THE HEART OF MEDICINE: Albert Einstein College of Medicine prepares a diverse body of students to become knowledgeable, compassionate physicians and innovative scientific investigators, and to create new knowledge.

It's been shown that most medical schools do not offer formal training on how to care for people with I/DD. Currently it's up to each medical school to decide on whether or not, and how, topics involving I/DD are covered. This is in comparison to dental schools in which the Commission on Dental Accreditation has required all U.S. predoctoral dental education programs to educate students on managing patients with intellectual and physical disabilities.

Through the U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, Healthy People provides science-based, 10-year national objectives for improving the health

of all Americans. Healthy People 2020 states that compared to individuals without disabilities, individuals with disabilities are more likely to "experience challenges in obtaining preventive healthcare services." To address these and other health determinants, the World Health Organization (WHO) recommended to achieve health equity among individuals with disabilities, "The expansion of disability and health training opportunities for public health and healthcare professionals." 2

CHALLENGES & BARRIERS

In order to understand the importance and need for education and training, one should consider the challenges and barriers that those with intellectual and developmental disabilities face. Disparities in care for those with I/DD continue to exist. It has been noted that approximately 6.5 million people in the United States have an intellectual disability. Despite the increase in life expectancy, adults with any type of developmental disabilities die on average 20 years earlier than adults without I/DD. The World Health Organization reports that those with disabilities are more likely not to have preventative cancer screenings and are more prone to obesity and high blood pressure. Studies have revealed that among adults with I/DD, two thirds had two or more co-morbidities, including obesity and chronic mental health needs. More than 40% were diagnosed with four or more chronic conditions in addition to I/DD. In an individual without I/DD, aging is not accompanied by high rates of medical and functional problems until after 70 to 75 years of age whereas in persons with a disability, these problems can present 20 to 25 years earlier.3 Adults with I/DD are nearly four times as likely to incur high annual healthcare costs than those without I/DD.

The different barriers to access of care are numerous, with lack of education, experience and training for health professionals at the top of the list. Without an understanding of the healthcare needs of people with I/DD, this can lead to poor communication and coordination of care. In addition, a common problem referred to as "Diagnostic Overshadowing" can occur when all the changed or unusual behaviors and behavioral symptoms are attributed to the intellectual disability or, conversely, everything is attributed to a psychiatric disorder without acknowledgement of the

impact and interrelationship between one's physical symptoms and behavioral expressions.4 For example, a patient with an intellectual disability who is non-verbal, is being evaluated for new-onset head banging behavior. The patient is diagnosed with a psychiatric problem and prescribed medication. In actuality, the patient has communication challenges and can't express the pain in their mouth due to a dental abscess.

OVERCOMING EDUCATIONAL & TRAINING BARRIERS

National Curriculum Initiative in Developmental Medicine: In 2019, the Albert Einstein College of Medicine received a grant to develop a special curriculum for medical students on how to treat adults with intellectual and developmental disabilities addressing educational gaps in medical schools in order to reduce health disparities for this population. The grant, part of the National Curriculum Initiative in Developmental Medicine (NCIDM) was funded by the American Academy of Developmental Medicine and Dentistry (AADMD) in partnership with Special Olympics International, and has been led by Joanne Siegel, Co-Director of the Rose F. Kennedy University Center for Excellence in Developmental Disabilities at Albert Einstein College of Medicine. In addition to a didactic piece, 2nd year medical students engaged in small group discussions with adults with I/DD who are selfadvocates, as well as with their family members. What started out as a one-year grant funded project, has now been embedded into the curriculum at Einstein and is taught to 2nd year medical students every year.

The National Curriculum Initiative for Developmental Medicine has provided a tremendous impetus in exploring various ways in which medical students can engage directly with adults with developmental disabilities. Within the five years of the NCIDM effort, 18 medical schools across the country have participated in a unique set of program models. At Einstein, in addition to the curriculum enhancement, this effort has led to the creation of an Einstein AADMD Student Chapter under the mentorship of Vincent Siasoco, MD in which there are now over 50 members participating in activities online and in the community that