Western University of Health Sciences is dedicated to humanistic, whole-person care. Students are taught to see each patient as a unique individual, not as a symptom or diagnosis.
Fitting perfectly with this ethos, the Wellness Visit Workshop, part of the National Curriculum in Developmental Medicine (NICHE-MED) grant initiative, took place in the Sarkaria Family Patient Simulation Suite on the WesternU California campus.
Spearheaded by WesternU’s College of Osteopathic Medicine of the Pacific (COMP), in collaboration with the Harris Family Center for Disability and Health Policy and Thrive Adaptive, this first-of-its-kind workshop at WesternU is designed to prepare future health care professionals from COMP and the College of Podiatric Medicine (CPM) for inclusive, person-centered care.
NICHE-MED was awarded to WesternU to improve training for medical students in providing high-quality, respectful care to individuals with intellectual and developmental disabilities (IDD). During the workshop, individuals with lived experience of autism and/or IDD served as simulated patients during wellness visits. These sessions allow students to build empathy, practice effective communication, and better understand the unique needs of patients with IDD.
As part of this workshop, fourth-year COMP student Tasnia Haider examined Dominic Juarez, 25. She introduced herself to him and to his mother and caregiver, Jamie Currie. Haider asked Juarez questions about how he was feeling and if he had any health complaints. He typed his responses on a letter board, a laminated keyboard, and Currie explained what he was typing. Through this method of communication, Juarez told Haider that he was diagnosed with autism at age 2½, along with epilepsy and viral encephalopathy.
Addressing each patient directly is important because this is the person you’re taking care of, Haider said.
“We’re always taught that you should always assume everyone is competent and able to decide on their own, so that you know who you’re always referring to because it’s not always the caregiver making the decisions. It’s shared decision-making,” Haider said. “This gives us a little bit of exposure in a comfortable environment, before we go into the real world, where you know that you’re getting honest and good feedback and you know that you’re not intentionally trying to hurt someone. You can practice little changes in your words and how you phrase things to be more appropriate in an environment that’s comfortable. This teaches us different ways of communicating and how to be a better advocate for your patients of every different background.”
Currie owns a behavioral health agency that helps individuals with autism and developmental disabilities for regional centers, insurance companies, and school districts. She developed the learning module and facilitated the debrief for the students participating in the Wellness Visit Workshop.
“It’s great. It’s awesome to have a university receptive to learning and developing new ways of performing medical examinations for students and other doctors,” Currie said. “I think the greatest challenge is medical doctors being compassionate and treating (Dom) with presumed competence, that he’s capable even though he can’t speak. That would be the ideal, just the compassion piece of accepting the autism population and not being afraid when they have interest or behaviors that are self-stimulatory that create an uncomfortable environment in a medical office, because that’s what we deal with daily. So being patient and getting through medical visits, being able to accommodate the individualized needs that he might have.”
Currie said she wants students to understand that autism is a spectrum, so they need to understand intellectual disabilities and the co-morbidities that go along with those disorders – how they might play out with communication and observable behaviors, and then how to respond to when those types of events happen.
“The biggest takeaway is the willingness to accept individuals like our children into their practices or in hospitals once they’re licensed and on their own. It’s better to get practice now and be experienced because if they don’t start early in their career, they just get more set in their ways,” Currie said. “I think the best thing for us is being able to showcase and help other people that are willing to learn and hone in on those skills that they need, because so many medical doctors won’t even accept us in their practice. So, the fact that this university is putting this forward with their students is an honor, and it’s cutting edge.”
Joe Holt, co-founder and executive director of Thrive Adaptive, partnered with COMP Associate Dean for Student Affairs Michelle Emmert Park, EdD, and WesternU Harris Family Center for Disability and Health Policy Director Marcelle Daniels to secure the NICHE-MED grant. Thrive Adaptive is an organization with the mission of educating clinicians and aspiring clinicians to better care for folks with disabilities.
More than 15% of the broader global population has reported having a disability, and that number is likely substantially larger because many people don’t report things of that nature, Holt said.
“Also, disability is one of the only marginalized populations that somebody can join in an instant,” Holt said. “And as we get older and we age, it’s not a matter of if a student or a doctor encounters somebody with a disability, but when, and I think many of the medical schools just really fall short of preparing their students for those sorts of engagements. I really want to commend WesternU for being ahead of the curve and providing this space and platform to give their students these clinical experiences. I guarantee you that it will make them better and more well-rounded doctors as they progress in their careers.”
During Conference Week, students can choose lectures, activities and presentations they want to participate in. Communication drills are something that our students are very familiar with, but it’s not typically with lived experience individuals who have disabilities, Park said.
“I grew up with a sister who had cerebral palsy and intellectual developmental disabilities, but even for somebody who’s had that experience and been in that world, this was very eye opening for me because I now have a much better understanding of these individuals who are getting disparate care in our current system,” Park said. “Lived experience patients are people from our community who have the actual disabilities that we are learning about. And so it was really exciting to be able to provide this opportunity to our students to actually engage with real people who are experiencing this, who can share their personal experience with the health care system.”
For this first of three NICHE-MED learning modules, 313 students chose to do the module as an optional conference week activity, and 48 of those students had the opportunity to engage with 12 lived experience participants. These future physicians have learned something about autism and IDD and they’re going to go on rotations, graduate and interact with patients better because of it.
Park hopes students will have a much greater awareness of some of the challenges that patients face when they see a provider, and some of the challenges that they face in everyday life.
“My hope is that by the end of this, they will not only recognize some of those challenges, but the next time that they walk into a room and they see on the patient chart that they have a certain disability, that they’re going to have a familiarity and they can put that patient a little bit more at ease, and spend the extra time that’s needed to help them to be heard and to get the care that they need,” Park said.