Welcome to PM&R Physicians as Disability Educators in Medical Schools, Rationale and Strategies for Success. My name is Dorothy Tolchin, I'm in the Department of Physical Medicine and Rehabilitation at Spaulding Rehabilitation Hospital and Harvard Medical School, and I direct the Longitudinal Disability and Anti-Ableism Curriculum thread at Harvard Medical School. I would like to ask our other presenters to please introduce themselves. Hi, I'm Nathra Ankam, I am an Associate Professor of Rehabilitation Medicine at Sydney Kimmel Medical College at Thomas Jefferson University, and Wellness Thread Director for the Jeff MD curriculum, and also help co-direct the Jefferson Health Mentors Program, which is a large interprofessional, mandatory interprofessional education program. I'm Maya Theratil, I have lost my voice a little bit, so hopefully it doesn't sound too raspy. I am a medical student educator, and I am at Drexel University in Philadelphia, the Pathway Director for Physical Medicine and Rehabilitation, and pretty much have dabbled in everything in medical student education. Hi, I'm Leslie Ryberg, I work at the Shirley Reinability Lab and at Northwestern University in Chicago. I'm the Director of Medical Student Education and run our required PM&R clerkship, as well as work on disability education through Northwestern. Hi, I'm Glenda Liz Bosquez, I'm a PITS Rehab Physician, I'm the Chief of PITS Rehab Service Line at Dell Children's Medical Center, and the medical school at UT Austin. I have had experience with medical education, it's one of my passions, so I'm very glad to be here with you all. And we have some of our esteemed colleagues in disability education who will be facilitating some of our small group session with us, so Priya Chandan and Ravi Kasi, we're really glad that they're with us today, and you'll have the opportunity to learn from them as well. So in terms of objectives for today, the first is that we hope that by the end of this session, you'll be able to articulate the value of physical medicine and rehabilitation physicians as providers of disability education within their medical schools. And for those of you who are on this team and understand the importance, and many of you I know are involved already in disability education, hopefully this session will give you an opportunity to think more deeply and expand on some of the ideas that you've had and motivate you to additional disability education in your schools. Describe three disability learning objectives for medical students, you'll have an opportunity to analyze some of your existing medical school curriculum for opportunities to include focused disability education. And going forward, we hope you'll be motivated by the session and have some strategies to begin to formulate more concrete strategies for providing disability content to medical students that aligns with your local medical school curriculum structure. With that, I will post this first poll and hand over to Nethra. All right. So as medical student educators we are, we wanted to get to know our audience a little bit. So using this QR code, I see some of you have already done that, you can follow along with the polls. And so right now we know that we have about 36% practicing physicians medical educators here, about 29 to 30% medical students, 20% residents, and about 16% practicing physicians. And hopefully by giving the QR code at the beginning we've been able to capture some of the live stream people as well. So that's good for us to know. And then I'm going to go to the next poll. So what are the goals that you have for this session? Why did you come here? How to include disability content, types of disability content, how to advocate for disability content, what others are doing in their schools, resources available to support disability education. Why are you here? Is our question. So looks like resources available to support disability education is a big thing. What others are doing in their schools is a big thing. How to advocate for disability content, types of disability content, how to include disability content. I think people are interested in what we're going to talk about. This is good. All right. This is exciting to know that. But it sounds like what others are doing in their schools and resources available to support disability education have a little bit more interest. Just a little bit more. Okay. Cool. So words that come to mind when you think of disability. I'll give this a little more time because this is going to take, so this is going to generate a word cloud so we'll get an idea of what everyone thinks about disability or what comes to mind when you think about disability. I love how ability, access, are like these big, big words, but access is in the center. That's awesome. Advocacy, function, ableism, good. People are thinking about that already. But then there's also some words that, social isolation, barriers, inequity, inequity is a big one, quality of life, hidden, hidden disabilities, yes, let's see, physiatrist, like that someone put that in there, job insecurity, yes, limitations, okay, that's great, panic, I don't know what to do, yeah, it's a big one, right? All right, I think we've gotten a good sense of what this crowd is thinking about when they think of disability. All right, so I'm going to give a little bit of background. So we all know the CDC stats, one in four non-institutionalized adults in the U.S. has a self-reported disability, and self-reported disability means hearing, vision, cognition, mobility, self-care, instrumental activities to living, some deficit in one of those categories. And when we don't have explicit training in disability, we get this panic, I don't know what to do, right? And we bring our culture with us into the exam room, and into our care, and so what does our culture tell us? We have low expectations for those with disability, right? And that's not what people with disability are looking for, they want their health care to be health care. So I think we have to advocate for that explicit disability training, and who better than us as physiatrists to do that? There's disparities. Some of the disparities are due to diagnostic overshadowing. Physicians who don't know very much about disability may attribute non-related symptoms to the disability and halt the diagnostic process, right? We've all known traumatic brain injury, patients with traumatic brain injury who've been agitated in the hospital, on your consult service, and everyone's saying, it's the TBI, it's the TBI, it's the TBI, but come to find it's the pain in their foot, or the acid reflux, or something like that, right? So there are increases in agitation in IDD, attributed to the IDD, intellectual and developmental disability, rather than investigation of the physical symptoms, and that causes delays in care, because we identify and investigate symptoms of serious disease more slowly in patients with disability, and that can cause many kinds of cancer to be diagnosed at later stages of the disease process, especially with those with movement and complex activity limitations. So there's health disparities that happen. We have physician bias, implicit and explicit. The implicit association test revealed an overwhelming majority of healthcare professionals have implicit bias against people with disability. And we know that recent studies, recent surveys of physicians who care for people with disability, didn't include physiatrists in their survey, had that perception that physicians with dis... Sorry, people with disability have a worse quality of life than people without disability. How does that affect our physicians' care when they feel that way, right? And that translates into explicit bias, everyday behaviors and decisions, and then institutional bias, right, in the way we've set up screening tools, and it was most apparent with the crisis standards of care that initially came out with COVID when they used the SOFA score, and GCS was part of that, and part of that is, if you can't move your limbs, you have a lower score, right, or you can't verbalize, you have a lower score, then are you then put behind someone else because of something that has nothing to do with COVID for you, right? So these things have real-world implications, and we should name what that is, and that's ableism. Ableism is the discrimination of and social prejudice against people with disabilities based on the belief that typical abilities are superior, and at its heart, it's rooted in the assumption that disabled people require fixing, and defines people by their disability. Disability is not... When disability lives in the biomedical model, it is thought to be something that should be fixed and lives in the individual, right, whereas the effects of disability have to be fixed by the individual rather than society. So ableism classifies an entire group of people as less than, and includes harmful stereotypes, misconceptions, and generalizations. So we want to name this so we can eradicate it. Now, this is one of those seminal studies from 1994 where they surveyed emergency room providers, everybody from the physician to the tech to the nurses to, you know, I believe even like the admit staff or whatever, and they asked them to rate these statements. I feel I'm a person of worth, I take a positive attitude, I'm satisfied with myself as a whole. And the providers at the time of the survey, when they thought about themselves, showed those numbers, and then providers imagining, when they imagined themselves with an SCI, see those numbers, see they're much lower. But people who have a spinal cord injury, who had gone through the rehab process, who had gone through the adaptations, who were living in the community, their numbers were very similar to the people, the providers at the time of the survey. Imagine someone with a new SCI coming into this emergency room and their providers having this bias. What does that mean? And I don't think we've changed all that much from this. I know this was a long time ago, but we haven't changed that much. But this shows us that we as physiatrists have a bank of knowledge that we need to share in medical education. So it's important for us to activate ourselves as advocates. So with that, I will turn it over to Leslie. Can you get the polls going for us? Yeah. I'll get the polls going for you. Just tell me when to go to the next poll. Or actually, even better, why don't you just go to the next slide here, you click right there, and you can go to the next poll. Because that's all they see, right? That's all they see. So this is so you see it. All right, but they're good to go. They're good to go. All right. My turn to talk. Hopefully not too loudly. Let me know. So we have a couple more poll questions for you. So you can go ahead and scan and keep going with the poll. Right. So just click next. They've already done it? Yeah. So click next there. So then you'll get the next poll. Oh, so this is what they see. So I'm not the tech-savvy person in the group. So my area of interest with all of this is the actual interventions that we use to help teach medical students and other allied health professionals in terms of how we teach these interventions. So thanks for answering the question. When during medical school did you learn about care for people living with disabilities? And so far, the winning category is it didn't happen during medical school, okay? Although we've got elective clinical time, extracurricular activities that are shooting up next. And so I think that's interesting that this is a room of students who are interested in the field of physiatry, residents who are physiatrists, and practicing physicians. So I think that we probably are a group that chose to look for electives and other activities. And then down here, medical school was way too long ago. I don't remember what I learned. That is a little bit the category that I'm falling into. But also classroom courses, lectures, and mandatory clinical rotations. All right. I will go to see a couple more answers coming in. All right. I'll go to the next one. Does your school have structured disability content? Structured disability content. Yes, no, or I don't know. All right. The no's are about 50%. So about 50% of us here don't know, or I'm sorry, say no, their school does not have structured disability content. Which is a little sad for all of us up here on the stage, obviously. All right. I think we've got most answers there. All right. And what are the barriers to including disability? What did I do? I did not report the answers. So 13 people said I don't know, 16 people said yes, and 32 people said no to structured disability content. So about half said no, that they don't have it, and I'm sorry. All right. Perceived barriers to disability education. All right, we have a lot of great answers coming in here. I'm going to come back to that one when we get back to that topic. Thinking about disability education in the United States, first of all, does it exist? So about half of you said that no, you didn't get it in med school, your school doesn't have structured disability curriculum. So can you raise your hand if your school does have disability education? And okay, good, seeing a lot of people with hands raised. Now keep your hand up if you know what the curriculum is or, okay, good. Keep your hand up if you're involved in teaching it or designing it. All right, this is great. This is great. All right, so we've got some experts in the room. I think that's great. Now how did your medical school actually teach it? So there's lots of different educational strategies that medical schools employ. So raise your hand if your school teaches it with a clerkship. Required clerkship, elective clerkship, good, okay. Is there a classroom lecture, good. Is there a small group session? Is there a physical exam standardized patient, good, okay. Is there intercommunication skills, great. Is there, what are other things I'm forgetting? What else, anyone? Patient panel. Oh, patient panel, that's a big one. Patient panel, good. Anything else you want to throw out for me? Good, all right. So a good mix of things, right? But thinking about you, so we have a room full of physiatrists and future physiatrists here. How and where and when did you guys actually learn about disability? In your PM&R rotation, I heard that. How about during all of residency, right? How about in your outpatient clinic, right? A lot of it was really our clinical experiences and exposures as physiatrists, right? So I think that based on the nature of our field, we intrinsically get disability education in ways that other fields don't, right? All right, so does formal disability education exist out in the medical school landscape? So looking at a survey of medical student deans in 2015, about 50% reported disability in the curriculum, only 50%. And that was seven years ago, so I think that's actually growing. But the major barrier that they reported really was that there was a lack of advocate for disability content. No one wanted it there, no one was trying to teach it there, and so it wasn't there. Looking at a survey of family and internal medicine residents, about a third remembered learning anything about disability in medical school. So that was any kind of disability training at all. Only a third, a third of residents, this is a recall bias obviously, but only a third remembered that there was disability content, okay? And sitting on a bunch of the committees at my med school, I know how hard it is to rely on those surveys sometimes, because every single student has lockers, every single student has lockers, and we still get 97% saying they have lockers. We have lockers, right? What is with that 3% who don't remember the lockers? It's there. Anyway, sorry, a little event session, LCME visits and all that. All right, the medical student members of the AAFP, 36% endorsed that their medical training provided them with the knowledge necessary to provide high quality, comprehensive healthcare for people with disabilities. That's only a third, only a third, right? And the liaison committee on medical education standards has said that disability is a source of bias, right? So cultural competence and healthcare disparities is something that we should be addressing, okay? So it is in our medical schools in some ways, but not enough, right? So how is it being taught? In the places where it exists, what exactly exists? So the most common delivery methods based on review of the literature and the surveys is that it is in lectures. We're using standardized patients with disabilities, although not enough, I argue. That there are partnerships that medical schools have with community organizations, so we're learning through the community organizations. Having persons with disability come in and talk to large groups of medical students, one of the most common ways that it's taught. Having persons with disabilities speak in small group settings, right? And then another big way that it is being taught is through PM&R clerkships, right? And PM&R clerkships are by and far elective, so this is for a motivated group of students. This is not for all students across the med school. So looking at how many schools have access to PM&R clerkships, it's sadly not enough, right? There are 100 opportunities listed in the VLSO system for visiting students, so if you don't have PM&R at your school, there are definitely options for you to seek it out. But this is not a mainstay for medical schools across the country. And then looking at the IRJR study, looking at all of the interventions, it was a review article looking at all of the interventions to teach medical students about disability. They found 77 studies that looked at any sort of intervention for disability, and they thought that the quality of the studies wasn't that good, looking at what were their objectives, what were their outcome measures, how the studies were designed. And so there was certainly a group of studies, but there's not great robust literature here. If you look in MedEd Portal and type in disability and search through that, 58 articles came up and most of them had nothing to do with disability, sadly again. And then if you look at clinical clerkships, so some elective clerkships actually list a disability as part of their clerkship title, and so we know that that student population will get to see disability. And there are starting to be some clerkships that are elective rotations that are disability specific and not PM&R clerkships. So they're usually PM&R clerkships where you see people with disabilities, but that's not the primary goal is disability education. All right, and where there is disability content, what are we actually teaching? So thinking about communication skills was one of the more common things, teaching about physical examination skills, community resources for people with disabilities, Disability Rights Americans with Disabilities, the ADA, I think is a very important piece of it, healthcare disparities for people with disabilities, disability ethics, the personal and lived experience of people with disabilities, and in a much smaller percentage, but I was happy to see it was in there, was sexual health for people with disabilities. And so this is based on the structure of the program from the Seidel article looking at the curriculum deans and what they reported being included. And thinking about what types of disabilities they talked about, really it was the most common was physical disabilities, and then intellectual disabilities, sensory disabilities, and learning disabilities. And then back to this, what are the major barriers to the inclusion of disability content? There we go. All right, so if you can see, can they see this on their screen? They can't, okay. So I can see this very nice word map. At the very center of it is time in big letters, time being the biggest barrier, all right? So some other things that I see on here, so curricular time is the biggest thing, right? So how many of you have said, I have this great idea, there's something I'd like to put in the curriculum, and you go to suggest it, and everyone says, oh, we don't have time. Where are you going to put it? Right? Yeah, see? So whoever's managing this magic time is one of the biggest barriers that we have. All right, I also see on here lack of resources, funding, curriculum space, lack of support, not flashy for some, that's a good one, money, nobody cares, that one's sad. So thinking about the funding piece, right? So who gives us funding for medical education? Okay, how many of you, again, raise your hand if you're a medical educator, currently have a role as a medical educator? All right, how many of you get paid enough, get paid proportionate to the amount of work you put in to your time as a medical educator? All right, all the hands are going down. So I'm lucky enough to have academic support for my role as an associate program director and medical student education director, and I'm like 60% clinical, 20% medical education, and it's more like 70% medical education, 30% clinical I feel like is how it actually breaks down. So that's not how, unfortunately, a lot of what we do as educators is not supported funding wise. All right, and then what about advocates? So in order to get curriculum in, we have to have someone pushing for it to be there, right? So we have to have a seat at the table to make it count, and if we can get organizations to say that this is important, like the LCME, AAMC, then we get our students, we need to get it put in the curriculum, right? If it's on the boards, if it's going to be on an exam, it's going to be tested, then someone's going to do it, right? So we have to have these advocates or reasons to put it in the curriculum. And then, of course, like Nethra talked about, bias, right? We think about disability as other, right? Maybe you have this one lecture on disability somewhere in the curriculum because that's an other patient population, right? That's something to consider at one point, but we really want to think about how we can include it in all of the curriculum because it's a part of everything that we learn and everything that we do. We have to think about this group. All right. Thank you, Leslie. So we are all well aware of the multiple barriers to designing and including and assessing disability content in our curricula and really preparing our medical students to go into clinical practice with an understanding of what kinds of questions to ask. What do we need to know from our patients? What can we do to do a better job, and how do we educate our peers? Because the current core of educators have not had disability education either. So as we educate, we sort of have a dual role, right? We need to provide information and empower our students to take good care of patients with disabilities themselves and also to be able to teach that content, to empower them to make this sustainable. And so while we encounter many barriers, and this is hard, I am optimistic, as I think we all are, that we're in a period of a lot of positive change. There's opportunity to educate our colleagues. People are open to listening to what we have to say, particularly as pertains to equity and intersectionality, and to bring our expertise to move forward disability education. And so to help us all do that, it's important to know that while we are experts and we do have a role and we should be leading this effort, we're not alone. And there are a number of different stakeholders that we need to work together with to implement meaningful disability education. So who are these people? So people living with disabilities themselves. Now these are not only patients, right? Traditionally in medicine, you have heard these conversations, right? People with disabilities are the patients, they're not us. We remember that when we say disability community writ large, it's anybody living with a disability of any type, and their own expertise is valuable and important, and what they think should be taught is important for us to know as things that should be taught. We'll talk about that. Medical educators are also stakeholders, right? Even if they're not disability educators, even if they have not had disability education themselves, even if off the bat they think, well, maybe this isn't important, this is a niche topic. They do have an interest in graduating medical students to be clinicians who can take good comprehensive care of all patients. So they do have an interest in this. Who else? Medical students themselves, as immediate learners, right? They know what they're learning, they understand what they're not learning. Medical students are more socially conscious than ever, so we're actually sensitive to disability in large proportions, and also more and more medical students are coming to medical school living with disabilities themselves, both apparent and non-apparent. And so their expertise is really important, and they're able to understand and educate us about what they are learning and where the gaps are from in the trenches. And then, of course, we are a major piece of this stakeholder pie, and we all share these goals, that we want medical students to be able to provide better clinical care for people with disabilities, and when they do that, arguably, they take better care of everyone. It's important to all of us that we are able to identify sources of bias and then mitigate those through concrete strategies. And also, again, to be agents of sustainable change. So we're going to go through so that we all can be on the same page together about sort of what each of these stakeholders is sort of thinking about. It's important for us to know when we go in, and hopefully all of us are going to do this and to continue to do this, and when we go into our schools to advocate, who else is on our side and what are they thinking about? So we'll talk about stakeholder-driven competencies that have come from the disability community, because that voice is clearly important in educating us about what is important. About medical educators and what are they thinking, what are their goals, right? Because we need to sort of align and find ways to have a shared language around this. We'll talk about medical students as stakeholders, and including them in the entire process of curriculum design from development to implementation through assessment. And then, of course, here we are again, given our experience and expertise, which you know and you'll hear us continuing to say about how important it is that we really lead the charge and that we all be a community together of disability educators and learn from and depend on each other as we move disability education forward. So disability stakeholder-driven competencies. So the National Council on Disability put forth an equity framework earlier this year that describes a range of ways that we can foster equity for people living with disabilities across society. And one piece of this was centered around disability education and its role in fostering equitable healthcare and lived experience overall for people living with disabilities. And there are a number of sort of competency areas that are set forth as important for disability education for physicians, but really for all clinicians. And these include the sort of broad categories, and we invite you to read more about this. And Glenda's going to talk a little bit more and point you to some resources on contextual and conceptual frameworks of disability, professionalism in patient-centered care, legal obligations and responsibilities for caring for patients with disabilities, teams and systems-based practice, clinical assessment, clinical care over the lifespan and during transitions, effective communication and advocacy. And you'll hear some repeated themes, right? These came up as sort of topics that we sort of acknowledge are important, right? When we ask what people are teaching and we know what we're teaching, we are including a lot of these topics. But having this framework and a designated framework that's endorsed by our stakeholders is a really valuable set of information for us to take with us as we advocate. So how about medical educator stakeholders? What drives them? What competencies are they working toward? So the AAMC has a set of DEI competencies that we'll also point you toward. And there's some goals for medical students to work toward in the bigger picture of equity, but clearly overlap with a lot of our goals, right? Information being an important skill. How do we teach our students to self-reflect? What are they reflecting on and what do they do with the information they reflect on once they identify maybe challenges that they might have or things that they've seen done on the words that they want to be different? How do we support them? Identification of stigma and bias is part of that. Meaningful advocacy. What does that mean? We know what it means to advocate. We know what's important. We know we should stick up for our patients and for each other. But what are concrete ways that we can teach that? And if we can teach that through a disability, using disability as a lens, all the better for all of us. And we're teaching students broader skills. Role modeling is listed here, fostering systems-level change, and interprofessional teamwork. So you can see, while medical educators writ large may not be thinking about disability, you can see where the intersections lie in our work as physiatrists and disability educators. And then thinking about, we're trying to think about how do we come into a medical school and have a valuable and meaningful role? So what happens in medical schools, right? We want to prepare students to perform the duties of responsible physicians. We want to provide educational content that is clinically relevant. We want to nurture professional development. We want to utilize meaningful assessments. And we want to uniformly prepare all of our medical school graduates to take care of all patients. So I encourage you, for those of you who have not yet begun your medical education advocacy trajectories in your school, to think about what some of these points, when you go to talk to educators and align with them, that we share these goals and we have this really important and valuable lens that we can use to teach some of these skills. In terms of medical students as stakeholders, just a couple of examples, so a few years back the AAMC put out this beautiful report that was developed in concert with a number of medical students, and the medical students described their lived experiences as learners living with disabilities going through a medical student curriculum. And you can see that very clearly bubbles to the top some really important experiences and lessons for us to think about as educators, that when we think sort of top down about what is the content that needs to go in, sometimes we forget some of the, or maybe not immediately think of the details, but our students themselves can tell us these details pretty readily. So in this example, this is a disability service provider who recounted a student's reaction to hearing their disability described by a faculty member. I had one student with rheumatoid arthritis tell me that her experience of the lecture on this topic was alienating. The professor talked about them, the people with the disease, without any sense that someone in the class might have the disease. So her suggestion for the faculty member was, at all times, assume someone in your class has the disease you're talking about or has a family member with the disease. So already, this observation is really important when we think about, you know, what do we want to include in our medical education curriculum? So part of that is going to need to be faculty development, and part of that is specific lessons around language that we use. What is, you know, accepted as the way that we use disability language, right? What's person first language? What's disability first language? And moreover, let's talk about apparent and non-apparent disability. So this brings up a lot of more nuanced points for us. I'll share, at our institution, we put together a photo narrative exhibit centering the voices of a range of individuals in our community, both medical students and clinicians, as well as community advocates across a number of disability types, as part of our sort of disability education machine to provide some wraparound education, and this was an exhibit that went up in person and also online in our hospitals to do some immersive disability education. But importantly, two medical students stepped up to be highlighted themselves. And so this reminds us that we cannot depend on or ask a student, by virtue of just their having a disability, to be responsible for teaching or to be responsible for guiding teaching. But when there are opportunities, if students want to be involved in that teaching, to ensure that they have a place for that and a place for their voice. So Kelsey here describes her experience of chronic illness and disability, hiding my illness felt like conforming to a culture of silence among physicians facing their own health challenges. King described a diagnosis is not just a diagnosis, there's a story behind it. I envision a healthcare system and medicine to be a world where we're seen as human beings first. And when we brought forward these and other voices, and we talked with the sort of stakeholders, big stakeholders in equity in our institutions, they were so happy to have this information brought to them and readily supported this project. And so as we brought this forward, then our hospital put forth a statement in concert with our project. Mass General welcomes individuals with varying abilities and chronic health conditions as patients, providers, staff, and visitors. This exhibit reinforces our commitment to fostering a warm, inclusive, and welcoming environment for everyone. So sometimes, I think increasingly, as Leslie was talking about, there's going to be top down sort of imperative for disability education going forward. And of course, there are then also opportunities where we can do some bottom up education. And the voice of medical students is really valuable in that. So here we are again. So we talked about our stakeholders, our partners in this, right? The disability community, medical educators, medical students, and of course, physiatrists. Here we are again, and we take up a big part of that pie. I think we made our point that physiatrists should be doing this work. I think we've said it enough. I'll try not to say that again. And so the next piece we wanted to talk about is just curriculum review. So where do you start? So we're going to provide just some general sort of structure and questions that have been helpful for us in thinking about where we inject disability, where we advocate for it. So some of this may seem not like rocket science, but in some ways, it's not always done. So I think we need to start with sort of general conversation. And we can talk more about this in the small groups in terms of things that you have done that have been successful that may or may not be the same. So what is core curriculum content at your school, right? So we have disability content we want to include, but what's core at your school? So where is it going to be placed? And what does your school administration value? Where are we going to align? What do your clinical sites value? Because sometimes that's different. Where are the intersections between your school's priorities and disability priorities? And where is there an existing nod to disability where you can offer additional depth or value? So sometimes we're adding content where none exists. And sometimes we can say, oh, you do value disability. We see you talking about this. There's some other pieces here that we might want to include. So one example is in our genetics course. Every year, there's a lovely young woman who has Down syndrome who is interviewed in front of the class. And so we know that teaching about Down syndrome and various aspects of it is an important part of our curriculum. And we went in and said, this is so valuable. And we see you're asking students to pose questions to learn about this young woman and her life. There are some background content and skills that might be really helpful for your students to have in order to better ask those questions. We're happy to teach that. We think about that a lot. And so we went in, and we gave the students a primer. We do go in. We give the students a primer about language. What is person-first language? What is disability-first language? What are some questions you might want to ask this person about their life? Here are some things that individuals with intellectual and developmental disabilities encounter in the health care system. I wonder if it would be interesting to ask her if she has encountered those. And here are some ways to ask those questions. We talked about, in this context, too, we were able to talk a little bit about equity and intersectionality. So what are some other identities that this patient may hold? Does this patient hold a disability identity or not? And so we were able to build on what existed. And that has been an important strategy for us, and in our case, a welcome one. So we talked to you to sort of review your curriculum and sort of designate some places and think about what you're going to do next. Another way to think about this is, where can you make the quickest change? So sometimes there can be this inclination to say, OK, we have these eight categories of stakeholder competencies. We know we need to teach all of these things to really prepare our students best. And it's important to be deliberate and thoughtful about it, and that can take time. Sometimes we can say, where is there a quick place where we can put in some content now and then build on that? And that has been a successful strategy in our case, too, where we add some content. We talked about communication skills training. So we have content where we train students specifically on interviewing patients living with disabilities of all types. What are some key questions we might want to know about their function, et cetera? Once we have that content in, then medical educators came to us and said, we noticed there's not a lot of disability content other than that in this particular course. And they hadn't noticed that there was no disability content before. But once there was content in, then they noticed that, wait a minute, there wasn't more. And so that sort of reminds me, if there are opportunities to go in, do it, and then build on it. Think about what change would you like. So questions to think about, right? Where can you make the quickest change? And then, what change would you like to make that you can't make on your own for whatever number of reasons, either where you're placed, what your time limitations are, maybe what your expertise happens to be, maybe because you might not have connections with the particular stakeholders or individuals living with the type of disability you want to teach about. And as we know, it's important that we do this together. So who are the people you can rely on? Who are these other stakeholders? Who can connect you to relevant courses and curriculum committees? Often in PM&R, our departments are in different buildings than other departments or far away from the medical school. And so there's not a lot of face-to-face or a Zoom-to-Zoom connection with the medical educators who are decision makers. So who in your department can be that connection for you? And who can be on your team? So I talked about a couple of examples. I was going to talk about a couple of more and sort of challenges we encountered and how we handled them, but I think maybe I will leave that to our small groups because I'm really interested in hearing your experiences and making sure that we have time to talk about those. So I think with that, I will turn us over to a small group and ask Maya to come up. So I have the easiest part where I don't have to speak, I don't have to think. I can get you guys to speak, think, and put your heads together. So I do see that many of us are sitting all alone. I don't think you can put your heads together if you sit all alone. Can we at least have maybe three, four people come together so that you can talk to each other about where you could possibly introduce disability into your curriculum, right from the first day that the student walks into the school to the last day where they're getting prepared to go in for their residencies? Also, everybody who is online, please, can you write your thoughts on the chat so that we can look at it and share it with the group over here? We don't want any of you to miss out either. Thank you. So just to remind everyone, we have around 10 minutes for this discussion. And there are group members who are going to roam around you. And if you have burning thoughts, we'd stop in between and you'll share it with the group. So let's go to the next slide. So I think if we go to groups and group people are going to take 40 minutes to attend. So if you're not, the only way to interact with people now at a time is if you have a So those of you in the chat, on the live stream, if you put any of those opportunities for disability content in the chat, we can start responding to you. So please consider interacting with us in that way. So I love the energy in the room and everyone's having really good discussions. I'm going to ask you all to stop the discussions in your group for a couple of minutes and we have mics going around so you can share some of the talk that you've already all the discussions that you've had in your groups with the rest of the group because I'm sure the rest of the group wants to hear the great ideas in the smaller groups as well. Netra, since you have a mic over there you can start off. What does your group have to say? Can everyone pay some attention to the back of the room? They're going to share with us. Hello. My name is Ben. I'm a medical student at Upstate MS4. So we actually talked about a lot of things, but one of the things that we talked about is, you know, the importance of having a student or a resident advocate, but at the same time, you know, no matter how charismatic and, you know, no matter how much momentum a single or group of medical students or residents has, you know, what happens once they graduate, there's no, like, continue, like, continuity. So that being said, it's really important to have a faculty that's a core leader that can facilitate things, but at the same time, and also kind of going back, another point that we brought up was we just, so three of us are from the same school, so we were talking about, like, other experiences that we all had, and we realized that we were not aware of the other disability, you know, integration stuff that other people were doing at our school. So again, this goes back to the point that if there is a core faculty figure that could, you know, be the central figure for coordinating everything, it could, you know, gather a bigger group that can have more momentum and things moving forward. Wonderful. Every faculty member over here can go back as a faculty champion. Oh, we got volunteers. Volunteers. Hey. Maurice Scholes from the fantastic 300-year-old city of New Orleans, signature city, and we will be hosting you all next year. As a person that is not an academic, I'm a recovering academic, and sitting with a new department chair, it was an interesting conversation, one of the things that we focused on is sort of how do you introduce or incorporate disability awareness in things that already exist. So starting not just in rotations and clinical training, but preclinical training. Everybody in med school has a course where they focus on genetics. Everybody has a course where they focus on musculoskeletal, and this is a perfect time to talk about something like Duchenne's muscular dystrophy, which is a genetic-based heritable dystrophy that leads to disability and death, that we've now been able to change because it's a new medication. So when you have a discussion framed that way, you're not asking medical schools to introduce new material per se, you're asking them to incorporate disability and disability perspective into existing material, and I think that's a less heavy lift in a series of places and spaces where the curriculum is full and tight and everybody has something they want to add to it. Absolutely, and one of the key factors over there is not just introducing it, but if there's a question list that you follow, introduce a disability question into that list so no one's going to miss it, whether you were the small group facilitator or not. Hi, I'm Christina Sarmiento. So it's interesting, in our group we had a few different models of disability education represented. So we had, we have, you know, some small group sessions separated from the main curriculum. We have some integrated lectures in the preclinical curricula, some lectures in the clinical curricula, and then some kind of more elective disability experiences and disability education experiences. One thing that we talked about was the importance, kind of like our other group just said, of integrating the disability curricula into the other medical education curricula so that it's not, you know, being siloed into its own three-hour space and that it really represents how integral disability care is across all of medicine. Absolutely, and when you introduce it, I think, also do think of the principle where you might want to say that it is disability curriculum because it's just like when you give feedback, you have to first say, I'm giving you feedback, give the feedback, and when you finish you have to say, I have given you feedback, because otherwise when the questionnaire comes, nobody has ever got any kind of feedback, and it's going to be the same thing with the disability curriculum. So mind you, introduce that as well. Hi, I'm Lynn Weiss. We talked about a couple of things that people can do to introduce disability into the curriculum, and some of the things we talked about was including disabled patients in the OSCEs, having a disabled patient come to lecture to say what they can and can't do and some of the barriers that they've had, or, you know, having physiatrists come and lecture to the medical students, but again, you know, the medical students here indicated that there's not a lot of disability education in the curriculum. Anyone else burning to give an example? Hi, I'm Sarah Eichmeyer. I'm from University of Kansas. So I shared with my group, I had an opportunity this year, so we've, I think like many medical schools, have having a lot of conversations about diversity, health equity, and inclusion, and in a lot of those meetings, you know, you raise your hand sometimes and say things, and so I've just been raising my hand a lot and saying, well, what about people with disabilities? What about people with disabilities? Because I think that's part of that conversation, and so because of that, had a lot of great meetings and conversations over the last year, ended up on a committee that is looking at all of the PBL cases for the medical school for the first and second year through the lens of DHEI, and so I get to represent people with disabilities, and so as we're looking at all of our PBL cases, we're changing them and we're making them more diverse, and so we're trying to figure out ways to work in all different types of people that represent the people we actually take care of in the hospitals and in the clinics, and I've got to put a couple different disabilities and highlight things and highlight function in a way that I think is hopefully impactful, so we'll see. It'll go live next year, but I think that's a cool opportunity when you're thinking about integrating. You don't have to create a new curriculum. You can just raise your hand and try to get things more integrated. Wonderful. Why don't we give a round of applause for our great champion over there? There was someone here? That's okay. We need to... Do you guys want me to do a real quick summary? Okay, real quick summary. So we had a really powerhouse group, and so for the sake of time, I'm not going to repeat the things that everyone has said, but certainly DEI efforts are definitely opportunities to incorporate more curriculum. There is also need, as we talked about, on the UME side and also the GME side, so don't forget about the residents and opportunities that might be there. We also talked a little bit about politics and how that is something that can be a barrier, but also if you are strategic in sort of how you think about it, it can be an opportunity, and so one of the spaces that I think we need to be more intentional in thinking about is regarding funding. So advocacy towards funding for these efforts, and if we're going to advocate for that funding, for it to be sort of cross-disability in nature. So we talked a little bit about, there's folks here in the room that I know are passionate champions, about how if we're going to say disability is one in four, we have to be mindful that we're not exacerbating inequities, gaps that already exist, if we're sort of leaving some groups of people behind. So really concentrating on that equity lens is something we we took to heart. Thank you. I think to round it out, one thing our group talked about as well is involving individuals with disabilities in all stages of curriculum planning, and while that's possible with medical students with disabilities, we also need to be cognizant of the individuals who are not always in the room, namely people with intellectual disabilities and more severe cognitive disabilities, and making sure that those individuals are not only brought in as sort of token panelists part of the curriculum, but are really involved in deciding what needs to be taught, how it needs to be taught, and are an integral part in all of the curriculum decisions that are made around disability, and taking extra effort to make sure that those perspectives are considered, even though they might not be present within the medical education system as it currently exists right now. Thank you. So I didn't mean to actually share this, but I had this quick cute thought about something that we did many years ago at Albert Einstein in the Bronx, and we talked about bringing in people with disabilities to share their voices. Well, we actually had people who had no voices who spoke very powerfully about their disability, and I'm not even talking about living people, but the cadavers. So in our anatomy cadaver course, we introduced that the students actually look at the cadavers as a person, as their first patient, do a whole exam of it, look and see if there's anything that they could see which could have caused a moment disability or something where the patient could not get for medical care, and the students wrote about it, their reflections, and it was so beautiful to see how they spoke about what the life of their cadaver patient could have been because of the disability, because of the amputation they had, the leg length discrepancy, the CHF that they had, and actually talk about how difficult it would have been for them to access medical care. They looked at pressure ulcers on the back of the cadavers. It was just so beautiful. It blew me away as a physiatrist how much a first-year medical student in their first month in school could actually think about how diseases could cause problems to people, and how it would have made their life in their community and their families either difficult or easy for them, and how they could possibly have overcome it and had a better life and better medical care. With that, I'm going to turn it over to Glenda, who's going to do our conclusion. There's the question. So I just wanted to, you know, give you some kind of like quick virtual, you know, resources that you can have in your in your pocket. Now you've heard from multiple people around the audience, you know, like during your groups or something, about different ideas that either you can be building from or building at. Maybe you've also noticed that if no one is asking, are you the only one that is asking, maybe that finger needs to be pointed at you, that you just have self-identified yourself as the disability champion in your environment, in your learning environment. So having that in mind, we actually, this is a, our disclaimer is that this is kind of like one of our papers that we put together. This is a primer of how physiatrists can be champions in their learning environments, and gives you, it's almost like a primer on, kind of like a little bit of the framework on how to kind of like incorporate these things in your learning environment. And the Q, the Q scan code will lead you, would get you to the PubMed link for that. Another good resource is the Core Competencies on Disability for Healthcare Education. This actually was proposed by the Alliance for Disability in Healthcare Education, and they're included in the National Council on Disability Equity Framework recommendations for medical education as well. Also, when we are in talking in medical education, undergraduate medical education, LCME, the double AMC has also been publishing additional resources, framework, expectations about diversity, equity, and inclusion. And this was just published, and its competencies across the learning continuum. So these are stuff that the medical schools would need to start incorporating into their curriculum development, and we can be volunteering through our programs to be, to be members of the curriculum committees, and we can assist our medical schools to, in this effort as well. I also want to make a plug with the amazing work that Dr. Turk has been doing through the years. So there is the Disability Integration Toolkit, and there is a lot of like collaboration into this. You can also, if you feel that you don't have a medical school, and you still want to be a champion in disability, you could potentially be a collaborator to put a kit together regarding disability. And it also has a toolkit on how to integrate some of this stuff with your medical, locally in your medical school. And in our paper, when we were kind of like putting that paper together, we thought of disability as this kind of like journey, and we're being champions. So, you know, we're just kind of like looking to the horizon, and you guys are going to be, you know, helping leading the way locally, and hopefully we can continue this effort moving forward. Thank you so much for participating this way. All right, if anyone has questions. Question over here. Hi, thank you so much. I'm so excited to be in this room full of like very awesome, like-minded people. I'm Stephanie. I'm at Hopkins. I'm, I work with the Disability Medicine Advisory Board. Students, staff, disabled, allied, to inform changes to the curriculum. So I really hope that that's something that I can see popping up in multiple places. I know, you know, Harvard, Stanford, like there's, it's everywhere now. It's not just one or two places that it's happening. We talked about like accessibility of this type of content, and how it's so hard to teach the value of some of this stuff to like administrators and things like that. So, you know, sometimes it's just one foot in the door. So basically, I'm putting a shameless plug, because I started making videos and like replicating the lectures and the content that I want medical students to be exposed to, and I put them on YouTube. So if anyone is interested, check me out and connect with me at Disability Clinic on YouTube. I interview patients, people sharing their stories. I break down stuff, movies, disability representation in TV. So hopefully, we can continue to share, and thank you. Also, I would love to put in a plug to get some of your stuff into the Disability Integration Toolkit with peer review, mentorship, etc. So let us know. All right. Other questions? Yes, Priya is going to share a session tomorrow that will build on some of our conversation on equity. I don't have my back to some people. Okay. So tomorrow, we're having a session on equity. So it is called, if you're looking for it in the app, Equity Critical Conversations, and it's called Critical Conversations because we want it to be just that. So it is meant to be interactive. It is meant to be free-flowing. We're going to start sort of grounding the work in the special issue of PM&R Journal that was dedicated to equity. We've got some of our authors here, and so if you start sort of taking a look at that, you'll see kind of what we're going to start with. But the goal is to really take the discussions we're having here in the context of, you know, disability in medical education, but as well as a lot of the DEI content that you've seen throughout this conference, and sort of look at the intersection there. So where do our efforts as professionals on, you know, sort of health disparities, health equity for our patients, how does that interface with DEI efforts for the workforce, for our colleagues? So how do we think about equity with regards to different patient populations, but also how can we be better colleagues to each other? So bringing sort of those two things together. And so like I said, we're hoping it'll be a dynamic session. It'll be a room set up similar to this, so we'll do the best we can, but appreciate if you guys want to come tomorrow. We've got two of the folks here today lending their expertise for us tomorrow, so we really appreciate that. All right, so thank you to everyone for sticking with us, for all the work that you do, for being here today, and for all the work that you will continue to do going forward. It was really a treat to be able to hear about the work that is being done on the ground in your institutions, and we appreciate your sharing them so that we can all work together, and to crowdsource our ideas, and to really be a team together, and know that even if sometimes we feel alone in our institutions, that we do have a network of support and people who we can all continue to learn from. So we hope this will be one of many ongoing conversations, and thank you so much again.

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