We developed, through collaboration with multiple stakeholders in the disability community, a novel video-enriched curriculum for healthcare students on the treatment of children with physical disabilities. Our curriculum can be delivered virtually and improved student attitudes about caring for children with physical disabilities.
Participation in the virtual workshop resulted in healthcare students’ positive shift in attitudes. The improvement was statistically significant, with a medium effect size of 0.38. Students also exhibited a shift in views, moving from approaching CWPDs as “different” and “challenging” to seeing them “normal” and “resilient,” indicating a reduction in stigmatized views. Learners gained a sense that the interpersonal approach to patients with physical disabilities need not differ greatly. Indeed, such an insight is by design at the crux of the workshop; namely, that the treatment of patients with disabilities should at its core be interpersonally the same as that for able-bodied patients, while recognizing and maintaining respect for inherent differences. This message was felt by the members of our curriculum working group, who considered this “normalizing” as perhaps the most important lesson to impart to healthcare students. At the same time, they identified considerations unique to the care of CWPD, compiled as key points which we highlighted in the workshop and include in the supplementary teaching materials.
Our materials focus on the experience of a single child who uses a wheelchair during an outpatient clinic visit. Even as this workshop enhanced healthcare students’ attitudes of CWPD, we consider this but a first step in the development of a curriculum that properly prepares students to provide quality, compassionate care for patients with all forms of disabilities. Our work is aligned with the transformative potential of “disability-conscious medical education, training, and practice” , which draws on insights from intersectional disability justice activism. However, we do not address the many other forms of disability, including cognitive or emotional. A natural next step will be to develop additional curated materials that focus on the treatment of patients with cognitive or emotional disabilities, as well as those with concurrent physical and cognitive disabilities. We recognize the disability community is broad and varied, and that the materials developed for this study represent only a start at improving medical education efforts designed to increase the quality and sensitivity of healthcare delivered to patients with physical disabilities. We intend to develop materials that address other types of disability, particularly combined physical and cognitive.
We recognize the importance of direct student exposure to, and engagement with patients with disabilities, given that “only when healthcare providers, educators, and students are routinely and meaningfully exposed to the perspectives of people with disabilities can they develop a consistent proficiency in diagnosing and treating ableism, in their profession generally, as well as in their own practice”.  After the didactic and collection of endpoint measures, we had an additional, 30-minute, unstructured discussion with a panel of individuals with living experience with physical disability: two adults on wheelchairs and the parents of a child with physical disabilities. Since our goal was to evaluate the new didactic materials, we excluded the panel component from our pre/post outcome measures. However, we encourage incorporating, whenever possible, a patient and/or parent panel as a synergistic complement to the videotaped materials embedded in the workshop. For situations in which access to suitable volunteer panelists or disability advocates is not feasible, instructors can use the filmed discussion about one of the co-author’s experiences navigating the healthcare system as a person who uses a wheelchair. This 9-minute video addendum is available as part of the supplementary online materials.
The video clips present multiple springboards for rich discussion, including aspects of the model visit that do not completely reflect best practices. One such point is how the guardrail on the side of the patient’s bed was not raised during the physical exam to maximize patient safety. Another is that while the physician in the video is a model for interacting with a child with a physical disability, even as an expert there were instances in which she assumed the patient would be unable to perform a task before asking, such as during discussion of transfer to the exam table, when the physician asked how best to assist before confirming if any assistance was in fact needed.
This initial study represents a first step in establishing the effectiveness of our curriculum. To assess the long-term effects and clinical implications of our curriculum, we intend to expand our efforts and reach all students by incorporating the workshop into our programs’ routine clinical rotation in pediatrics. As the workshop becomes formally integrated into the medical school curriculum, we will be able to measure sustainability of effects, and ultimately behavioral change.
We recognize several limitations. First, participating students voluntarily attended the workshop outside of classroom time and may represent a biased sample. Students with greater interest in the subject matter might have been more likely to attend, have more knowledge and less stigmatized views at baseline, and report higher satisfaction. However, despite this likely bias in sampling, we documented improvements in attitudes after participation in the workshop.
Second, we acknowledge that one of our two professional actors was an able-bodied child, a shortcoming we made explicit at the end of the workshop (and in the addendum interview). We were not able to recruit a CWPD to serve as a SP, but are committed to doing so in future iterations, following guidelines for “authentic representation” set forth in an influential white paper advocating for the employment in television of actors with disabilities. 
Third, we filmed the workshop during the COVID-19 pandemic. To ensure safety, all participants wore face masks. Masks veiled facial expressions and constrained non-verbal communication. At the same time, they provided a “time stamp” to the pandemic years during which these enduring videos were produced.
Fourth, we measured outcomes upon completion of the workshop, alerting to immediacy recall bias. Finally, we did not include a control group, which could have helped determine the unique pedagogic contribution of the video component.