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Physician Training in Assistive Technology

Introduction

Since 1993, Tech Act projects have been collaborating with the American Medical Association on physician training in assistive technology. This partnership has resulted in physicians being trained in seven states to date. This section describes the training and its impact on physicians, lessons learned and steps other Tech Act projects can take to institute the training in their states.

Identification of Need

In 1992, the Nebraska Assistive Technology Project conducted a series of public forums on the barriers/issues affecting individuals with disabilities regarding assistive technology. An issue that was consistently identified was the need to train physicians about assistive technology and the potential it has for patients. Physicians are usually the first contact that newly disabled persons have. They are also the primary contact for persons with persistent medical problems. Both types of patients seek direction from their physicians concerning assistive technology that might prove helpful.

The project first sought out its state medical society to set up training but was not successful. What was needed was a national training effort through a group with direct access to physicians. Nebraska looked to the American Medical Association (AMA) to lend credibility to the training and provide an "in" to its state medical society. To broaden the training effort, the Nebraska project collaborated with four other state Tech Act projects: Arkansas ICAN, Iowa Program for Assistive Technology, Maine CITE, and Minnesota STAR Program. The Department of Geriatric Health within the AMA was identified as the prime contact. It had developed guidelines and a training program in the area of home health care and would use that model to develop the assistive technology training.

Development of Training

Training was targeted to primary care physicians since they provide most of the medical care for individuals with disabilities. The AMA conducted focus groups with physicians, allied health professionals, and consumers to identify what primary care physicians needed to know. The results of these focus groups were used to develop the guidelines and curriculum materials used in the training.

The guidelines, Guidelines for the Use of Assistive Technology: Evaluation, Referral, Prescription, included sections on the role of the physician, the physician-patient relationship, patient assessment, the team concept, the rehabilitation process, the technology assessment, the importance of consumer training, and funding information.

The training materials consisted of lecture notes, case studies, slides, overhead transparencies and three videotapes. The videos demonstrated the benefits of assistive technology. Their purpose was to generate interactive discussions. For example the "Mrs. Jennings" video presents an elderly woman being assessed by a primary care physician. During the training session the tape is stopped for discussion. Most workshop participants assume she needs to be cared for in a nursing home. However the second half of the video portrait shows the patient in her own home, independent, taking care of herself with the help of several AT devices.

Training topics were designed to be presented in small discrete sections so that individual training sessions could be tailored to fit audience interests and time allotted. Pre- and post- training questionnaires completed the curriculum.

Phase One Training: First Five States

Each of the initial five states sent an interdisciplinary team composed of at least two physicians, one other health professional (occupational therapist, physical therapist, etc.), and a member of the Tech Act project to a train-the-trainers one-day workshop conducted by the AMA. The faculty teams included a variety of medical specialties, such as family medicine, low vision, geriatrics, pediatrics, rehabilitation medicine, and neurology. Teams members were chosen because they were opinion leaders in their state medical communities.

Each state faculty team committed to conducting two workshops during the next year. These workshops were scheduled into regularly planned conferences that the various state medical societies/organizations conducted. Continuing medical education (CME) credit was provided through the AMA.

Each team customized its training to fit the needs of the state. For example, in Arkansas, a hands-on component was added to give participants the chance to see and try out various assistive technology devices. Additional materials were included to lengthen the section on medical necessity. In Nebraska, case studies using Nebraska patients were substituted. One faculty member's presentation was video taped for use in other training sessions.

Minnesota, like Arkansas, incorporated hands-on experiences with assistive technology. The state team also used state data rather than national figures whenever possible. The introductory background material was shortened and incorporated as appropriate into the faculty presentations.

Maine invited physicians to bring one other health care professional to the workshop free of charge. The project also included hands-on experience as part of the training. At one of the workshops there was even an exhibit of some durable medical equipment. During the workshop break, the faculty "worked" the crowd and was able to discuss the benefits of assistive technology with fellow physicians and other attendees.

A total of 10 workshops were conducted in the first year: two in Arkansas, Maine, and Minnesota; one in Iowa; and 3 in Nebraska. Sessions ranged from 1 1/2 hours to 3 hours in length. Sponsors included family medicine academies, medical schools, pediatric academies, hospital grand rounds, and medical societies.

Additional training and other dissemination activities were engaged in after the first year. The Minnesota STAR Project conducted training for residents at one of the state's medical schools. It also was successful in training staff of a statewide managed care network. The Iowa project developed a 24-minute video to be used with family practice residents and osteopathic residents. It has continued to present an hourly segment at the annual family practice conference.

Both Nebraska and Iowa disseminated the Guidelines to other physicians in the state. Iowa mailed the Guidelines to every family practice physician office, except in one region where area agencies on aging volunteers hand delivered copies of the Guidelines. Members of the Nebraska Peer Support Network, an active group of consumers and project advisors located throughout the state, disseminated packets of information on a one-to-one basis to all physicians in their regions. AT training materials are now routinely included in the residency programs of Maine's two largest teaching hospitals.

Phase Two Training: Two Additional States

Once the assistive technology training was launched in the first five states, other Tech Act projects were invited to participate in the training program. Two state Tech Act projects, Texas Assistive Technology Partnership and South Dakota's DakotaLink, requested that the AMA train their faculty teams. Each project wanted to reach rural medical providers via existing distance learning networks.

For Phase Two training, the AMA no longer provided continuing medical education credit to physicians being trained. Instead, the state Tech Act Projects needed to negotiated themselves with their state medical societies to get the training approved for CME credit.

The Texas Assistive Technology Partnership contracted with the Texas Tech Health Sciences program, The Center for Rural Health Initiative. The Center provides continuing education for rural physicians and allied health workers broadcast over the state medical interactive video network. Assistive technology became one of the topics broadcast.

The project enlisted a large interdisciplinary faculty team that included a geriatric specialist, developmental pediatrician, social worker, occupational therapist, and speech-language pathologist. Faculty presented a 2-hour training program that was broadcast to 100 rural hospitals across the state. It included video case studies produced by the Center for Rural Health Initiative and several interactive question and answer sections with the audience. Since Texas Tech Health Sciences was approved as a provider of CME, physicians received credit for their participation.

DakotaLink worked with its university affiliated program (UAP) to train physicians in the state using teleconferencing. Two series were conducted, one with a geriatric focus, the other with a pediatric focus. The faculty teams ware composed of a variety of medical and allied health specialists. For the geriatric series, training was broken into four 75-minute segments. Each segment included an introduction by faculty members, a video case study, and a question and answer section. The UAP produced original video case studies from South Dakota cases. The pediatric series was similar, but had only three segments.

Training reached approximately 100 health professionals at 16 teleconference sites (including some in Texas, North Dakota, and Nebraska). An audio bridge was used for the interactive parts of the training to connect the faculty panel with participants. When the video was to be shown, instructions were given to participants to play the video tape that was supplied to the site for that session. Participants returned to the interactive audio teleconference to discuss the video they had seen. The university affiliated program, as the state's CME provider, provided the continuing medical education credit.

Training Evaluation

One hundred fourteen of the attending physicians and residents completed both the pre-and post- training questionnaires during the Phase One training. A 3-month follow-up questionnaire was also administered. The data showed that the training was well received (94% felt they received useful information) and the training met its objectives. The training sensitized the physicians to issues related to assistive technology and people with disabilities. It provided them with a wealth of information. It also changed their attitudes and provision of care behavior.

Specifically post-seminar, physicians indicated they had:

A significant positive change in attitude toward conducting screening functional assessments (from 40% to 70%).

An increase in knowledge of community resources regarding assistive technology (from 22% to 53%).

An increase in agreement that patients with functional limitations should be evaluated for the use/benefit of assistive technology (from 56% to 65%).

An increase in confidence that they could provide or arrange care for persons with disabilities (an 8% increase).

An increase in attitude about referring patients to rehabilitation therapists and community agencies (from 12% to 36%).

Through a 3-month follow-up assessment, the AMA found that physicians were putting their new found knowledge and attitudes to use:

45% had implemented changes in their practices to better accommodate patients with functional impairments.

35% had made physical access and equipment changes to their offices.

27% had made changes to their scheduling and coordination of care.

74% had referred hospitalized patients to physical therapists, 60% to occupational therapists.

73% had used the resources of social workers in the hospitals.

In the home setting, 64% utilized physician therapists; 52% utilized social workers; 56% used the services of occupational therapists.

Lessons Learned

Several lessons were learned from the experiences of the seven states.

Partnering with the AMA provided the necessary entry for the state Tech Act projects to reach the state medical groups and physicians. The AMA could also offer continuing medical education (CME) credit. This proved to be an important feature of the training, as physicians need this credit for continued state licensure. The AMA was an excellent national dissemminator of information. Routine press releases, such as the one announcing the release of the Guidelines, were circulated to 4,000 major media sources. Articles authored by the Department of Geriatric Health physician liaison were placed in several national physician-oriented journals and newsletters. AMA representatives actively sought out national conferences at which to make presentations. All of these activities raised the awareness of a wider audience of physicians.

The composition of the volunteer faculty proved to be crucial. The projects found that recruiting must be done wisely. Ideally the faculty members should be good presenters, well respected in their field, and true believers in the benefits of technology. Physicians and other faculty need to recognize the benefits of technology beyond a medical, rehabilitation context. The faculty team should be as diverse as possible and include members from several disciplines. Presentations need to emphasize the team concept.

States found that training tailored to the needs of the state was well received. Projects worked with their state medical society to find out its members perceived needs. Health and safety issues and disability prevention through the use of assistive technology seemed to be popular topics and address universal concerns of the audiences.

Physicians and residents were particularly responsive to getting hands-on experience with a variety of assistive technology devices. They were also responsive to following the decision making process involved in selecting the appropriate device for an individual. For example, realizing that there may be 25 types of eating utensils to choose from got their attention and helped explain why simply referring patients to a catalog is not a good practice.

Maine was successful in multiplying the effect of the training. The project invited physicians to bring, free of charge, other members of their staff who would provide follow-up to attend the training session. Physicians brought their physician's assistant, nurse practitioner, social worker and office nurse.

Scheduling sessions into existing conferences proved to be difficult, primarily because there was such a long lead time between the planning of the conference and the actual conference. It was felt that the lag time between when the faculty team is trained and when they actually conduct their first training should be no more than 3 months.

Follow-up activities are important to continue the momentum generated by the training. Follow-up activities might include sending participants copies of the project newsletter or sending them special quarterly mailings on health care topics.

Distance learning proved to be extremely successful in reaching a large number of physicians and for reaching rural physicians, especially when the teleconference is conducted during the lunch hour. The strategy of bringing the training to the physicians rather than having the physicians go to the training needs to be explored by more Tech Act projects.

Providing CME credit through the state rather that the AMA could have been a problem for the Phase Two states. For credit to be given, it is mandatory that the CME provider in the state participate from the beginning in the planning and implementation of the training. In both Texas and South Dakota, the CME provider was identified early and did participate. so physicians could receive credit for their participation. For new Tech Act projects, attention must be paid to identifying the key players prior to planning any training. South Dakota found that building the critical alliances and partnerships both nationally and in the state were essential and took about six months to establish.

Texas learned it was important to maintain involvement and final editorial authority when producing videos and other training materials, with contracted production groups.

Steps for States

A state Tech Act project interested in implementing similar training in its state needs to do the following:

Contact the AMA and receive a preliminary packet of information that describes the training.

Identify the CME provider in the state to begin planning for the training.

Identify a multi-disciplinary faculty to teach the sessions.

Develop a marketing plan that details the conferences/ distance learning set-up in which training will occur.

Have faculty attend a train-the-trainers workshop conducted by the AMA.

Tailor the training to fit the state.

Conduct physician training.

Conduct follow-up activities to keep physicians engaged.

Contact for the AMA Physician Training Program:

Dr. Joanne Schwartzberg or Sheila Malkind
Department of Geriatric Health
American Medical Association
515 North State Street
Chicago, IL 60610
312/464-5085

Resource:

Schwartzberg, J.G., Kakavas, V.K., & Malkind, S. (Eds.) 1996. Guidelines for the Use of Assistive Technology: Evaluation, Referral, Prescription, 2nd edition. Chicago, IL: Department of Geriatric Health, American Medical Association. This second edition reflects a strong consumer orientation.

To order copies of the second edition of the Guidelines, call 312/464-5085, Department of Geriatric Health, American Medical Association, 515 North State Street, Chicago, Illinois 60610. Single copies are $5.00 each; $4.00 for 25 or more or $100 for packages of 25.

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The National Assistive Technology Technical Assistance Partnership is a cooperative agreement between the U.S. Department of Education and RESNA. The grant (Grant #H224B050003; CFDA 84.224B) is funded under the Assistive Technology Act of 1998, as amended and administered by the Rehabilitation Services Administration, Office of Special Education and Rehabilitative Services at the U.S. Department of Education.

This website is developed with grant funds. The information contained on these pages does not necessarily reflect the policy or position of the U.S. Department of Education or the Grantee and no official endorsement of the information should be inferred.