Feasibility of a semiautomated, individualized coaching intervention for glycemic management in adults with type 1 diabetes: a pilot randomized controlled trial.

Approximately 19% of Americans have a disability, including 17% of children aged 3–17 years. Disability has been defined by the World Health Organization as an umbrella term for impairments, activity limitations, and participation restrictions. It is a complex concept that involves the interaction between the individual, their health condition, their environment, and other personal factors. Each individual lives with a unique disability experience, and providers should be able to demonstrate comfort and competence when interacting with this population. It is well documented that individuals with disabilities experience disparities in screening and preventive services, cancer diagnosis and treatment, reproductive and pregnancy care, communication with healthcare professionals, and satisfaction with care. While the Americans with Disabilities Act was enacted more than 30 years ago, physicians across specialties continue to report decreased confidence in taking care of individuals with disabilities. Recent surveys reveal only 40.7% of physicians across multiple different specialties were “very confident” about being able to provide the same quality of care to disabled patients as non-disabled patients. This lack of confidence is thought to stem in part from inadequate education and training to prepare them to care for patients with disabilities. This discomfort is present early in medical education, as evidenced by one survey in which 80% of medical students reported inadequate disability education. They reported feeling less comfortable obtaining a history, performing a physical exam, and establishing a differential diagnosis when working with individuals with disability. As recently as 2015, only 52% of surveyed medical school deans reported having a disability awareness program, defined as “a program that provides education about living with a disability that is not limited to teaching about the medical/biological aspects of disability but extends to education on the psychosocial aspects of living with a disability”. Of those institutions who had structured disability education, students spent an average of just 10 h over four years on disability-related topics. The Disability Education Network and the Disability Education Toolkit are two current efforts to create readily available disability modules for medical students. In recent years, the Liaison Committee on Medical Education, the accreditation body for medical schools in the United States, has begun to target this area of education. Disability is now included under the umbrella of healthcare disparities, and accredited medical schools are required to provide education regarding healthcare disparities and inequities. While this is a positive change, the content and format of this education remain variable and may be insufficient to replace dedicated education offered at a more advanced stage of medical training. However, graduate medical education programs (i.e., residency and fellowship training) have also been limited in the disability education they provide. Emergency Medicine program directors reported only 43% of training programs offer disability-focused content, which averages 1.5 total h annually. Similarly, only 28.9% of Internal Medicine residency programs reported offering disability-focused curricula and, of those, only 61.5% made this education mandatory for their residents. These primary care program directors felt both internists and their own residents (88.3% and 77.8%, respectively) were inadequately educated in the care of people with disabilities.