Lesi FEA, Odukoya O, Melia C. Attitudes of medical students toward disabilities in Nigeria. Int J Disabil Hum Dev. 2015;14(2):131-140. doi:10.1515/ijdhd-2014-0017
Seidel E, Crowe S. The State of Disability Awareness in American Medical Schools. Am J Phys Med Rehabil. 2017;96(9):673-676. doi:10.1097/PHM.0000000000000719
Andrews EE, Forber-Pratt AJ, Mona LR, Lund EM, Pilarski CR, Balter R. #SaytheWord: A disability culture commentary on the erasure of “disability”. Rehabil Psychol. 2019;64(2):111-118. doi:10.1037/rep0000258
Association of American Medical Colleges (AAMC). Core Competencies for Entering Medical Students.https://www.aamc.org/services/admissions-lifecycle/competencies-entering-medical-students. Accessed April 7, 2022.
Medical School Admission Statistics for UCLA Graduates Dashboards | UCLA Student Affairs Information & Research Office. Accessed April 6, 2022. https://sairo.ucla.edu/amcas
Borowsky H, Morinis L, Garg M. Disability and Ableism in Medicine: A Curriculum for Medical Students. MedEdPORTAL. Published online January 25, 2021:11073. doi:10.15766/mep_2374-8265.11073
Low HM, Zailan F. Medical students’ perceptions, awareness, societal attitudes and knowledge of autism spectrum disorder: an exploratory study in Malaysia. Int J Dev Disabil. Published online December 5, 2016. Accessed April 6, 2022. https://www.tandfonline.com/doi/abs/10.1080/20473869.2016.1264663
Santoro JD, Yedla M, Lazzareschi DV, Whitgob EE. Disability in US medical education: Disparities, programmes and future directions: Health Educ J. Published online June 15, 2017. doi:10.1177/0017896917712299
Scott SS, McGuire JM, Foley TE. Universal design for instruction: A framework for anticipating and responding to disability and other diverse learning needs in the college classroom. Equity Excell Educ. 2003;36(1):40-49.
Walker JS, Coleman D, Lee J, Squire PN, Friesen BJ. Children’s Stigmatization of Childhood Depression and ADHD: Magnitude and Demographic Variation in a National Sample. J Am Acad Child Adolesc Psychiatry. 2008;47(8):912-920. doi:10.1097/CHI.0b013e318179961a
Yun GW, Trumbo CW. Comparative Response to a Survey Executed by Post, E-mail, & Web Form. J Comput-Mediat Commun. 2000;6(1):0-0. doi:10.1111/j.1083-6101.2000.tb00112.x
Andrews MW. Who Is Being Heard? Response Bias in Open-ended Responses in a Large Government Employee Survey. In: A Section on Survey Research Methods. ; 2005:7.
Havercamp SM, Barnhart WR, Robinson AC, Whalen Smith CN. What should we teach about disability? National consensus on disability competencies for health care education. Disabil Health J. 2021;14(2):100989. doi:10.1016/j.dhjo.2020.100989
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