INTELLECTUAL AND DEVELOPMENTAL DISABILITIES AAIDD

2016, Vol. 54, No. 3, 202216 DOI: 10.1352/1934-9556-54.3.202

Preparing Tomorrows Doctors to Care for Patients With Autism

Spectrum Disorder
Susan M. Havercamp, Karen Ratliff-Schaub, Patricia Navas Macho, Cherelle N. Johnson, Kelsey L.
Bush, and Heather T. Souders

Abstract
People with autism spectrum disorder (ASD) and other developmental disabilities have poorer
health and face unique barriers to health care compared to people without disabilities. These health
disparities can be partially attributed to physicians limited knowledge about caring for patients with
developmental disabilities. The purpose of this study was to determine the effectiveness of ASD
training for medical students. Our training included a lecture and a panel presentation that featured
people with ASD and family members. Students reported improved knowledge, skills, confidence,
and comfort in caring for patients with ASD.
Key Words: disability; medical education; autism spectrum disorder

People with autism spectrum disorder (ASD) and
other developmental disabilities (DD) face dispar-
ities in health and access to quality health care.
Adults with developmental disabilities are more
likely than adults without disability to have a
variety of healthcare needs (U.S. Public Health
Service, 2002), including unhealthy weight (Bhau-
mik, Watson, Thorp, Tyrer & Mcgrother, 2008;
Yamaki & Taylor, 2005), physical inactivity
(Havercamp & Scott, 2015), inadequate emotional
support (Havercamp & Scott, 2015; Stancliffe et
al., 2007), epilepsy (McGrother et al., 2006),
mental illness (Cooper, Smiley, Morrison, Wil-
liamson, & Alan, 2007), and overall poor health
(Havercamp & Scott, 2015). Although few studies
have reported on the health of adults with ASD,
one study found young adults with high functioning
ASD to have poorer health-related quality of life
compared to the normative sample of adults in the
domains of physical health, psychological health,
and social relationships (Kamp-Becker, Schroder,
Remschmidt, & Bachmann, 2010).
Health disparities for patients with ASD and
other developmental disabilities may be attributed
to their limited ability to participate in their own
health care due to communication difficulties,
limited comprehension, and behavioral difficulties
(Lunsky, Emery, & Benson, 2002; Raposa, 2009).
The inability to effectively communicate ones
distress or discomfort makes the recognition,
diagnosis, and treatment of health problems
challenging for people with DD, their caregivers,
and healthcare providers (Ouellette-Kuntz, 2005).
Once the distress message is successfully delivered,
then a treatment plan must be communicated back
to the patient, understood, and followed (Lennox
& Kerr, 1997). In addition to communication
difficulty, people with ASD may display problem
behaviors that could be symptomatic of a psychi-
atric or physical disorder (McClintock, Hall, &
Oliver, 2003) or indicative of communication
frustration. Patients with ASD often present with
complex problems, which are exacerbated by the
increased time required to obtain a history and
physical exam. Healthcare providers report feeling
unprepared, uncomfortable, and overwhelmed by
the complex needs of patients with ASD and DD,
which negatively affect quality of care (Boreman,
Thomasgard, Fernandez, & Coury, 2007; Bruder,
Kerins, Mazzarella, Sims, & Stein, 2012; Golnik,
Ireland, & Borowsky, 2009; Shah, 2001; Wilkin-
son, Dreyfus, Cerreto, & Bokhour, 2012). Societal
attitudes toward disability (Wilson & Scior, 2014),
as well as those of healthcare providers, tend to be
negative and may compromise treatment (French,
1994; Gething, 1992; Tervo, Azuma, Palmer, &
Redinius, 2002). The need for ASD training to
improve the quality of care for these patients was
widely expressed by healthcare providers (Bruder et
al., 2012; Golnik et al., 2009).

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There is a small body of literature addressing
what healthcare providers should know about ASD
and other developmental disabilities and less on
how such content is best taught. Lennox and
Diggens (1999) identified core competencies in
intellectual disabilities for undergraduate medical
students that included objectives pertaining to
knowledge, skills, and attitudes. Similar objectives
for disability broadly defined were identified by
researchers in the United States (Kirschner &
Curry, 2009; Minihan et al., 2011).
In a survey of United Kingdom medical school
curriculum, Lennox and Diggens (1999) found that
most intellectual disability content was covered in
didactics, although the authors pointed out that
firsthand experience working with people with
intellectual disability was necessary to develop skills
and improve attitudes. Khatan et al. (1994) reported
on innovative teaching practices in the United
Kingdom in the area of disability and rehabilitation.
In a survey of all 23 medical schools, the authors
found that medically led lectures and seminars were
most commonly used but that schools also used
clinical examination and history taking of patients
with disability, visits to centers and disability service
agencies, small-group teaching led by community
members with disabilities, and home visits with
families that included a person with a disability. One
of the more innovative programs included a drama
workshop led by actors who had intellectual
disabilities (Hall & Hollins, 1996). In that program,
medical students had face-to-face contact with
adults with intellectual disability and saw them in
socially valued roles of teachers and leaders.
Students also prepared an ethics debate about a
complex clinical dilemma, participated in small-
group seminars conducted in partnership with a
parent, and conducted a home visit in pairs. The
course focused on improving attitudes toward and
skills communicating with adults who had intellec-
tual disabilities.
In Australia, much work has been done to
provide disability training to future healthcare
providers (e.g., Tracy et al., 2008). In one study,
Tracy and Iacono (2008) evaluated a communica-
tion-skills training session for fourth year under-
graduate medical students that included direct
contact with people with developmental disabilities
in a valued role (tutor), followed by a structured
discussion. They found that students evaluated the
session very positively and reported being more
S. M. Havercamp et al.
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DOI: 10.1352/1934-9556-54.3.202
comfortable interacting with people with disabili-
ties after the session.
In the United States, Woodard, Havercamp,
Zwygart, and Perkins (2012) developed a primary-
care clerkship on developmental and other disabil-
ities that included lecture, model patients with
disabilities, disability-related community site visits,
service learning for adults with intellectual disabil-
ities, and home visits. Significant changes in medical
students disability knowledge, attitudes, and com-
fort level were found over this 6-week module.
Eddey, Robey, and McConnell (1998) trained adults
who were nonverbal due to cerebral palsy to portray
common ailments in standardized patient encoun-
ters. After a discussion about effective communica-
tion with patients who were nonverbal, third-year
medical students were asked to establish a mode of
communication, establish rapport, question the
individual about symptoms and medical history,
conduct a directed physical examination, and arrive
at a preliminary diagnosis. The students ratings on a
semantic differential scale completed before and
after the session moved toward greater comfort and
skill and toward more rational and objective
approaches to the patient. Sharma, Lalinde, and
Brosco (2006) sent medical trainees to visit the
homes of children with disabilities to challenge
limiting attitudes about disability.
The importance of including people with
disabilities and family members in training efforts
was universally emphasized in these and other
studies (Long-Bellil et al., 2011; Symons, McGui-
gan, & Akl, 2009). In addition to this person-
centered training element, medical education
research has explored best practices in teaching
about professional values and attitudes. Birden et
al. (2013) identified role modeling and personal
reflections as being the most effective. Experiential
learning is a process by which learning occurs by
having an experience, such as an encounter with a
patient with a disability. However, the experience
must be interpreted and integrated into existing
knowledge structures to become new or to expand-
ed knowledge. Reflection is crucial for this active
process of learning. Reflection, in essence, is a
deliberate process used to develop an understanding
or to make sense of a situation so that future actions
can be informed (Sandars, 2009). Reflection may
be guided by a conversation with a supervisor or a
written exercise.
Previous literature has focused on intellectual
disability; at the time of this writing, neither
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quantitative nor qualitative data have been report-
ed about the effect of educating medical students
on caring for patients with ASD. Only Shah (2001)
reported on medical students autism awareness at
different stages of their medical career, without
implementing any additional training focused on
patients with ASD. We designed a brief ASD
encounter for third-year medical students (N 99)
that included people with ASD and family
members in teaching roles discussing the healthcare
needs of children and adults with ASD. Our goals
for this training were to help students feel more
comfortable and confident providing care to
children or adults with ASD. The training included
a lecture on ASD and a facilitated panel discussion.
In keeping with previous research, we included
people with ASD and their family members in the
training and used written reflections as part of our
evaluation. The perceived benefit of this training
in terms of student satisfaction, comfort, and
perceived skills is reported in this article. Variables
such as gender, race, and knowing someone with a
disability were taken into account to further
explore differences in student perceptions about
the experience.
Method
Participants
A total of 99 third-year medical students at The
Ohio State University attended the training (on-
line lecture covering ASD diagnostic criteria and
medical home followed by a panel discussion with
professionals, people with ASD, and family mem-
bers on the healthcare needs of children and adults
with ASD). Their age ranged from 23 to 37 years
(M 25.5, SD 2.25). Information regarding other
demographic characteristics such as gender, eth-
nicity and previous knowledge about disability is
presented in Table 1.
Procedure
We provided online lectures and panel discussions
from April to September of 2013 as a required (not
elective) component of the medical curriculum
within the ambulatory care rotation. Panels
consisted of a facilitator (a developmental-behav-
ioral pediatrician) and four to five panel members
made up of adults with ASD and parents of
children with ASD. We recruited panelists from
local autism organizations and community support
groups; panelists volunteered their time. Panel
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Table 1
Participant Demographics
Variable No. (%)
Gender
Male 49 (49.5%)
Female 50 (50.5%)
Race/ethnicity
White 30 (30.3%)
Nonwhitea 58 (58.6%)
Previous disability knowledge
No professional knowledge 80 (81.0%)
No personal knowledge 53 (53.5%)
a
Students distributed across other race/ethnicity groups as
follows: Asian (N 15); African American (N 5);
Hispanic (N 4); Asian American (N 3); Asian
American / Pacific Islander (N 2); and Arab American
(N 1). However, because some statistical tests, including
chi-square, may perform poorly if more than 20% of the
expected values are less than 5 (Cochran, 1952), we
recoded race/ethnicity into two values: white (1) and
nonwhite (0) for the quantitative and qualitative analysis.
Demographic data were missing for 11 participants.
discussions ranged from 45 min to 1 hr, with 15
min for student questions. Although panel discus-
sions were not scripted, we guided the discussion
to certain topics that have been identified in the
scientific literature as a concern in healthcare
encounters with patients with ASD and their
families. These topics included: effect of diagnosis,
misconceptions, and stigmas associated with ASD
diagnosis; acute healthcare experiences; and best
and worst experiences with medical professionals,
medications, therapy, community services, transi-
tion to adult services, and healthcare financing.
Before the panel encounter, we asked students to
view an online ASD lecture by a developmental
behavioral pediatrician that described features of
ASD, the value of a medical home, and patient-
centered care.
In the month following the training, students
completed 10 closed-ended questions about the
experience and wrote a brief (100250 word)
reflection about its effect on their medical educa-
tion and future practice.
The Ohio State University Behavioral Science
Institutional Review Board approved this study.
Measure
Medical students completed a survey (see Table 2)
composed of 10 closed-ended questions about the
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2016, Vol. 54, No. 3, 202216
following: (a) perceived effect of the training (these
questions asked about change in disability knowl-
edge, confidence and comfort, skills, and ability to
provide better care to patients with disabilities); (b)
their interest in working with people with disability
in the future; (c) the quality and their satisfaction
with the panel experience; and (d) one question
about the extent to which further disability training
would benefit their future practice.
Finally, every student wrote a brief (100250
word) reflection about the educational experience
and the effect on their medical education and future
practice. Their reflections were analyzed by qualita-
tive procedures to identify important topics to be
covered in future trainings and aspects to improve.
Data Analysis
We used a mixed methodological approach, which
involves the collection, analysis, and integration of
both qualitative and quantitative data in a single
study. Qualitative (students 100250 word reflec-
tions) and quantitative (closed-ended questions)
data were collected at the same time. This
approach aims to broaden and triangulate research
findings in a way that sheds more light on these
findings (Schifferdecker & Reed, 2009).
Quantitative data. We carried out quantitative
analysis of student feedback (N 99) using SPSS
Statistics 21 and assessed differences in categorical
variables using Chi-square tests and computed
means and standard deviations for continuous
variables. Pearsons chi-square test was used to
examine whether there was an association between
two categorical variables (e.g., gender and previous
knowledge about disability). To do so, some
variables with multiple categories (e.g., race/
ethnicity) were recoded into two broad categories
(white/nonwhite).
With the goal of analyzing differences in
student perceptions about the training as a function
of variables such as gender and race/ethnicity, and
because some response categories were never used
(e.g., very negative change), we recoded students
responses into: 0 (no change or negative change)
and 1 (positive or very positive change) for
quantitative analyses.
Qualitative data. We analyzed students reflec-
tions using QSR NVivo software (version 10; QSR
International, 2012). Data analysis (i.e., coding)
involved organizing raw data into categories (Baralt,
2011) by reading and discussing recurrent themes.
S. M. Havercamp et al.
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DOI: 10.1352/1934-9556-54.3.202
Table 2
Medical Student Survey
Itema
1. Knowledge about what to do or say when
examining a person with a disability
2. Confidence and comfort level in working with
people with disabilities
3. Understanding of the challenges (both physical
and attitudinal) that people with disabilities
face when visiting a doctor
4. Skills in helping a patient with a disability feel
welcome and comfortable during a medical visit
5. Overall competence in communicating with
people with disabilities
6. Ability to provide better care for people on the
autism spectrum
7. How interested are you in working with people
with disabilities in the future?
8. What is your overall level of satisfaction with
this learning experience?
9. How would you rate the quality of the
teaching provided?
10. How much would further disability training
(about other developmental disabilities,
mobility disabilities, and sensory disabilities
such as blindness/deafness) benefit your future
practice as a healthcare provider?
a
All items were rated on a 5-poing Likert scale where 5
indicated very positive/interested/satisfied, and 1 indicated
very negative/uninterested/dissatisfied.
Using themes as the coding unit meant that we
assigned the text (regardless of size) to a specific
category as long as it represented a single theme of
relevance to our research (Zhang & Wildermuth,
2009). Although categories were defined to be as
externally heterogeneous as possible, on some
occasions, we assigned the text to more than one
category. We derived categories inductively (Pope,
Ziebland, & Mays, 2000) by constant comparison of
the students comments among three researchers.
The three researchers discussed disagreements and,
as suggested by Baralt (2011), they refined and
restructured the coding scheme.
The researchers finally identified nine main
themes (called parent nodes in Nvivo) and
subthemes (or child nodes) for five out of the nine
main categories. The final coding framework
(Table 3) was used to code the rest of the dataset.
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Table 3
Student Reflections

Theme % Discoursea % Students Citingb

Better understanding of ASD
[S07] This experience also allowed me to learn more about autism 21.7% 68.7%
in general. This is something that had only briefly been discussed
thus far in my medical school curriculum.
Subtheme: Better understanding of ASD (symptoms and features) 11.2% 40.4%
[S12] I also had no idea how sensitive people with autism are to
stimuli, which is very important to consider with regards to their
examination
Subtheme: Better understanding of ASD (knowledge about 9.5% 28.3%
healthcare needs)
[S06] One of the bigger take home messages for me was that
people with autism spectrum disorders also have other medical
issues like diabetes, appendicitis, etc. You cant chalk up all their
various symptoms to their autism or other developmental
disorder
Specific and positive mention to aspects of the training
[S05] I think that the panel was a really great and unique 20.1% 64.6%
experience in my medical education. It was very eye opening
Subtheme: Specific and positive mention related to the format 11.2% 35.4%
[S23] I found the panel to be extremely worthwhile, and loved the
fact that people with autism were able to participate and lend their
perspective. It is incredibly helpful to hear a first-hand account
when trying to understand a developmental disability, and several
of the comments were really insightful.
Subtheme: Specific and positive mention related to the content 7.1% 24.2%
[S83] I found the concept of the autism patient group home very
interesting as it seemed to have great promise in maintaining
stability and continuity of care with well-known healthcare
providers.
Subtheme: Specific and positive mention related to the speakers 1.8% 8.1%
[S80] I thought it was deeply touching and feel appreciative that
the four mothers took the time to talk to us about something so
personal
Tools and strategies to use in the future
[S49] I learned many useful tips about interacting with autistic 17.2% 53.5%
patients and things that I can do to work with my patients to make
their visits to their physician a better experience. As someone who
is considering going into primary care, I will be using a lot of the
principles covered today such as how to make autistic patients
more comfortable.
(Table 3 continued)

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Table 3
Continued

Theme % Discoursea % Students Citingb

Subtheme: Specific tools and strategies learned 8.8% 21.2%
[S39] I liked how the mothers and the one patient explained how
their children or they themselves preferred the patient encounter
to progress, for example show the person with autism what you
are going to do to examine them before you do it and let them
play with the stethoscope before using it on them.
Healthcare Barriers
[S21] It was particularly interesting to learn the difficulties they had 13.8% 40.4%
establishing care with a family doctor, I did not think it would be
so difficult to find someone to understand their situation.
Aspects to improve
[S92] I would save discussions such as this one for didactic 7.9% 26.3%
sessions during the rotation, once weve gotten our feet wet.
Subtheme: improvements with regard to the speakers 3.52% 11.1%
[S63] I would have liked the addition of the perspective of a
health care professional who works with this population.
Subtheme: improvements with regard to the format 2.56% 10.1%
[S99] In the future, I would consider having 2 or 3 panelists
share their experiences rather than 4; some of the stories and
responses seemed to overlap too much, making some of the
session a little redundant.
Subtheme: improvements with regard to the content 1.82% 8.1%
[S62] One area that wasnt covered was why physicians might
have missed autism.
Confidence
[S36] Before this experience, I had always dreaded having to 7.5% 29.3%
interact with this type of patient population, but I feel that Ive
learned some of the appropriate methods to do so, and will be a
better physician in the future because of it.
Communication
[S72] this presentation made it clear that it is crucial to form a 6.7% 17.2%
relationship with the caretakers and family members of the patient as
they can be valuable allies in understanding how best to communicate
with the patient and figuring out what is wrong
Subtheme: specific communication strategies learned 4.9% 14.1%
[S04] The most helpful advice that I was provided in this
experience was to ask a patient or patients family with a
developmental disability or ASD what is the best way to
interact with you, how can I best approach you, or how
does your DD/ASD affect you? This question would allow me
to ensure that I minimize unsettling or unnerving experiences in
the patient interview.
(Table 3 continued)

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2016, Vol. 54, No. 3, 202216
Table 3
Continued
Theme
Attitudes
[S16] Movies like Rain Man or media portrayals in television
influenced my thinking, mostly because I had never met a patient
with autism. I used to think of the kids that scream, space out, and
you cant grab their attention. After meeting the panel, and meeting
two functioning adults with autism, it really opened my eyes.
Note. ASD autism spectrum disorder.
Interrater reliability was established using Cohens
Kappa coefficient on 50% of the dataset that was
coded by two authors. We interpreted the Kappa
coefficient according to the following criteria
(Viera & Garrett, 2005): Slight agreement (,
.20), fair agreement (.21.40), moderate agreement
(.41.60), substantial agreement (.61.80), and
almost perfect agreement ( .81). Kappa values
ranged from moderate to almost perfect agreement
(.53.97).
Results
Quantitative Data
Students reported very positive or positive changes
associated with the training with respect to caring
for patients with developmental disability in all of
the closed-ended questions: knowledge about what
to do or say, understanding challenges faced,
confidence and comfort, skills to help patients,
ability to communicate with patients, and ability to
provide better care (Figure 1). However, males
were less likely to report positive or very positive
changes in their competences after the experience
(Table 4) especially when they were asked about
their level of understanding of the challenges
individuals with ASD and their families face, or
their communication skills to work with this
population. Gender influenced the perceived ben-
efits of the training more than previous personal or
professional knowledge about disability; in fact, no
differences were found between those who had
previous knowledge about disability (personal or
professional) and those who did not have this
knowledge with respect to perceived positive
changes in the aforementioned competences.
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% Discoursea % Students Citingb
5.2% 17.2%
With regard the closed-ended questions about
their interest in future work with people with
disability, about the quality of the training, and the
perceived benefit of further disability training,
results varied by gender and by having previous
disability knowledge. Males were more likely to
question the benefit of future training, and students
without previous professional knowledge about
disability were significantly more likely to rate
the training as good or excellent (Table 5). When
asked about their interest in working with people
with ASD in the future, students with previous
personal knowledge about disability were signifi-
cantly more likely to be interested in working with
this population than those without this background
(Table 5).
Because having met someone with a disability
personally seems to influence students willingness
to work with this population in the future, and
females reported more positive changes after the
training, we explored demographic differences in
knowing someone with a disability. No statistically
significant differences were found in this sample
regarding knowledge (either professional or per-
sonal) about disability by gender or race/ethnicity.
Qualitative Data
Table 3 shows a selection of quotes from students
reflections and includes the text coverage or the
percentage of the entire text (discourse) that was
coded under each specific theme and subtheme.
The number of students addressing or citing each
theme is also listed.
Students most frequently reported better un-
derstanding of ASD (specifically those symptoms
and features associated with this developmental
disability) as a result of the training (Table 3),
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2016, Vol. 54, No. 3, 202216
Figure 1. Changes reported after the training. Note. DD developmental disabilities.
representing 21.7% of students discourse. This was
reported even by students with previous personal
knowledge about disability, acknowledging that,
having a family member with ASD has allowed me
to forget about the spectrum part of the Autism
spectrum [S14].
Students also reported increased knowledge
about tools and strategies to use in their future
practice (17.2% of students entire discourse), and
almost half of the students discussing this issue
(Table 3) mentioned specific strategies they had
learned, such as minimizing time spent in the
waiting area and having comfort items available in
the patient rooms, to show the person with autism
what it is going to be done before doing it, or
finding out what someone likes and trying to relate
to their interests as the best way to build trust.
Some students even used these strategies shortly
after the training and before completing the survey
as reported by [S18]: This has already led to a change
in my behavior: This week, rather than simply walking
up to patients with my hand extended to take theirs, I
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ask, May I shake your hand? I have begun asking
patients, Do you have any concerns about being
examined? before we begin. I have gotten generally
positive feedback from patients for doing so.
A total of 64 students highlighted positive
aspects of the training; this topic represented 20.1%
of students entire discourse. The format of the
training and having firsthand experiences with
people with ASD and their families was mentioned
as one of the aspects most valued by students (11.2%
of students discourse, representing 55.7% of the
entire discourse dedicated to highlighting positive
aspects of the training) not only because of the
stories they told, but the way they told it because it
helped make it stick, as one student stated.
Increased awareness about healthcare barriers
faced by people with ASD and their families was
the fourth theme most discussed by students (13.8%
of students discourse). Thus, students reported
increased knowledge about barriers such as finan-
cial burden and lack of appropriate transition
services.
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Table 4
Positive or Very Positive Changes in Competences Reported After the Training
Male (N 49) Female (N 50)
Increased knowledge about what to do or say when
examining a person with ASD
Higher level of understanding for the challenges that
people with ASD face when visiting a doctor
Increased confidence and comfort levels in working
with people with ASD
Better skills in being able to help a patient with
ASD feel welcome and comfortable during a
medical visit
Improved overall competence in communicating
with people with ASD
Better ability to provide better care for people on
the autism spectrum
Note. ASD autism spectrum disorder. aExpected frequencies are less than 5 in the category Negative or no change, so
chi square test may perform poorly in this case.
Students reflections also indicated that this
training provided them with the opportunity to
increase their exposure to developmental disability.
This opportunity led students without previous
personal knowledge about DDcompared to those
with previous personal knowledgeto focus their
reflections on the healthcare barriers that people
with ASD and their families may experience
(50.9% vs. 28.3%; v2 (1, N 99) 5.262; p , .05).
Comparisons based on demographic attributes
of participants showed a similar gender effect to
that found in the quantitative data. Females were
more likely to report in their reflections increased
knowledge about tools and strategies to use in a
future practice (64.0% vs. 42.9%) and were more
likely to mention positive aspects of the training
compared to males (74.0% vs. 53.1%).
Discussion
To the widespread problem of physicians lacking
skills and comfort caring for patients with DD, we
propose a training solution. Our training provided
medical students the opportunity to learn from
people with ASD and their families. Panelists shared
experiences and touched on topics that might be
important to consider when delivering healthcare
services to patients with developmental disability.
Importantly, the very presence of advocates and
family members challenged prevailing and limiting
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Gender Sub Comparisons
v2 p
79.6% 92.0% 3.14 .076
83.7% 96%a 4.14 .042
69.4% 80.0% 1.48 .224
75.5% 90.0% 3.65 .05
65.3% 88.0% 7.15 .008
83.7% 88.0% .38 .537
assumptions about disability and reflected the
diversity that is autism spectrum disorder.
Following this training, students reported
positive or very positive changes in their knowl-
edge, communication skills, confidence, and level
of understanding of the challenges faced by people
with ASD and their family. When students were
given the opportunity to write openly and anony-
mously about their experience, they reported better
understanding of ASD, increased knowledge about
tools and strategies to use in their future practice,
and increased awareness about healthcare barriers,
along with specific and positive comments about
the training.
Given these positive findings, we were inter-
ested in exploring differences in the effect of the
training across student demographic groups. We
found significant differences in the learning
experience of male versus female students. These
differences were found in both quantitative and
qualitative data, whereby females were more
satisfied than males with the training and were
more likely to report a positive change in their
communication skills and knowledge about strate-
gies to use in their future practice with patients
with developmental disabilities. Other researchers
found that females may have greater tendency to
imagine themselves in anothers place (Hoffman,
1977) and score significantly higher on empathy
rating scales (Chen, Lew, Hershman, & Orlander,
2007; Hojat et al., 2002), so they may benefit more
Preparing Tomorrows Doctors for ASD
S. M. Havercamp et al.
2016, Vol. 54, No. 3, 202216

Table 5
Interest in Working With People With Autism Spectrum Disorder (ASD) and Satisfaction With the Training

Previous Knowledge About Disability

Gender Professional Personal
Male Female Yes No Yes No
INTELLECTUAL AND DEVELOPMENTAL DISABILITIES

(N 49) (N 50) v2 p (N 19) (N 80) v2 p (N 46) (N 53) v2 p

Interested in working
with people with
ASD in a future 36.7% 56.0% 2.97 .08 52.7% 45.1% .359 .549 60.9% 34.0% 7.16 .007
Students reported
being satisfied with
the training 69.4% 84.0% 2.96 .08 63.2% 80.0% 2.44 .118 78.2% 75.5% .107 .74
Training is perceived
as beneficial for
future practice 69.4% 88.0% 5.13 .02 79.0% 78.8% .011 .918 86.9% 71.7% 3.43 .07
Quality of the training
reported as good or
excellent 91.8% 98.0% 1.96 .161 84.2% 97.5% 5.65 .017 95.7% 94.4.% .088 .76
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INTELLECTUAL AND DEVELOPMENTAL DISABILITIES
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from this experience in which they were exposed to
medical and personal experiences shared by people
with ASD and their families. Previous researchers
found that male medical students were more likely
to hold negative attitudes toward people with
disabilities compared to female medical students,
which may also have affected our findings (Paris,
1993; Tervo et al., 2002). Evidence points to a
significant interaction between gender and learning
style (Smits et al., 2004), which could also explain
the results of this study. Some researchers have
pointed out that men show greater preference for
traditional educational modalities, whereas women
key into the affective aspects of the learning
experience and generally have more diverse
learning styles (Philbin, Meier, Huffman, &
Boverie, 1995; Slater, Lujan, & DiCarlo, 2007).
Future medical education research should focus on
these variables to maximize positive changes for
male and female medical students. For example,
educators may discuss prevailing attitudes toward
people with disabilities and implicit bias within the
medical curriculum and combine direct patient
contact with traditional readings and clinical
guidelines. Including a control group in future
training experiences would improve our under-
standing of differences between males and females
in their willingness to care for patients with ASD.
According to the results of the survey, although
not statistically significant, females were more
willing than males to work with patients with
developmental disability in the future (54% vs.
36.7%). Having previous personal knowledge about
disability also increased the willingness of medical
students to care for this population. Similar results
have been reported by other researchers (McConkey
& Truesdale, 2000) and highlight the importance of
giving medical students firsthand experiences with
diverse populations early in the medical curriculum.
This study has limitations. First, it wasnt
possible to evaluate the short- and long-term effects
of this educational experience on healthcare
professionals, a limitation that is frequently associ-
ated with the examination of educational outcomes
(Towle et al., 2010). We did not ask students what
medical specialty they were planning to pursue,
which could influence the perceived benefits of the
training. In this sense, Patel and OHare (2010)
found that pediatric residents were significantly
more likely than internal medicine residents to
anticipate caring for patients with ASD in the
future and also feel significantly more comfortable
treating this population. The truth is, however, that
212
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DOI: 10.1352/1934-9556-54.3.202
people with ASD and other disabilities are not
protected from developing a full range of other
health conditions and requiring care from health-
care providers in any number of specialty and
subspecialty areas. We believe that future health
care providers of all disciplines and specialties
should have exposure to and develop comfort and
competence in caring for patients with disabilities,
and that this training should be developed in
partnership with the disability community.
Two Surgeon General reports (U.S. Public
Health Service, 2002; U.S. Department of Health
and Human Services, 2005), one Institute of
Medicine Report (2007), the National Council on
People with Disabilities Report (2009), and the
World Health Organization World Report on Disability
(U.N. World Health Organization, 2011) all recom-
mended that we, as a society, improve the knowl-
edge, skills, and attitudes of healthcare providers to
improve the care and health of people with
disabilities. Although the Liaison Committee for
Medical Education (LCME) in the United States
emphasizes the value of diversity and providing
culturally competent care in its accreditation stan-
dards (Liaison Committee on Medical Education,
2015), there is no requirement to include disability in
the training of future physicians in the United States.
The fact that any student learns about caring for
patients with DD is thanks to individual champions
within medical schools. If LCME standards were
expanded to address the health needs of 20% of the
population with disabilities (McNeil, 2001), we
could begin to improve health care for children
and adults with developmental disabilities.
In conclusion, this relatively brief training had
a significant effect on medical students perceived
knowledge, skills, comfort, and confidence in
caring for patients with developmental disabilities.
Future healthcare providers should learn about
disability and have the opportunity to develop
knowledge, skills, and attitudes toward disability
that will prepare them to provide quality care to
this vulnerable population.
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The authors wish to express our gratitude to the many
adults with autism spectrum disorder and their family
members who volunteered their time and shared their
stories. We would also like to thank the medical
educators and curriculum directors who made time in
the curriculum for this training. Finally, we would like
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to thank the medical students who are our hope for the
future of healthcare. This study would not have been
possible without support from our funder, the Health
Resources and Services Administration Grant#
H6MMC22849.
Authors:
Susan M. Havercamp, The Ohio State University
Nisonger Center, Columbus, Ohio; Karen Ratliff-
Schaub, The Ohio State University Nisonger
Center and Nationwide Childrens Hospital, Co-
lumbus, Ohio; Patricia Navas Macho, Department
of Personality, Assessment and Psychological Trat-
ment, INICO, University of Salamanca, Salaman-
ca, Spain; Cherelle N. Johnson, Kelsey L. Bush,
and Heather T. Souders, The Ohio State Univer-
sity Nisonger Center and Nationwide Childrens
Hospital, Columbus Ohio.
Correspondence concerning this article should be
addressed to Susan M. Havercamp, Associate
Professor of Psychiatry, Psychology, and Genetic
Counseling, The Ohio State University, Nisonger
Center, UCEDD, 1581 Dodd Drive, Columbus OH
43210 USA (e-mail: Susan.havercamp@osumc.
edu).
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2016, Vol. 54, No. 3, 229230
Preparer les medecins de demain a prendre soin
des patients ayant un trouble du spectre de
lautisme
Susan M. Havercamp, Karen Ratliff-Schaub,
Patricia Navas Macho, Cherelle N. Johnson,
Kelsey L. Bush et Heather T. Souders
Les personnes ayant un trouble du spectre de
lautisme (TSA) ou un autre trouble du developpe-
ment ont une sante plus fragile et font face a des
obstacles uniques aux soins de sante comparative-
ment aux personnes sans handicap. Ces disparites
en matiere de sante peuvent etre partiellement
attribuees aux connaissances limitees des physiciens
sur les soins pour les patients ayant un trouble du
developpement. Lobjectif de cette etude etait de
determiner lefficacite de lentranement sur le
TSA pour les etudiants en medecine. Lentrane-
ment incluait une conference et une table ronde
qui mettaient en vedette les personnes ayant un
TSA et les membres de leur famille. Les etudiants
ont rapporte une amelioration de leurs connaiss-
ances, de leurs habiletes, de leur confiance et de
leur aisance a prendre soin des patients presentant
un TSA.
Creer une Echelle dintensite de soutien Un
protocole de revision annuelle pour determiner le
besoin de reevaluation
James R. Thompson, Karrie A. Shogren,
Hyojeong Seo, Michael L. Wehmeyer et Kyle M.
Lang
LEchelle dintensite de soutien version adulte
(SISA) a ete largement adoptee partout en
Amerique du Nord et dans le monde depuis sa
publication il y a un peu plus dune decennie.
230
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DOI: 10.1352/1934-9556-54.3.229
Plusieurs organisations et juridictions sont assujet-
ties a des reglements qui requierent une evaluation
annuelle des personnes qui recoivent des services et
du soutien finances par des fonds publics. Le temps
et lenergie consacres a une reevaluation annuelle
du SISA sont devenus des preoccupations dans
les cas ou linformation recueillie est largement
redondante avec linformation obtenue lors de
levaluation precedente. Cet article presente les
resultats dune etude sur deux approches pour creer
un protocole pour aider les utilisateurs du SISA
en distinguant les situations ou il y a une forte
probabilite que les besoins de soutien naient pas
change de maniere significative des situations ou il
y a une probabilite raisonnable que les besoins de
soutien aient change. Le protocole de revision
annuelle du SISA a ete cree sur la base de ces
analyses de meme que sur la consideration des
problemes conceptuels associes a levaluation des
besoins de soutien. Des manieres selon lesquelles ce
protocole peut etre utilise, ainsi que des donnees
qui ont besoin detre collectees pour evaluer son
utilite, sont discutees.
La traduction des resumes en francais a ete
coordonnee par AAIDD Chapitre Quebec
avec la collaboration de Caroline Faust, Carole
Legare, Julie Beauchemin, Isabelle Assouline et
Diane Morin.
AAIDD Quebec Chapter has coordinated the
French translation of the abstracts in collabora-
tion with Caroline Faust, Carole Legare, Julie
Beauchemin, Isabelle Assouline, and Diane
Morin.
Resumes en Francais
INTELLECTUAL AND DEVELOPMENTAL DISABILITIES
2016, Vol. 54, No. 3, 231232
Preparando a los Medicos del Futuro para Atender
a Pacientes con Trastorno del Espectro Autista
Susan M. Havercamp, Karen Ratliff-Schaub,
Patricia Navas Macho, Cherelle N. Johnson,
Kelsey L. Bush, y Heather T. Souders
Las personas con trastorno del espectro autista
(TEA) y otras discapacidades del desarrollo tienen
peor salud y se enfrentan a barreras unicas para el
cuidado de la salud en comparacion con las
personas sin discapacidad. Estas desigualdades en
la salud pueden atribuirse en parte al limitado
conocimiento de los medicos sobre el cuidado de
los pacientes con trastornos del desarrollo. El
proposito de este estudio fue determinar la eficacia
de la formacion sobre el TEA para estudiantes de
medicina. Nuestra formacion incluye una confer-
encia y una mesa redonda que conto con las
personas con TEA y miembros de la familia. Los
estudiantes informaron un mejor conocimiento,
habilidades, confianza y comodidad en el cuidado
de pacientes con TEA.
Creacion de la SISA Protocolo de Revision
Anual para Determinar la Necesidad de
Reevaluacion
James R. Thompson, Karrie A. Shogren,
Hyojeong Seo, Michael L. Wehmeyer, y Kyle M.
Lang
La Escala de Intensidad de Apoyos - Version para
Adultos (SISA) ha sido ampliamente adoptada
en toda Norteamerica y el mundo desde su
publicacion hace un poco mas de una decada.
Muchas organizaciones y jurisdicciones operan bajo
las regulaciones que requieren una evaluacion
anual de las personas que reciben servicios y apoyos
que son financiados con fondos publicos. El tiempo
y la energa dedicada a la reevaluacion anual de la
SISA se han convertido en una preocupacion
232
AAIDD
DOI: 10.1352/1934-9556-54.3.231
cuando la informacion resultante es en gran medida
redundante con la informacion de una evaluacion
previa. Este artculo presenta los resultados de una
investigacion de dos enfoques para la creacion de
un protocolo para ayudar a los usuarios de la SIS
A en situaciones distintivas donde hay una alta
probabilidad de que apoyar las necesidades no haya
cambiado de manera significativa a partir de
situaciones en las que hay una posibilidad razonable
de apoyar las necesidades que han cambiado. El
Protocolo de Revision Anual de la SISA fue
creado sobre la base de estos analisis, as como la
consideracion de aspectos conceptuales asociados a
la evaluacion de las necesidades de apoyo. Se
discuten formas en que se podra utilizar este
protocolo, as como los datos que deben ser
recogidos para evaluar su utilidad.
La traduccion de los resumenes al espanol ha
sido coordinada por la Universidad Catolica del
Maule, Talca, Chile. Con la colaboracion de
Camila Rojas-Rojas, Constanza Sepulveda-Her-
nandez, Marcela Aguilar-Mercado, Beatriz Men-
doza-Albornoz, Camila Rebolledo-Briones,
Nicole Abdala-Rebolledo, Palmenia Pinochet-
Quiroz, Francisco Liberona-Riquelme, Sandra
Sanchez-Pena, Manuel Monzalve-Macaya y Juan
Lagos-Luciano.
The translation into Spanish has been coordinat-
ed by Catolica del Maule University, Talca, Chile;
with the colaboration of Camila Rojas-Rojas,
Constanza Sepulveda-Hernandez, Marcela Agui-
lar-Mercado, Beatriz Mendoza-Albornoz, Camila
Rebolledo-Briones, Nicole Abdala-Rebolledo,
Palmenia Pinochet-Quiroz, Francisco Liberona-
Riquelme, Sandra Sanchez-Pena, Manuel Mon-
zalve-Macaya, and Juan Lagos-Luciano.
Resumenes al Espanol
Reproduced with permission of the copyright owner. Further reproduction prohibited without
permission.