Bridging Undergraduate Medical Education in Autism Spectrum Disorder (ASD) To Physicians’ Early Detection Practices

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Hutchinson, Paula S.
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Mount Saint Vincent University
Health care providers, parents, and educators are calling for earlier diagnosis and treatment of Autism Spectrum Disorder (ASD). ASD is a devastating, life-long disorder that puzzles and even paralyzes both parents and professionals. Delayed diagnosis of ASD and constrained developmental surveillance is a critical issue because of physicians’ variable detection practices and the increasing prevalence of ASD. The premise of this inquiry was to discover if the variability in physicians’ practices also exists in undergraduate medical education, because once physicians leave medical education, continuing medical education has limited effect on practice behavior. Therefore, the rationale of this study was this: medical school is the best setting-and where there is the greatest opportunity-to teach physicians about ASD and early detection practices. Borrowing from an ethnographic perspective, this study investigated curricula and education practices used in an undergraduate medical school for identifying and treating children with ASD. Rich descriptions of these curricula, along with common themes emerged from the data which included telephone interview transcripts from 13 participants (2 medical school administrators, 7 fourth year medical students, and 4 instructors), curricula syllabi, and in some instances curricula content. The analysis of the findings followed Miles & Huberman’s Interactive Model and the Six-Step Approach to Curriculum Development for Medical Education. Methods such as triangulation, respondent validation, and member checking confirmed the findings. This needs assessment of undergraduate medical education provides a framework for the content and structure of ASD curricula in order to understand and to change the underpinnings of physician detection practices. Three factors delay ASD diagnosis until late preschool: physician detection practices, misinterpreted and inaccurate parent reports, and the symptomatic nature of ASD. The findings suggest all the factors that delay diagnosis in clinical practice are present in current practices in undergraduate medical education. Four major themes emerged: (1) Curricula structure and medical education’s current pressures affect child development and ASD integration in the curricula; (2) Students learn basic developmental milestones as a method to detect ASD and other developmental disorders; (3) Clinical guidance is constrained for detection practices of ASD and other developmental disorders, and (4) Students experience limited ASD patient contact and do not have the skills for early detection practice. These findings provide opportunities and have implications for learning and teaching ASD curricula in undergraduate medical school. This study offers insight to the practice gap in early child health surveillance and provides educational goals and teaching strategies for medical students on early detection practices. The findings provide curriculum planners with a baseline for evaluating the impact of ASD curricula. The long-term goal of this research is to ensure ASD curricula is relevant and succinctly comprehensive. The anticipated long-term outcome is to prepare medical students for their future practices so they have a positive impact on the health of children with ASD and their families.
Medical Education , Children , Autism Spectrum Disorder (ASD)