Simulated Clinical Encounter Research Protocol

The present project has further expanded OSUCOM’s disability curriculum by providing medical students with an opportunity to interact with real people with disabilities (both developmental and physical) in a medical setting. In order to assess student learning, pre- and post-encounter surveys were administered, and students also wrote reflections on their experience after the encounter. While initially utilized for educational purposes, results that may indicate potential increases in student comfort and confidence in interviewing people with disabilities would be valuable to the scientific and educational community.

Our research question, to be addressed by analyses of the pre- and post-encounter surveys and qualitative analysis of the reflections, is whether or not a brief clinical encounter with a person with a disability (either developmental or physical) improves medical students’ competence in working with people with disabilities.

Background and Rationale

Recent research has indicated that individuals with intellectual and developmental disabilities (IDD) experience healthcare disparities (Havercamp & Scott, 2015; Minihan, Bradshaw, & Long, 2004). In states including Ohio, people with disabilities struggle to access and receive high quality healthcare services (Prokup, Andridge, & Havercamp, 2017).

Medical student education has often been cited as the solution to this problem. The Ohio State University College of Medicine (OSUCOM) has integrated a self- and parent-advocate panel to educate medical students on autism spectrum disorder (Havercamp, Ratliff-Schaub, Macho, Johnson, Bush, & Souders, 2016). Lectures, presentations, didactic training, and interacting with model patients have been included in other university medical school settings (Symons, McGuigan, & Akl, 2009; Woodard, Havercamp, Zwygart, & Perkins, 2012).

The present research attempts to determine whether students experiencing encounters with real people with disabilities (hypothetically closer to life than a lecture, presentation, didactic training, or model patient encounter) improves student attitudes and overall comfort with the probability of working with people with disabilities in their future practices.

Procedures

A. Research Design

The data collection during the simulated encounter experience consisted of a pre- and post-encounter survey of attitudes. This design is appropriate to answer our research question of whether a simulated clinical encounter impacts (and improves) medical students’ self-reported comfort and confidence, among the other attitudinal variables addressed on the survey.

B. Sample

The sample participants are the 118 medical students who have participated in the simulated clinical experience and provided their feedback through the pre- and post-encounter survey. Their responses are anonymous.

C. Measurement / Instrumentation

The pre- and post-encounter survey comprised of demographic questions, questions about the disability of the person with whom they spoke, and a Likert scale-style questionnaire modified from the Healthcare Provider Questionnaire administered in healthcare and disability research done by Robey, Gwiazda, and Morse (2001). There are no reliability or validity data available on this questionnaire. The items asked students to rate their confidence/apprehensiveness, skill/lack of skill, comfort/discomfort, grace/awkwardness, efficiency/inefficiency, and level of calm/anxiety that they anticipated maintaining throughout the encounter (in the pre-encounter survey) and that they felt they actually maintained during the encounter (in the post-encounter survey). The students were also asked to write a short (4-5 sentences) reflection on the encounter’s impact on their professional perspective.

D. Detailed study procedures

Medical students arrived for their simulated clinical encounter, which took place in the same center as their Formative Observed Simulated Clinical Experiences (FOSCEs). Students were instructed by the encounter facilitator that they would not be graded on their performance, and that their goal was to obtain a social history.

Students were asked to complete the pre-encounter survey, and before entering the encounter were given a brief description of their simulated patient. Following the encounter, students completed the post-encounter survey, and then proceeded to a debriefing discussion with several other students and a faculty member expert in patient care with people with disabilities.

The second run of the program included an added peer observation element. Students completed the surveys directly before and after their encounter; approximately half of the students began by observing an encounter, then participating, while the other half participated in the encounter experience first.

E. Internal Validity

The addition of a peer observation, which some students completed before their own pre-encounter survey, encounter, and post-encounter survey, may have influenced those students’ pre-encounter beliefs about their performance, their performance during the encounter, and potentially the extent to which they rated themselves following their own encounter. This will be explicitly explained in any interpretation of analyses and data.

F. Data Analysis

Repeated measures t-tests will be conducted to determine whether significant differences exist between the pre- and post-encounter ratings of confidence, skill, comfort, grace, efficiency, and calm. Corrections will be made for familywise error rates.

Additional between-subjects t-tests may be conducted, with the between subject groupings of type of disability (physical or developmental, visually noticeable or “invisible,” etc.) with the goal of determining whether there are significant differences in the changes between pre- and post-encounter ratings. Again, corrections will be made for familywise error rates.

Qualitative analysis of reflections will include basic frequency counts of themes of interest, including but not limited to desire to have further disability education, unanticipated aspects of the encounter experience from the students’ perspectives, and general feelings about the success of the simulated experience.