Preparing Clinicians to Provide Competent Care to Patients with Disabilities

By Rick Rader, MD, FAAIDD, FAADM

Sixty years ago, Sir Robert Platt, the respected British physician and medical educator wrote in the British Medical Journal, “The first staggering fact about medical education is that after two and a half years of being taught on the assumption that everyone is the same, the student has to find out for himself that everyone is different.”

Perhaps nothing rings truer than how this applies to teaching students about people with intellectual and developmental disabilities. While the literature is abundant with descriptions about these complex syndromes, conditions and disorders, the reality is that they are all novel, unique and challenging. It has been well established that the lack of comprehensive medical education relating to learning disability-based clinical competencies is a major contributing factor in the life shortening healthcare disparities that have been long studied and acknowledged.

For the past 30 years, in my capacity as the Director of the Morton J. Kent Habilitation Center at the Orange Grove Center (Chattanooga TN) working in the field of intellectual and developmental disabilities, much of my time, effort and focus have been directed to furthering disability-inspired healthcare education.

We have made some inroads, including having CODA, The Council on Dental Accreditation mandating (2017) that all dental schools MUST train dental students in treating patients with disabilities.

I was given the privilege of being the first physician to be invited to address the United Nations on the need for global medical education reform and the rationale for disability-based training for ALL 1.5 million medical students. (March 21, 2024, World Down Syndrome Day, Health Equity Meeting)

The Board of Directors at the Orange Grove Center recognized how disability healthcare education needed to be enacted and that it required a “full-tilt”, “moon shot” approach. They have provided funding for a three-year initiative that has been inaugurated as Project D.I.M.E. (Disability Inspired Medical Education). It is a three-prong approach targeting MD, PA and NP programs. I am honored to have been appointed as the Director of Project D.I.M.E.

Project D.I.M.E. has recognized two pivotal “game changing” milestones which serve to fortify our resolve.

In 2002, Surgeon General of the United States Dr. David Satcher assembled a task force which resulted in the landmark report, “Closing the Gap: A National Blueprint to Improve the Health of Persons with Mental Retardation.” One of the most significant “take aways” from the meeting resulted in the recommendation (Goal 4), “Train Health Care Providers in the Care of Adults and Children with Mental Retardation.”

Little has been done. In fact:

*Every year, 30,000 medical students graduate from over 200 medical schools. In their four years of school, they each receive less than 11 minutes of training in treating patients with disabilities.

*Every year, over 44,000 Nurse Practitioners (NPs) graduate from over 500 programs with little or no clinical training in the treatment of patients with disabilities.

* Every year, over 11,000 Physician Assistants (PAs) graduate from over 300 programs acknowledging that they lack the skills, confidence and experience to provide competent care to patients with disabilities.

In 2022, a landmark research article appeared in the Journal Health Affairs (Vol 41, No.10), “I Am Not The Doctor For You: Physicians’ Attitudes About Caring for People With Disabilities” (Lagu, Haywood et al), physicians identified physical, communication, knowledge, structural, and attitudinal obstacles when caring for patient with disabilities.

Many physicians did not feel that the lives of people with disabilities had the same value as those without disabilities. The report concluded that, “Improvements in medical education and training are needed to better prepare physicians to care for people with disabilities.”

We think that the combination of the Surgeon General’s Report (2002), coupled with the Health Affairs study (2022) provides “the Perfect Storm” where clinicians lack the skills and confidence to treat patients with disabilities, coupled with a reported stigmatized prejudice.

The goal of Project D.I.M.E. is to mandate (not suggest, recommend or promote) that disability clinical competency training becomes an integral part of the curriculum in the training of MDs, DOs, NPs and PAs.

We are energized by having The National Council on Disability (ncd.gov) announce their support for requiring disability competency training for all healthcare students.

We are in close collaboration with the Alliance for Disability Health Care Education and promote the inclusion of their Core Competencies in Health Care Education as the standards for health professionals to care for people with disabilities. (adhce.org)

Early supporters of Project D.I.M.E. include the American Academy of Developmental Medicine and Dentistry (aadmd.org), The American Association on Health and Disability (aahd.us), The Developmental Disabilities Nurses Association (ddna.org) and People Advocating for Optimal Health (paoh.org).

One of the initial actions of Project D.I.M.E. was to identify and recruit a cadre of respected professionals to form its Advisory Committee. We are proud to announce that the following individuals have the skills, commitment and determination to help navigate Project D.I.M.E. and are members of the Project D.I.M.E. Advisory Committee:

Karl Cooper, JD, Executive Director, American Association on Health and Disability

Matthew P. Janicki, Ph.D. – Co-chair of the US National Task Group on Intellectual Disabilities and Dementia Practices; Research Associate Professor at the Institute of Disability and Human Development, University of Illinois Chicago

Holly Brown, DNP, RN, PMHNP-BC, PMHCS, Executive Director, Golisano Institute for Developmental Disability Nursing Innovation

David Ervin, BSc, MA, FAAIDD, Chief Executive Officer Makom, Vice Chair, The Council on Quality and Leadership

Vanessa Rastović, JD, Director - Serves on the Board of Harmony Health and on the City of Pittsburgh-Allegheny County Task Force on Disabilities.

Matt Holder, MD, MBA, FAADM, President American Board of Developmental Medicine, Co-Founder, Lee Specialty Clinic, Director KD Health

Project D.I.M.E. will provide ongoing status reports in HELEN.

Project D.I.M.E. appreciates the support of Tera Parsons, the Executive Director of the Orange Grove Center (orangegrovecenter.org), as well as the Orange Grove Center Board of Directors for their guidance and funding.

For further information and ideas on how to become involved please visit our website: