Abstract
Context:
In order to design undergraduate medical education responsive to the American Academy of Pediatrics’ recommendation that physicians learn about special education law and practices, it is important to understand medical students’ baseline knowledge about children with disabilities, special education law, available services, and the sources of this information.
Objectives:
To develop an instrument to measure what second-year medical students know about children with disabilities, special education law, and available services; to determine the most common sources of this information; and to establish a baseline on which to design curricula that address this topic.
Methods:
This study adopted a survey design. The survey took place in 1 school of osteopathic medicine in a Northeastern state of the United States. One hundred fifty medical students in their second year of full-time enrollment were invited to complete the survey. The instrument designed by the authors consisted of 30 items organized into a demographics section and 3 domains: (1) perceived level of knowledge about children with disabilities, (2) sources of information about children with disabilities, and (3) actual knowledge about children with disabilities and special education.
Results:
Ninety-eight students (65%) participated. Although students were accurate in self-assessment, their source of knowledge was limited. Medical students who identified personal experiences (t=1.64) and coursework as their source of knowledge had more correct responses (t=2.62).
Conclusion:
This preliminary study demonstrated a lack of knowledge among second-year medical students with regard to children with disabilities, special education laws, and social services. Curricula emphasizing disabilities and special education along with longitudinal experiential training may be effective methods to deliver these topics.
The American Academy of Pediatrics endorses family-centered care, community-based supports and services, and accessible, coordinated, and continuous support,
1 with a focus on special education law and services
2 as attributes of quality health care for children with disabilities. Physicians actualize these attributes by identifying children with developmental delays, facilitating referral to early intervention (EI) or special education services
3 and promoting the well-being of all children in the educational setting and in health care.
2
Children with disabilities are protected under 2 federal laws: The Individuals With Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act of 1973. The IDEA ensures that people from birth to age 21 years with diagnosed disabilities are provided with a free appropriate public education in the least restrictive environment.
4 Free appropriate public education mandates the provision of special education without cost to families in an appropriate school setting. The least restrictive environment mandate calls for children with disabilities to be educated with nondisabled peers to the maximum extent appropriate. A student is eligible for special education under IDEA if a disability has been diagnosed, the disability adversely affects educational performance, and specially designed instruction is required.
Early intervention for children from birth to 3 years of age is a component of IDEA that is intended to reduce potential adverse effects and enhance development.
5 Children qualify for EI services if they have a developmental delay or a diagnosed condition that results in a high probability of developmental delay.
6 Although states have discretion in setting eligibility criteria, IDEA guarantees supports and services for infants and toddlers and their families.
7 In the event a person aged 3 to 21 years is not deemed eligible for special education services yet still needs accommodations to access the school curriculum, Section 504 of the Rehabilitation Act of 1973, a civil rights law designed to prohibit discrimination based on disability status, mandates provision of the necessary accommodations through a 504 Plan.
8
Physicians who understand special education laws and practices can help parents access services for their children, monitor school progress during well-visit appointments, increase collaboration with schools, and assist in the planning for the transition of older children with disabilities to adult services. Understanding special education, resource availability, and the impact of disability can benefit physicians who work in specialties such as internal medicine, family medicine, surgery, and psychiatry,
9 where they will likely encounter children or adults with disabilities or their family members.
The number of people with disabilities across the age span is growing, validating the need for physicians to be prepared to meet their health care needs. During 2014-2016, the prevalence of children aged 3 to 17 years with a diagnosed developmental disability such as autism spectrum disorder, intellectual disability, communication disorders, and learning disabilities, increased from 5.76% to 6.99%.
10
Currently, most training for physicians in the area of developmental disability and special education occurs during pediatric residency or residency periods for specialty areas (eg, developmental pediatrics, family medicine), with training often dependent on mentor contributions.
11-14 Research on training is primarily focused on medical students’ attitudes toward people with disabilities rather than on their knowledge of special education law and practices.
15 A study by Shah et al
16 demonstrated a disconnect between pediatricians’ attitudes about special education and reported practices. The authors speculated that a lack of specific training regarding the special education process may explain the discrepancy. Moreover, primary care physicians recommended modifying their medical school experience by including experiential learning
3 and expanding disability-specific education to better equip them to care for patients with disabilities.
17
We are currently developing curricula to improve medical students’ knowledge, attitudes, and skills in the area of treating children with disabilities and collaborating with these patients’ families. The objectives of the current study were to develop an instrument to measure what second-year medical students knew about children with disabilities and special education law and available services, to determine the most common sources of this information, and to use the pilot data to establish a baseline on which to design curricula.