1. Toward Healthcare Parity for Floridians with Disabilities: Training Healthcare Providers Susan M. Havercamp, PhD The Ohio State University Nisonger Center, UCEDD Myrna Veguilla, MSMS USF Florida Center for Inclusive Communities, UCEDD

2. Disability Module Background  Major curricular reform in the 3rd and 4th years  Opportunity to insert new topics previously omitted from the curriculum  Patients with disabilities are encountered by all physicians, regardless of specialty, yet most physicians are not trained in the care of this group  The Surgeon General created a call to action to improve the health and wellness of persons with disabilities in 2005, citing the importance of training physicians

3. Disability Module Goals: To encourage patient centered care that allows students to see the patient as an individual To help students understand that disability is part of life, through a concept of varying abilities rather than disease model To help students develop respectful communication and examination techniques resulting in more effective therapeutic outcomes To help students become familiar with some of the more common disabling conditions Objectives: Students will: 1.Demonstrate an adequate comfort level when interacting with patients with disabilities in the clinical setting 2.Practice and demonstrate appropriate history and physical exam techniques with standardized patients with disabilities 3.Locate and provide adequate community resources for patients with disabilities 4.Participate in service learning projects, behaving respectfully and remaining open-minded toward alternate learning activities

4. Disability Module Overview

5. Evaluation and Feedback Evaluation of student performance –Log of student activities including online communication –Disability questions included in clerkship exam –Patient with disability in final OSCE type exam Module evaluation –Student performance and feedback –Home visit patient feedback –Evaluation protocol taken pre- and post- module Significant changes in knowledge, attitude, and comfort with patients who have disabilities –Long-term follow-up through UCEDD

6. Evaluation Results Difference (Post-Pre) SD t-value (df) Two-tailed Knowledge2.362.4014.76 (224) ** Attitude4.2017.273.62 (221) ** Cognitive1.666.893.70 (234) ** Affective2.7111.333.60 (225)** Behavioral.026.10.04 (235) Comfort15.0037.455.95 (220)** Case 12.5813.112.99 (230)* Case 24.3513.115.01 (227)** Case 38.2915.608.11 (232)** * p<.01 ** p<.001

7. Feedback from Students “I thought this was a wonderful experience. You can learn much more from a patient in their home than in the clinic and you are able to discuss things that you would not be able to discuss in class. I would definitely continue this experience in the future.” “What an eye-opening experience! I really enjoyed this portion of the block. Getting to see how a patient with a serious disability goes about their day-to- day activities was very educational and humbling. I really enjoyed having a chance to talk with the pt’s caregiver as well and to better understand what they go through to take care of their loved ones. Textbooks don’t provide the same emotional impact as person-to-person communication!” “The model patient exercises were very revealing. I would hope that this exercise influenced my approach to patients with disabilities in the future. It was very revealing and demonstrated the importance of taking extra time with these patients.” “I learned about the significant social discrimination that occurs affecting people with disabilities. I learned about some of the multitude of resources available for these patients as well as some helpful hints for their medical care.”

8. USF College of Medicine is committed to sustaining this curricular innovation. FCIC will help maintain evaluation efforts, including long-term follow-up.

9. Recent Publication Article describing curriculum and evaluation just accepted for publication in Academic Medicine –Description of a Required Clerkship Module Focused on Patients with Disabilities –Laurie J. Woodard, Susan M. Havercamp, Kira K. Zwygart, and Elizabeth A. Perkins

10. Healthcare Access for Persons with Disabilities Part 1: Persons with Physical and Sensory Disabilities Susan M. Havercamp, PhD

11. Healthcare Access for Persons with Disabilities Part II: Persons with Developmental Disabilities Susan M. Havercamp, Ph.D. The Ohio State University Nisonger Center, UCEDD

12. Toward Healthcare Parity We hope that training medical students and healthcare providers will improve the availability, access, and appropriateness of healthcare for Floridians with disabilities.

13. For more information… Susan M. Havercamp, PhD Associate Professor of Psychiatry and Psychology The Ohio State University Nisonger Center, UCEDD 1581 Dodd Dr Columbus OH 43210 Tel. (614) 247-6629 Email: susan.havercamp@osumc.edususan.havercamp@osumc.edu Myrna Veguilla, MSMS Florida Center for Inclusive Communities Department of Child and Family Studies College of Behavioral and Community Sciences University of South Florida 13301 Bruce B. Downs Blvd., MHC 2113A Tampa, FL 33612-3807 Tel.: 813.974.7008 Email: veguilla@usf.eduveguilla@usf.edu