Turning education into learning: Medical student self reflection and learning about disability in a standardized patient exercise

Individuals with disabilities experience barriers to healthcare access, risking lower quality and less comprehensive services. Educating health professionals about disability potentially reduces and eliminates health disparities for persons with disabilities. This current project examines medical students' reflective communication in a standardized patient exercise focused on disability – education is internalized as learning, providing insights maximizing educational effectiveness. Simulated interviews of trained standardized patient educators (SPEs) - with actual disabilities - and clinical medical students were videotaped (N=150 dyads) in 30-minute exercises during a required family medicine clerkship. Fifteen-minute feedback sessions included student, SPE, peer and faculty observers. Utilizing qualitative empirical analysis, four independent raters reviewed all feedback session transcripts. Medical student self-reflection and learning behaviors around disability were identified, clustering over three arenas: attitudes around disability, disability itself, disability impact on treatment decisions. Medical students' self-reflections of initial disability-related attitudes reflect heightened sensitivity yet avoidance of disability; other reflections focus on concerns about maintaining sensitivity while ensuring accurate history-taking and respectful language when asking about disability, plus overall student deference to SPEs. Medical students' self-reflections evolve over feedback session, with transformations in attitudes and perspectives. Adult learning theories provide framework for reflective learning patterns. Initial conflicts between “wanting to do the right thing” and “not knowing” create impetus for learning; feedback sessions reinforce SPEs' authoritative voice, and foster focused self-reflection efforts; important topic includes SPE as expert in their own life and condition. Implications for continuing to develop programs for education and opportunities for self-reflection about disability are included.