An analysis of the training offered to medical students regarding the assessment and treatment of individuals with an intellectual disability
Date
2014-04-02
Authors
Wieringen, Annemarie Van
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Abstract
Individuals with ID have the same or greater health needs than the general population but it is being compromised by diagnostic overshadowing, poor medical management, inappropriate medical technology and insufficient or inappropriate training of health professionals. This study looks specifically at the training which is offered to undergraduate medical students at Wits University in order to prepare them for the appropriate care of individuals with an intellectual disability (ID). Materials and Methods: The study used a combination of qualitative methodologies. A retrospective record review of all curricular material prescribed and distributed by curriculum implementers to medical students was conducted and analysed. In total, 18 key informants were purposively selected on the basis of being involved in curriculum development and or training of medical students. Three focus group discussions were held with 15 students. Thematic content analysis was used to analyse data. Results Teaching Materials and Methods: The teaching materials and methods used to cover the subject of ID were diverse and in many cases not specific to ID. Differences in the quality and nature of training offered on clinical rotations were highlighted and the practical exposure to patients with ID was found to be limited and mostly opportunistic. The latter was both due to a lack of specific focus on the subject and a reported shortage of time to cover all necessary core competencies. Comparison with the Lennox and Diggens Model with Respect to Teaching in the Areas of ID
Of the five aspects of knowledge, four were found to be thoroughly covered by at least one department and the aspect which was the least well represented was that of „principles and philosophies of health care for persons with ID.‟ All four skills aspects were found to be thoroughly covered by at least one
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department although two areas, „communication with people with ID and their families‟ and „resourcing information from carers and other sources‟ were found to be the most lacking. The attitudes section fared the most poorly of the three areas with 4 of the 6 aspects being thoroughly taught by one department only. Appropriateness of the Teaching Materials and Methods: In general, the current training was considered to be inadequate and/or inappropriate. This was mainly attributed to a severe lack of contact time in which to teach the students the subject matter and this was further complicated by the subject of ID not being considered as a priority when competing against epidemic diseases such as HIV and emergency medicine. Discussion, Conclusions and Recommendations: The study found that Wits medical students are taught about the subject of ID to varying degrees across the Departments of Human Genetics, Paediatrics, Neurosciences and Family Medicine. Although 12 of the 15 aspects of the Lennox and Diggens model have been thoroughly covered by at least one of the aforementioned departments, much of the teaching is generic in nature and not necessarily specific to ID only. Lecturers and students alike felt that the students will complete their studies with a very basic knowledge of the subject of ID, but the students expressed that they are apprehensive about treating patients with ID unsupervised and about their ability to manage complicated cases. The most significant shortcoming of the training was found to be the lack of planned clinical exposure of students to children, and especially adults with ID and this was attributed both to insufficient time within the syllabus and an unfocused approach to the subject itself.
As a result, the recommendations are that a specific module on intellectual disability be included within the Wits syllabus to allow at least one department to dedicate sufficient time and attention to the subject, and that planned practical clinical exposure to patients with ID be included in the syllabus.