ADDRESSING PHYSICIAN MEDICAL EDUCATION
MEDICAL EDUCATION A DEVELOPMENTAL MEDICINE FELLOWSHIP TRAINING PROGRAM
BY JORDAN KEMERE, MD
Sitting down in the exam room, I introduce myself to the new patient and her mom. They both appear anxious and not sure about transitioning from their pediatrician to the adult health care system. I carefully explain our clinic, "We are a patient-centered medical home for adults with intellectual and developmental disabilities (IDD)." I explain that I am an adult primary care doctor and in response, this mom asks me a question I have heard many times, "How do you become an expert in caring for adults with IDD?"
I detail to her how I have learned from my coworkers and extensively from patients and families. They have taught me so much about what their daily lives look like and their struggles finding appropriate health care for their family member with IDD. The patient and mom seem relieved that our relationship will be a team approach. Finally, the mom asks, "You mean there isn't any formal training to care for adults with special needs?" My response, "No, unfortunately at this time there is not." According to the CDC, in the United States, there are approximately 61 million people living with disabilities, and about 6.5 million who have cognitive disabilities.1 Just as the life expectancy of the neurotypical has increased over the last few decades, the life expectancy for individuals with intellectual disability is also increasing, thanks to advances in healthcare, greater resources in the community, and increasing advocacy.2 The need for adult physicians who are competent and comfortable taking care of adults with IDD is greater than ever and yet, physicians are not receiving the training. There are no current requirements for medical students, residents, or practicing physicians to receive any education in caring for patients with IDD. Schools of medicine, hospitals, and continuing medical education efforts seldom address the IDD population's health care needs.
When interviewed regarding care of individuals with IDD, primary care physicians have said they feel underprepared, lacked confidence, lacked knowledge about resources, felt anxiety about behavioral challenges, and felt overwhelmed delivering care for this population. When asked how they would like to learn about the health care needs of individuals with IDD, physicians expressed the desire to learn experientially about the general approach to these patients.3 In response to this growing need and underprepared workforce, a new and necessary field of training is emerging with support of the American Academy of Developmental Medicine and Dentistry (AADMD) and Special Olympics. Change needs to take place at all levels, with added required curriculum and experiences for medical students, residents, and already practicing physicians. We need continued advocacy efforts at each of these levels of training.
One solution is indepth training for doctors who specialize in primary care and wish to devote their practice to delivering health care for individuals with IDD. With support from a grant from the Texas Council for Developmental Disabilities, the Baylor College of Medicine Section for Transition Medicine in Houston, Texas is offering a one-year Developmental Medicine Fellowship to formally train Med-Peds, Family, or Internal Medicine physicians as leaders in the care of individuals with IDD. The fellowship will begin July 1st, 2020.
Just as pediatricians have trained in "In response to this growing need and underprepared workforce, a new and necessary field of training is emerging with support of the AADMD and Special Olympics." Developmental-Behavioral Pediatrics and Neurodevelopmental Disabilities, our fellows will become experts on the healthcare needs for adults with many of the same childhood conditions that pediatricians currently treat. The yearlong fellowship will develop the individual into a national leader and advocate for adults with diagnoses of autism, cerebral palsy, Down syndrome, spina bifida, and other conditions associated with intellectual disabilities. Our fellows will have clinical training working in a multidisciplinary team within the Texas Children's Hospital-Baylor College of Medicine Transition Medicine Clinic, a clinic dedicated to providing health care for individuals with neuro-developmental disabilities. Specialty clinical experiences will round out the fellow's experience. Additionally, fellows will gain valuable community exposure in mental health services, long-term care services, community living, employment training, day habilitation with expectation to engage in team building opportunity in the community through partnership with the local LEND (Leadership Education in Neurodevelopmental and Related Disabilities) program.
Improving healthcare for individuals with IDD will require curricular changes in the nation's medical schools, increasing exposure to the population in residency training and continuing education programing for physicians in the community. Ultimately, the goal for medical schools is to expose this type of training to their undergraduate and graduate medical education mission. If enough medical schools recognize the need and develop their own fellowships, the Accreditation Council for Graduate Medical Education (ACGME) hopefully will dedicate resources to this initiative as an area of importance in graduate medical education.
At the end of my visit with the new patient and her mom, we reviewed our discussion and developed a plan of care going forward. We discussed that the patient would have the right to stay in school until she was 22 years old and to start thinking about what types of volunteer and/or job opportunities she wanted to pursue. We reviewed medical insurance changes coming at age 21 and supportive decision making. The patient agreed to come back in three months to discuss adaptive exercising and healthy nutrition. The Developmental Medicine Fellow's training will insure that they too will be able to deliver comprehensive health care aimed at improving the quality of life for individuals with IDD. •
QUESTIONS OR INTERESTED IN APPLYING? Contact Dr. Cynthia Peacock cpeacock@bcm.edu or Dr. Jordan Kemere kemere@bcm.edu
ABOUT THE AUTHOR:
Jordan Kemere, MD is an internal medicine physician at Baylor College of Medicine in Houston, Texas. She works as a primary care doctor at the Texas Children's Hospital-Baylor College of Medicine Transition Medicine Clinic, a clinic dedicated to providing health care for individuals with neurodevelopmental disabilities.
References
1. Centers for Disease Control and Prevention. Disability and Health Data System (DHDS) [Internet]. [updated 2018 May 24; cited 2018 August 27]. Available from: dhds.cdc.gov 2. Bittles, A., Petterson, B., Sullivan, S., Hussain, R., Glasson, E., & Montgomery, P. (2002). The influence of intellectual disability on life expectancy. The Journals of Gerontology Series A: Biological Science and Medical Science, 57, 470-472. 3. Wilkinson, J., Dryfus, D., Cerreto, M., Barkhour, B. Intellect Dev Disabil. 2012 June ; 50(3): 243–250. doi:10.1352/1934-955650.3.243.