What Can I Learn From This Interaction? A Qualitative Analysis of Medical Student Self-Reflection and Learning in a Standardized Patient Exercise About Disability

Abstract

Patients with disabilities receive fewer health services than the general population, yet they have greater health needs. Similarly, physicians report limited training in disability. The current project examines medical students' learning about disability in a project using individuals with disabilities as medical educators. Family medicine clerkship students (N = 138) across an academic year were videotaped during interviews with standardized patient educators with disabilities and during feedback sessions following the interactions. Qualitative analysis of feedback transcripts identifies three primary areas of integrating learning, reflective practice, and disability: (1) learning how disability impacts the treatment plan, (2) self-reflection and recognizing attitudes about disability, and (3) learning about the practice of medicine generally from the disability exercise. Themes are identified within each of the primary learning areas. Medical student reflection provides evidence of learning to connect disability with pain, everyday life, and treatment. Medical students learned to recognize patients' expertise in their own condition and in health care navigation. Medical students also examined how their language implies attitude. The current investigation provided evidence of the ways examining disability can serve as a cornerstone for building relationship-centered patient care and encouraging reflective practice overall.

The authors thank Matt Morris, Colleen Coburn, Jenifer Gaze, Marjorie McCormick, and Hilary Weismann from Boston College, who worked on this project as research assistants. The authors acknowledge the interaction team behind the project, especially Paula Minihan, PhD, MPH, MSW, from Tufts University School of Medicine and Linda Long-Bellil, PhD, JD, from University of Massachusetts Medical Center, who are crucial to the success of the ongoing project, as well as the dedicated TUSM faculty members, clinical and academic, who regularly share time to provide formative feedback for medical students. The authors also acknowledge the commitment, talent, and professionalism of the Standardized Patient Educators: Liz Casey, Jeanette Ector, Karen Foran Dempsey, Charlie Gamer, Lillian Johnson, Paul Kahn, Betsy Laitinen (1965–2007), Kia Scott (1970–2007), Robert Sneirson, and MacArthur Williams. In addition, Family Medicine Coordinators, Rachel Fouche, Katina Kefalas, and Vanessa Rios are greatly appreciated.

Initial support for development of the standardized patient exercise was provided by a grant from the Massachusetts Developmental Disability Council and a federal Family Medicine Predoctoral Training Grant from the Bureau of Health Professions, Health Research and Services Administration, Department of Health and Human Services; continuing support for the educational interactions is provided by Tufts University School of Medicine through the Department of Public Health and Family Medicine and by the Office of Educational Affairs. Research support was provided by a Boston College Faculty Fellowship to the first author.