186852 Integrating core communication constructs within medical interactions focused on disability: A qualitative analysis of medical student self reflection and learning in a standardized patient exercise about disability

Tuesday, October 28, 2008

Ashley Duggan, PhD , Communication Department, Boston College, Chestnut Hill, MA
Ylisabyth S. Bradshaw, DO, MS , Department of Public Health & Family Medicine, School of Medicine, Tufts University, Boston, MA
Shannon Carroll , Communication Department, Boston College, Chestnut HIll, MA
Sara E. Rattigan, BA , Department of Public Health & Family Medicine, School of Medicine, Tufts University, Boston, MA
Matthew Morris , Communication Department, Boston College, Chestnut HIll, MA
Wayne Altman, MD , Department of Public Health & Family Medicine, School of Medicine, Tufts University, Boston, MA
Individuals with disabilities experience barriers to healthcare access and risk receiving lower quality and less comprehensive services. The current project explores medical students' self-reflection and communication issues in learning about disability in a program designed to provide experience with individuals with disabilities. Interactions between clinical medical students and trained standardized patient educators (SPEs) were videotaped (N=150 dyads) during a 30-minute family medicine clerkship exercise including simulated interview and feedback with a peer, faculty facilitator, and SPE. After feedback sessions were transcribed, four independent raters identified medical students' self-reflection and learning regarding 1) attitudes about disability, 2) disability per se, 3) how disability impacts treatment plans, and 4) the role of communication in medical practice. Qualitative empirical analysis provides evidence for reflective learning within each area. Medical students' reflections regarding attitudes about disability are observed in concerns showing sensitivity while gathering accurate information, using respectful language asking about disability, and how students query and elicit advice from SPEs. Adopting new attitudes is observed in self-reflections about behaviors and new insights. Learning about disability per se is observed when students respond as SPEs solicit students' questions about disability. Reflection and learning about how disability impacts treatment plans are observed as students address SPE roles and relationships, and acknowledge (or fail to acknowledge) the SPE as expert in their own life and condition. Learning and reflection about communication in medicine are observed in students' descriptions of their interview strengths and challenges. Suggestions for research, medical education, and integrating theory and practice are described.

Learning Objectives:
1. Outline how communication behaviors and medical curricula are able to be integrated. 2. Describe the ways learning and self reflection can qualitatively be assessed through transcript analysis. 3. Analyze the ways medical studentsí attitudes are reflected in their language choices and their self evaluation. 4. Summarize patient-centered concerns about physicians caring for people with disabilities. 5. Describe implications for medical studentsí learning about individuals with a disability. 6. Highlight the potential for changing health outcomes for both physicians and patients through experiential learning and reflective practice.

Keywords: Health Education Strategies, Disability

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: This abstract follows from a project my team and I initiated in 2001 at our institution so that medical students would be able to have expanded opportunities for experiential learning in collaboration with people with disabilities as as to improve their communication skills and knowledge about disability. We have continued to examine the learning process that is developed through these interactions; we have spent a year videotaping 150 interactions, and a year in beginning to analyze them. We have had one joural article in a peer- reviewed publication, and over 15 presentations, primarily oral ones at national conferences. This project continues to educate over 160 medical students each year. It has served as the dissertation focus for one of the teams' doctoral degree in health policy. The lead author is a Health Communications PhD, and the presenting author is a physician and public health professional. , and conferences. about the p, and has ev,olved to a the result of research i
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.