Disabilities and Disability Education

As of 2016, the number of Americans with a disability was estimated to be 61 million. ^{Reference Wiesner, Kappler and Shuster6} As the prevalence of individuals with disabilities is expected to increase, physicians will likely encounter individuals with disabilities at least once during their time of practice. ^{Reference Agaronnik, Pendo and Campbell7,Reference Ankam, Bosques and Sauter8}

Currently, disability education is not a requirement for health care program accreditation or licensure, such as Physician Assistant (PA) and medical school programs. ^{Reference Seidel and Crowe9} Despite repeated calls for increased coverage in health care programs about disabilities, there is still little information about the prevalence of disability awareness training. ^{Reference Ankam, Bosques and Sauter8} Schools that are not currently incorporating disability training have identified some common barriers. The most common barrier identified is a lack of advocacy for disability education in their curriculum. ^{Reference Agaronnik, Pendo and Campbell7,Reference Ankam, Bosques and Sauter8} A second barrier is the time constraint in health care programs’ intensive curriculum. ^{Reference Ankam, Bosques and Sauter8} A final significant identified barrier is the lack of proper resources to develop disability training. ^{Reference Ankam, Bosques and Sauter8}

Some programs have started to integrate disability education to improve attitudes toward individuals with disabilities, therefore teaching inclusive patient care to their students. ^{Reference Santoro, Yedla, Lazzareschi and Whitgob10} It is estimated that 20% of medical schools in the United States have incorporated disability education into their curriculum. ^{Reference Ankam, Bosques and Sauter8} Many medical professionals report feeling they lack the appropriate knowledge, confidence, and skills to work with individuals with disabilities and have expressed an interest in further education in disabilities. ^{Reference Bu, Veloski and Ankam11} The purpose of this study was to assess the current status of disability and emergency preparedness training in the curricula of accredited PA programs in the Midwest region of the United States.

Programs that are not currently incorporating disability training have identified some common barriers. The most common barrier identified is a lack of advocacy for disability education in their curriculum. ^{Reference Agaronnik, Pendo and Campbell7,Reference Ankam, Bosques and Sauter8} A second barrier is the time constraint in health care programs which is prevalent in PA programs across the country. ^{Reference Ankam, Bosques and Sauter8} A final significant identified barrier is the lack of proper resources to develop disability training. ^{Reference Ankam, Bosques and Sauter8}

Disability Education in PA Programs

According to the Accreditation Review Commission on Education for Physician Assistants (ARC-PA), the curriculum standards are currently lacking information and resources material about developmental disabilities. ^{Reference Trollor, Eagleson and Turner12} The standards only will prepare students to provide medical care to patients from diverse populations. ^{Reference Trollor, Eagleson and Turner12} Neither didactic nor clinical training in PA programs is explicitly required to incorporate disability training through accreditation or competency requirements. ^{Reference Trollor, Eagleson and Turner12} Educating students on the proper communication skills and knowledge to treat individuals with developmental disabilities is not a simple task. Still, it is essential for providing the necessary care to individuals with disabilities. ^{Reference Trollor, Eagleson and Turner12,Reference Sanders, Kleinert and Free13} Additional program challenges may include access to a population with disabilities. ^{Reference Trollor, Eagleson and Turner12} The lack of access would require programs to connect with providers in the community to identify individuals with disabilities. Programs could establish a relationship with a provider and send students to clinical sites to increase students’ diversity awareness in the patient population.

As the number of individuals with disabilities continues to rise, the number of health care providers, specifically PAs, will increase to properly distribute health care to these individuals. ^{Reference Trollor, Eagleson and Turner12} To better train PA students, 1 program has provided 2 multimedia virtual-patients as a clinical training tool for a patient with developmental disabilities. ^{Reference Trollor, Eagleson and Turner12} After implementing this program, the improvement in knowledge and perceived difficulty for students was statistically significant. ^{Reference Trollor, Eagleson and Turner12} This program only further highlights the benefit of incorporating individuals with disabilities during lectures and virtual simulations as a useful training tool among PA students. ^{Reference Trollor, Eagleson and Turner12}

Emergency Preparedness and Emergency Preparedness Education

As the rate of natural disasters and public health emergencies is projected to increase, the need for emergency preparedness training for health care professionals is greater than ever. ^{Reference SteelFisher, Blendon and Brulé2} After the terrorist attacks in September 2001, the Association of American Medical Colleges (AAMC) suggested that disaster response training should be incorporated into the medical school curriculum. ^{Reference Patel and Dahl-Grove3} Despite these suggestive actions, currently, there is no national consensus for an emergency and disaster curriculum. ^{Reference Patel and Dahl-Grove3} Moreover, such events are a vivid reminder of the importance of emergency preparedness and training. SteelFisher et al. ^{Reference SteelFisher, Blendon and Brulé2} referenced a study addressing a national survey to assess preparedness and training for bioterrorism and naturally occurring infectious disease epidemics. The findings from the referenced study suggest that infectious disease training is somewhat more widespread than bioterrorism training. Moreover, a previous survey of US medical schools revealed that only 31% reported having any type of disaster training in their curriculum. ^{Reference Pollard, Bachmann and Greer5,Reference Wiesner, Kappler and Shuster6} From the programs that have started to incorporate the training, surveys of students displayed that only 17.2% believed that they were receiving adequate education for disasters or natural disasters. ^{Reference Pollard, Bachmann and Greer5,Reference Wiesner, Kappler and Shuster6} Health care workers are often recognized as volunteers during emergency situations, yet frequently feel unprepared due to complex and unfamiliar scenarios with the proper medical response. ^{Reference Patel and Dahl-Grove3}

Emergency Preparedness in PA Programs

When a disaster or an emergency occurs, PAs are often one of the first responders to the scene to offer their assistance. ^{Reference Sanders, Kleinert and Free13,Reference Stewart14} Although PAs often feel they lack the proper skills needed to provide assistance, PAs do possess the necessary medical skills that can be used to help patients in times of disaster and emergency, such as triage and creation of treatment plans. ^{Reference DiMaggio, Markenson and Redlener15} The current laws surrounding PAs and their capabilities are essential to consider, especially when PAs assist in a disaster or emergency. It is suggested that a framework be created for the scope of practice for PAs for the assumption to exercise their professional roles in times of disaster and emergency. ^{Reference Sanders, Kleinert and Free13,Reference Stewart14} A framework would allow for PAs to step in to help fill in the gap in a lack of available health care providers during times of crisis.

The integration of emergency and disaster training within health care and medical curricula continues to be researched. One underutilized section of health care across teaching hospitals and local disaster response is disaster-trained health professionals. ^{Reference Wiesner, Kappler and Shuster6} With properly taught disaster response principles, individuals are, therefore, able to act within a uniform standard of care in the most stressful disaster situations. ^{Reference Patel and Dahl-Grove3}

The purpose of this pilot study was to evaluate whether PA programs in the Midwest integrate both disabilities and emergency preparedness education into 1 curriculum.