Why didn't you ask about my disability? A qualitative analysis of feedback around medical students' addressing disability in a standardized patient exercise

Healthcare providers report limited healthcare training about people with disabilities, despite evidence individuals with disabilities experience barriers accessing healthcare, and are at risk for receiving lower quality and less comprehensive services. This project explores communication issues for medical students learning about disability. Interactions between third or fourth year medical students and trained standardized patient educators (SPEs) were videotaped (N=120 dyads) during a 30-minute family medicine clerkship exercise. Trained coders transcribed all portions related to disability in the medical interview and feedback session. Qualitative analysis of feedback around the ways medical students address disability demonstrates multiple approaches. Responses to an initial open-ended “How did it go?” are described (from immediately insightful, self-disclosing reflection to limited awareness about disability and its complexities), and categorize student needs. SPE and observing faculty successes and challenges in coordinating efforts to prioritize and address such needs are presented, particularly addressing students who ignored disability altogether. Ways that SPEs integrate biomedical questions—teaching how disability affects everyday life and appropriateness of asking about disability—are included. Experiential learning uses challenges for teaching; such methods—including humor and parody—are characterized. Analysis of peer-feedback is reported, demonstrating powerful, non-threatening incentives for self-awareness. Students encounter greatest difficulties if still integrating skills to both gather information and develop empathetic interactions. Implications are presented for soliciting and addressing information about disability, acknowledging people with disabilities as experts in their own conditions, and anticipating needs of patients with disabilities. Implications for medical training and integrating theory and practice are described.