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Managing Editor Scott Harris sharris@aamc.org Staff Writer Elissa Fuchs efuchs@aamc.org

Innovations in Medical Education: Communicating In Other Ways

A New Jersey program will help medical students around the country train to communicate in alternative ways with patients with developmental disorders

Clearer communication: Medical students from UMDNJ-New Jersey Medical School conduct standardized patient exercises during their visit to the Matheny school and hospital, part of their third-year training.

Finding a way to talk with patients who cannot communicate in standard ways is not an easy task for any physician. If the patients have developmental disorders such as cerebral palsy, or the more rare Lesch- Nyhan disease, communicating effectively can be even more challenging.

A program at the Matheny School and Hospital in Peapack, N.J., is aimed at helping medical students deal with this challenge. The facility hosts third-year medical students from the UMDNJ-New Jersey Medical School (NJMS) in Newark, who visit Matheny for a full day to deal with the facility's medically complex patients, many of whom communicate nonverbally.

"Most healthcare professionals have had little experience dealing with patients who have developmental disabilities," says Kenneth Robey, Ph.D., director of the Matheny Institute for Research in Developmental Disabilities and an assistant professor of psychiatry at NJMS.

Based on the program's work with the medical students, Matheny plans to send out CD-ROMs to all AAMC-member medical schools this spring to share the students' experiences and to offer ways to help medical students nationwide communicate better with similar patients. Matheny received a $125,000 federal grant in 2001 from the National Institute on Disability and Rehabilitation Research to develop the CD-ROMs.

Dr. Robey says that many of the medical students cite their visit to Matheny as one of the highlights of their medical education, and that it helps to break down stereotypes of people with disabilities. Often, medical students are surprised that patients' developmental disabilities do not mean they have cognitive disabilities as well, but the real challenge is the communications issue, he says. "This population is particularly challenging; it's a medically complex patient population."

Standardized patient exercises

The material to be sent to AAMC-member schools will include protocols for standardized patient exercises, in which medical students learn how to interact with people with developmental disabilities, Dr. Robey says.

The patients in the exercises are adults, generally with cerebral palsy, who communicate nonverbally. They are trained to act with symptoms of conditions such as TMJ (temporo-mandibular joint) dysfunction, appendicitis, and pneumonia, and, like standardized patients at medical schools, are paid for their acting services and skills.

"We have them do exercises with the patients where they need to elicit yes or no answers, which can be very different from a normal patient interview," Dr. Robey says. Without the use of verbal communication, students express yes or no in different ways, such as turning or looking in a particular direction, he says.

"At the end of the simulation exercise, the standardized patients are quite good at providing feedback to the medical students either using their electronic communication devices or with more yes/no questioning," Dr. Robey adds.

Altering attitudes

Matheny, which was founded in 1946 by a couple whose son had cerebral palsy, offers a wide range of services to people with disabilities of all ages. The facility includes a school and a 100-bed hospital and has about 90 resident students, 18 day students, and 36 adult medical day-care participants.

Gary Eddey, M.D., director of the Matheny Center for Medicine and Dentistry, and an associate professor of pediatrics at NJMS, set up the medical education program in the mid-'90s. Dental students are scheduled to begin rotating through Matheny next year, he says.

"Unfortunately, this patient population is often ignored by physicians, though not advertently," says Dr. Eddey, who has been at Matheny for 15 years. He says the ability to approach different patient populations and their associated clinical conditions is key to a sound medical education. "One thing that has not been done is to apply a cultural competency in a medical education program to specialized patient populations," he says.

Medical students should seek to understand the disability they are dealing with, the associated clinical conditions related to those, and "run-of-the-mill" medical conditions the patients need to manage, such as diabetes, Dr. Eddey says. He points out that points out that one of the program's main goals is altering attitudes about people with developmental disabilities.

The visiting medical students have come to understand that "when I'm here, I'm a guest in their home," he adds.

Editor's note: For more information, visit www.matheny.org and www.disabilityhealth.org.

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