Michelle+Matz

**Michelle Matz** **Design Document** //Last Updated: May 2, 2010 //

** Course/Program Title Preventative Health Care for Women with Disabilities: A Curriculum for Physicians **

**Course goals ** This curriculum will provide physicians and health care professionals with a means to identify special considerations for female patients with a disability, provide preventable health care services to female patients with a disability, use proper communication techniques, methods, and technologies, and develop a co-expert model of care, ensuring therapeutic goals correspond with patient desires.

**Course objectives** Given a female patient with a disability in a typical physician office setting, the medical student or resident will be able to: 1) Identify if a female patient has a disability in 95% of affected patients 2) Classify which disability, a sight, speech or hearing disability or combination of them, the patient has, in at least 90% of affected patients 3) Demonstrate how to revise a physical examination at least 90% of the time, by: explaining each step of the examination to the patient, standing in front of the patient (so the patient can read their lips and hear them clearly) when explaining each step of the examination, and asking the patient's permission before performing any part of the examination. 4) Apply "best practices" of effective physician-patient communication with the patient. 5) After identifying the patient, classifying their disability, and speaking with the patient about their experience, recommend three specific ways to make changes to the practice to make it more user-friendly for the patients.

Participants will be health care professionals, specifically medical students and residents, ranging in age from 25 to 35, on average. Medical students and residents will be knowledgeable and experienced in communicating with patients, taking a thorough patient history, and performing a complete physical examination on a female patient. Due to time constraints and on-call schedules, the blended delivery method will allow learners to complete some activities asynchronously. Students will be comfortable learning as a group and also completing assignments and activities individually. Learners will be computer literate and have prior familiarity using online courses with audio, video and interactive activities.
 * Intended audience **

This program will be an instructor-led blended (online, synchronous and asynchronous, and in-person) curriculum. It will include live lectures, videotaped online presentations, discussion boards, email, and face-to-face feedback to allow students to interact with the instructor and each other. Online presentations will be self-running online Flash-based presentations. Students will need access to a computer with an Internet connection and a web browser that supports Flash files. Students will implement what they have learned during an in-office appointment with a woman with a disability. This program should be established as an integral part of medical student education to provide the best health care to women with a disability.
 * Delivery method **

This course will be broken up into a six topics and administered weekly. Students will be exposed to various methods of instruction, both online and in-person. The course content will be presented using problem-based learning methodologies and case-based scenarios. Both experiential learning and interactive instruction will be used and reflect both the constructivist learning theory and the cooperative learning environment (communities of practice).
 * Instructional approach/strategies/methods **

A variety of materials will be used for this curriculum including: PowerPoint slides and presenter notes, video recordings, audio podcasts, Articulate presentations, multimedia case studies/scenarios, role-playing, interactive activities, research activities, group projects, discussion boards, wikis and patient simulations.
 * Instructional materials **

Iezzoni LI, O'Day BL. More Than Ramps: //A Guide to Improving Health Care Quality and Access for People With Disabilities.// Oxford University Press Inc, 2006, ISBN: 0-19-517276-0
 * Required reading**

 Students will be able to define the term disability and list the characteristics of a sight, speech and hearing disability. Upon completion, students will be able to: · <span style="font-family: 'Arial','sans-serif'; font-size: 9pt;"><span style="font-family: 'Arial','sans-serif'; font-size: 9pt;"><span style="font-family: 'Arial','sans-serif'; font-size: 9pt;">Define the term disability <span style="color: #808000; font-family: Symbol,sans-serif; font-size: 9pt;">· List Americans with Disabilities Act (ADA) definitions <span style="color: #808000; font-family: Symbol,sans-serif; font-size: 9pt;">· Classify sight, speech, and hearing disability characteristics <span style="color: #808000; font-family: Symbol,sans-serif; font-size: 9pt;">· Identify a patient with a sight, speech, or hearing disability || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 9pt;">** Visual ** 1) Learners watch an Articulate presentation that has embedded video of the presenter and animated slides. 2) Learners also watch a webcast on 'Top 10 Barriers to Quality Health Care for Women with Disabilities'. // These activities allow the visual learner to watch the video of the presentation and a webcast. Both of these engage the visual learner with animation and movement on screen and visually stimulate them with imagery, colors and content. // <span style="font-family: Arial,Helvetica,sans-serif; font-size: 9pt;">** Auditory ** 1) Learners will listen to the Articulate presenter/ presentation as well as the audio in the webcast. These will also be provided as podcasts.   <span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 9pt;">2) Learners will listen to a patient describe herself and the learner will be asked what type of disability she has. // These activities will engage the auditory learner, allowing them to listen to the content in both the presentation, webcast and patient description. // <span style="font-family: Arial,Helvetica,sans-serif; font-size: 9pt;"> 1) Learners will have a drag and drop activity matching descriptions and characteristics with the corresponding disability. 2) Learners will team up into groups of two and will meet virtually and be asked to read a case study. The team will then discuss what disability the woman in the case study has and describe the reasons/rationale for their decision. They will post their answers to the course discussion board. // These activities will allow the kinesthetic learner to be active individually and with a partner in the learning activity. The drag and drop activity is a motor activity (kinestetic). For the case activity they will have to discuss their answer (by talking with their partner; a doing activity) and then come to a agreed upon decision and then post it their answer (by doing) to the discussion board. //
 * <span style="color: #404040; font-family: 'Arial','sans-serif';">Lesson content outline **
 * **<span style="font-family: 'Arial','sans-serif'; font-size: 9pt;">Topic ** || **<span style="font-family: 'Arial','sans-serif'; font-size: 9pt;">Goal/Objectives ** || **<span style="font-family: 'Arial','sans-serif'; font-size: 9pt;">Activities ** || **<span style="font-family: 'Arial','sans-serif'; font-size: 9pt;">Media ** || **<span style="font-family: 'Arial','sans-serif'; font-size: 9pt;">Readings/Resources ** || **<span style="font-family: 'Arial','sans-serif'; font-size: 9pt;">Assessment ** ||
 * <span style="color: #808000; font-family: Arial,Helvetica,sans-serif; font-size: 9pt;">**Introduction** || **<span style="color: #808000; font-family: 'Arial','sans-serif'; font-size: 9pt;">Instructional goal **
 * Learning objectives**
 * Kinesthetic **

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12px;">** Synchronous Session ** 1) Introduction to the course, syllabus review, review of the grading rubric, and details about final project.

1) <span style="font-family: arial,helvetica,sans-serif;">Let us start the class off by sharing a little bit about ourselves and post a short bio so we can get to know you. Some information you could include would be: your background, where you currently work, type of patient population you work with, what you expect to gain from this class, something that you want to be covered in class, any questions you have, and finally, share a hobby you enjoy outside of work. 2) <span style="font-family: arial,helvetica,sans-serif;">After completing the reading for this week's lesson, think about your professional experience with female patients with a sight, speech and/or hearing disability. How have they been treated in your office? Please share both good and bad examples and how you could suggest making changes in how the patients received treatment, were treated, or any other observations. || - PowerPoint slides and script - Video recording of the slide presentation - Audio podcast - Articulate presentation - Case study - Interactive activities || ** 1) ** ADA Definition
 * Discussion Questions **

** 2) ** CDC Women with Disabilities Overview


 * 3) ** CDC Access to healthcare

** 4) ** CROWD Disability Overview and Statistics

** 5) ** ACOG Access to Healthcare: ADA Requirements and Incentives and Disability Culture

**6)** Iezzoni book, ch. 1-3 || ** Online ** 1) Pre- and Post-test; multiple choice

2) Participation in online interactive activities and discussion question

1) Ability to identify the correct disabiltiy that a patient has by watching a video of a patient || An Introduction to Barriers and Solutions** || <span style="font-family: 'Arial','sans-serif'; font-size: 9pt;">**<span style="color: #808000; font-family: 'Arial','sans-serif'; font-size: 9pt;">Instructional goal ** <span style="font-family: 'Arial','sans-serif'; font-size: 9pt;"> Students will be able to describe the impact communication has on a woman with a disability the level of health care that is provided to her. Upon completion, students will be able to: <span style="color: #808000; font-family: Symbol,sans-serif; font-size: 9pt;">· <span style="font-family: 'Arial','sans-serif'; font-size: 9pt;"><span style="font-family: 'Arial','sans-serif'; font-size: 9pt;">Define three communication barriers <span style="color: #808000; font-family: Symbol,sans-serif; font-size: 9pt;">· <span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 9pt;">Develop three solutions to solve communication barriers    || <span style="color: #808000; font-family: Arial,Helvetica,sans-serif; font-size: 9pt;">**Visual** 1) Learners can watch a video of a summary of the presentation from this week. 2) Learners watch a video of a physician and patient communicating. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 9pt;"> **Auditory** 1) Learners will listen to the lecture as a podcasts.  <span style="font-family: Arial,Helvetica,sans-serif; font-size: 9pt;">** Kinesthetic ** 1) Learners will have a crossword puzzle to complete that lists barriers to communication. || <span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 9pt;">- Articulate presentation - PowerPoint slides - Videos - Audio podcast - Case study as an online activity - Interactive activities - Discussion question || **1)** Iezzoni book, ch. 6, 12 || <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 9pt;">** Online ** 1) Pre- and Post-test; multiple choice
 * In-person **
 * <span style="color: #808000; font-family: Arial,Helvetica,sans-serif; font-size: 9pt;">**Communication:
 * Learning objectives**

2) Participation in online interactive activities and discussion question

1) Working in groups, students will have a case study and have to develop three solutions to the barriers || Communication Aids** || <span style="font-family: 'Arial','sans-serif'; font-size: 9pt;">**<span style="color: #808000; font-family: 'Arial','sans-serif'; font-size: 9pt;">Instructional goal ** <span style="font-family: 'Arial','sans-serif'; font-size: 9pt;">  Students will be able to explain what an interpreter does and name at least three communication aids. Upon completion, students will be able to:  <span style="color: #808000; font-family: Symbol,sans-serif; font-size: 9pt;">· Define what an interpreter does and their responsibilities to the patient   <span style="color: #808000; font-family: Symbol,sans-serif; font-size: 9pt;">· Analyze possible Communication Aids that you may need to use and schedule for an in-office examination || <span style="color: blue; font-family: Arial,Helvetica,sans-serif; font-size: 9pt;">** Visual ** 1) Learners watch a video of an interpreter and a patient to understand how they work together. 2) Learners a slide presentation that explains and shows different types of communication aids. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 9pt;"> **Auditory** 1) Learners will listen to a narration and recording of different types of communication aids, including a screen reader.  <span style="font-family: Arial,Helvetica,sans-serif; font-size: 9pt;">** Kinesthetic ** 1) Learners will have a matching activity to match images of communication aids with their definitions and descriptions. || <span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 9pt;">- Videos of patient stories - Articulate presentation - PowerPoint slides - Audio narration - Interactive activities - Discussion question || **1)** Iezzoni book, ch. 7 || <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 9pt;">** Online ** 1) Pre- and Post-test; true and false
 * In-person **
 * <span style="color: #808000; font-family: Arial,Helvetica,sans-serif; font-size: 9pt;">**Using Interpreters &
 * Learning objectives**

2) Working in pairs and given a specific communication aids, groups investigate the aid and post their research onto the course wiki

1) An interpreter and different communication aids are shown to students and they explain how and when to use them ||
 * In-person **

Physician-Patient Communication** || <span style="font-family: 'Arial','sans-serif'; font-size: 9pt;">**<span style="color: #808000; font-family: 'Arial','sans-serif'; font-size: 9pt;">Instructional goal ** <span style="font-family: 'Arial','sans-serif'; font-size: 9pt;"> Students will be able to identify effective and ineffective physician-patient communication skills and suggest ways to improve it. Upon completion, students will be able to: <span style="color: #808000; font-family: Symbol,sans-serif; font-size: 9pt;"><span style="color: #808000; font-family: Symbol,sans-serif; font-size: 9pt;">· <span style="font-family: 'Arial','sans-serif'; font-size: 9pt;"><span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 9pt;">Recognize examples of both effective and in-effective communication skills <span style="color: #808000; font-family: Symbol,sans-serif; font-size: 9pt;">· <span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 9pt;">Illustrate effective communication "best practices" using a role play activity    || <span style="color: blue; font-family: Arial,Helvetica,sans-serif; font-size: 9pt;">** Visual ** 1) Learners can watch a taped presentation with the professor and also some interviews with patients explaining their stories, showing both good and bad examples. 2) Learners watch video case scenarios. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 9pt;"> **Auditory** 1) Learners will listen the patient stories with physician narration and rationale for the correct and incorrect ways to communicate.  <span style="font-family: Arial,Helvetica,sans-serif; font-size: 9pt;">** Kinesthetic ** 1) Learners will watch the video case scenarios and will be able to "choose your own adventure" to select the best communication between the physician and patient through out the case. || <span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 9pt;">- Video - PowerPoint slides - Videos - Audio podcast - Video case study as an online activity - Interactive activities - Discussion question || **1)** Iezzoni book, ch. 8, 12, 13 || <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 9pt;">** Online ** 1) Pre- and Post-test; multiple choice
 * <span style="color: #808000; font-family: Arial,Helvetica,sans-serif; font-size: 9pt;">**Effective
 * Learning objectives**

2) Participation in the video case scenario and select the best way to handle decisions in the case.

1) Working in groups, students discuss their solutions to the case and through compromise come up with a group decision about how case should have been handled. || Friendly Practice Changes** || <span style="font-family: 'Arial','sans-serif'; font-size: 9pt;">**<span style="color: #808000; font-family: 'Arial','sans-serif'; font-size: 9pt;">Instructional goal ** <span style="font-family: 'Arial','sans-serif'; font-size: 9pt;">  Students will be able to identify traits of a user-friendly practice and formulate steps to make a practice user-friendly practice. Upon completion, students will be able to: <span style="color: #808000; font-family: Symbol,sans-serif; font-size: 9pt;">· <span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 9pt;">Classify changes that a practice could implement to allow it to be more user-friendly · <span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 9pt;">Evaluate a practice and determine the necessary steps to make it user-friendly  || <span style="color: blue; font-family: Arial,Helvetica,sans-serif; font-size: 9pt;">** Visual ** 1) Learners can watch a captured lecture. 2) Learners watch a video of an actual patient going to two offices, one that is user-friendly and the one that is not. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 9pt;"> **Auditory** 1) Learners will listen to the lecture as a podcasts.  <span style="font-family: Arial,Helvetica,sans-serif; font-size: 9pt;">** Kinesthetic ** 1) Learners will have an online simulation of an office and are taken through different processes to see if they can find and select items that should be revised to make the office user-friendly.
 * In-person **
 * <span style="color: #808000; font-family: Arial,Helvetica,sans-serif; font-size: 9pt;">**Making User-
 * Learning objectives**

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 90%;">** Discussion Questions ** 1) In your experience is your office user-friendly? If yes, explain why and what makes is user-friendly. If not, share some examples of things that you would suggest changing in your office.

1) Do you think it is important to make an office user-friendly? Explain why or why not. Also, give an example why you may not make an office user-friendly. || <span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 9pt;">- Video - PowerPoint slides - Videos - Audio podcast - Office simulation - Interactive activities - Discussion question || **1)** Iezzoni book, ch. 4, 5, 7, 10, 14
 * Blog Discussion **

**2)** ADA Guidelines: Removal of Barriers (Sections 36.304 - 36.406)


 * 3)** ADA Q&A: Health Care Providers

** 4) ** Efficient Office Design for a Successful Practice: The Ideal Exam Room

** 5) ** Office Layouts for Doctors<span style="font-family: arial,helvetica,sans-serif;"> || <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 9pt;">** Online ** 1) Pre- and Post-test; shown a video of a mock office and asked to list items that should be changed

2) Participation in the online discussion topic and reaction to the patient's visit to the two offices. Discussion of the pros/cons of offices are discussed

<span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 9pt;"> 3) Students watch a video of a patient and her experience in her physician's office. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 9pt;"> 1) Students are blind folded, have ear plugs or cannot speak so they can see/feel how a female with a sight, speech, or hearing disability experiences sensory events and a non-user-friendly room. Then the students are asked to correctly list five items that should be changed. || Legal Issues** || <span style="font-family: 'Arial','sans-serif'; font-size: 9pt;">**<span style="color: #808000; font-family: 'Arial','sans-serif'; font-size: 9pt;">Instructional goal ** <span style="font-family: 'Arial','sans-serif'; font-size: 9pt;"> Students will be able to identify legal and ethical issues and categorize a list of issues. Upon completion, students will be able to: <span style="color: #808000; font-family: Symbol,sans-serif; font-size: 9pt;"><span style="color: #808000; font-family: Symbol,sans-serif; font-size: 9pt;">· <span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 9pt;">Describe three ethical issues <span style="color: #808000; font-family: Symbol,sans-serif; font-size: 9pt;"><span style="color: #808000; font-family: Symbol,sans-serif; font-size: 9pt;">· <span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 9pt;">Determine the ethical or legal issue after reading a case study and describe three possible solutions   || <span style="color: blue; font-family: Arial,Helvetica,sans-serif; font-size: 9pt;">** Visual ** 1) Learners can watch a video of a lawyer speaking about the legal remifications of not becoming 508 compliant. 2) Learners watch an Articulate presentation of slides with narration. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 9pt;"> **Auditory** 1) Learners will listen to the lecture as a podcasts.  <span style="font-family: Arial,Helvetica,sans-serif; font-size: 9pt;">** Kinesthetic ** 1) Learners will have a matching game to determine if certain issues are ethical or legal in nature.
 * In-person **
 * <span style="color: #808000; font-family: Arial,Helvetica,sans-serif; font-size: 9pt;">**Ethical &
 * Learning objectives**

<span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 12px;">** Synchronous Session ** 1) Discuss the case study and their group's solution.

1) Groups will have a brainstorming area to discuss their solutions to the case and to finalize the solution they will present to the class. 2) What do you feel are the three most important ethical issues that you have to consider in treating female patients with a disability? || <span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 9pt;">- Video of a lawyer - PowerPoint slides - Articulate presentation - Audio podcast - Case study as an online activity - Interactive activities - Discussion question || **1)** Iezzoni book, ch. 9, 11, 15, 16
 * Discussion Questions **


 * 2) ** CDC: Access to Healthcare

** 3) ** AMA Medical Code of Ethics

** 4) ** How to achieve patient satisfaction<span style="font-family: arial,helvetica,sans-serif;"> || <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 9pt;">** Online ** 1) Pre- and Post-test; multiple choice

2) Participation in discussion board and debate the implications of legal and ethical issues

3) Watch the two videos and debate what if any ethical issues there are and what you would do.

<span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 9pt;">4) Course Survey <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 9pt;"> 1) Working in groups, students will have a case study and have to develop three possible solutions ||
 * In-person **