42. Attitudes Among Medical Students Towards Persons With Disabilities

Abstract

Various studies endorse that exposure to patients with developmental disability (DD) reduces bias and discomfort among physicians. However, few medical schools or residency programs offer structured experiences for learning about patients with special needs. Lack of such training contributes to substantial health disparities in this population. The Debbie Project (DP) was established to provide medical students with structured, longitudinal exposure to children with DD at the Debbie School (DS), working to increase attitudes of confidence, comfort, and willingness to provide care to this patient population. Attitudes can be measured as either explicit, a conscious consideration, or as implicit, an unconscious association. This study aims to explore attitudes among medical students towards persons with disabilities prior to intervention. This survey was designed and distributed online via Project Implicit. The questionnaire was administered anonymously prior to the first volunteering session at the DS during a mandatory lecture for first year medical students. Of 152 participants, 39 had signed up to volunteer with the DP during the 2017-2018 school year and 113 had not; 62, 87 and 2 identified as male, female, and nonbinary respectively. The survey included three components: demographics, the Implicit Association Test of Disability (IAT), and the Multidimensional Attitude Scale Towards Persons with Disabilities (MAS). The IAT measures involuntary association that indicates implicit attitudes against disabled individuals. The MAS is a 34-item self-report questionnaire, on a 5-point Likert scale, that measures explicit attitudes toward persons with disabilities through 3 categories: affect, cognition, and behavior. The results of the IAT and MAS indicated baseline differences among participants. Males exhibited a higher implicit association score (IAT D Score) than females (P=0.012, Standard Error Difference (SED)=0.0767), indicating a higher implicit attitude against individuals with disabilities. Volunteers and non-volunteers showed no significant differences in IAT D scores. There was no significant difference in IAT D scores for students with or without a family member with a disability. Average IAT D Scores were 0.6028 +/-0.4675, indicating an overall negative implicit attitude towards disability across all first year student participants. Total MAS Scores, however, demonstrated no significant differences between demographic groups of medical students. Few studies have quantified medical student biases towards persons with disability. Our study results demonstrate a divergence between measures of implicit and explicit attitudes. Despite explicit attitudes as measured by total MAS, our study group revealed negative implicit attitudes, as measured by the IAT. Additionally, differences in explicit attitudes based on gender or volunteer status are not mirrored in the IAT’s measure of implicit attitudes. This study demonstrates a discrepancy between implicit and explicit attitudes in medical students. The results are discouraging, as implicit attitudes influence non-verbal behaviours, and likely account for the negative experiences reported by individuals with intellectual disabilities. These baseline measures are a part of a larger study exploring whether a structured, longitudinal exposure to children with developmental disabilities reduces implicit and/or explicit biases toward this patient population.