Diversity, Equity, and Inclusion Curriculum Embedded in a Physical Medicine and Rehabilitation Residency Program.

ABSTRACT: Diversity, equity, and inclusion initiatives are continuing to have increased importance in medical training, including rehabilitation medicine. Although resident-led curricula have been integrated into medical education in other training programs, to our knowledge, this the first report focusing on integrating these topics into resident education for a physical medicine and rehabilitation program. We created a didactic curriculum for our rehabilitation residents that included: quarterly lectures on diversity, equity, and inclusion topics followed by small group discussions. Each session also included an article that was included in the discussion. The sessions used both anonymous presurvey and postsurvey data to assess the efficacy of our initiative. Our initial data showed that our quarterly sessions created a safe and comfortable environment for discussing diversity, equity, and inclusion topics. In addition, our session specific data supported that increased awareness of diversity, equity, and inclusion disparities with rehabilitation and medicine was achieved. Our committee used the data and feedback to create further iterations of this initiative within our program, and we believe that this is a model that can be adopted by other physical medicine and rehabilitation residencies.

Failure to achieve assent in a communicative patient: what are the caregiver's obligations?

Disclosure of facts related to an individual's health care, including level and location of care, are central to the fulfillment of informed consent. When an individual is unable to provide informed consent because they lack the decision-making capacity to process the information and/or they have been deemed legally incompetent, the health care team should obtain assent from the individual whenever possible. Questions remain as to how to proceed when assent cannot be gained and the decision involved causes a level of distress for the individual that is difficult to resolve. A focus on maintaining hope and support with a clear transition and follow-up plan are important variables to consider for an ethical, caring response.

Is informed consent a "yes or no" response? Enhancing the shared decision-making process for persons with aphasia.

Respect for patient autonomy and the need to have a comprehensive discussion of the risks and benefits of a medical intervention are two important issues involved in the process of obtaining informed consent. In dealing with individuals with aphasia, there may be particular challenges in balancing these two ethical imperatives. Although decision-making capacity may be preserved with aphasia, the patients' ability to fully participate in a dialogue regarding a proposed medical intervention is frequently impaired. We propose a process of enhancing informed consent for persons with aphasia while continuing to respect and enhance patient autonomy and the exercise of decision making for these patients. The use of a patient-selected "helper" during the informed consent process can improve the quality of the informed consent, while reserving final decision-making authority for the patient.

Clinical ethics in the context of language and cognitive impairment: rights and protections.

Ethical dilemmas are particularly complex when a patient has a communication disorder. Questionable decision-making capacity can affect an individual's ability to participate in the informed consent process. When other cognitive impairments as well as language deficits are present, the risk of losing one's right to autonomy is greatly increased. Alternatively, the protection afforded those who are clearly incompetent may be limited if a person appears to have decision-making capacity but is unable to adequately process information. These challenges are illustrated in this article by use of clinical case descriptions. They also serve to demonstrate ways in which speech-language pathologists can provide the expertise needed to assist patients and medical teams in addressing these particular issues and ensuring patient autonomy.

Ethical issues in rehabilitation: a qualitative analysis of dilemmas identified by occupational therapists.

Little available research exists to address the range of ethical issues encountered by occupational therapists (OTs) in their daily clinical work. The few articles in the literature have tended to be case-based or anecdotal or have focused on professional issues rather than clinical issues. To characterize the array of clinical ethical issues in occupational therapy, we asked OTs in a free-standing academic rehabilitation hospital to describe in some detail up to three scenarios or situations from their clinical practice that raised morally troubling questions. A coding system was developed to preserve the richness of the detail but to allow for some categorization of the topics. A second section of the survey asked the therapists to rate whether various traditional ethics topics were of high, medium, or low interest to them. A third section asked that they identify the formats that would be most appealing to them for future educational interventions. Of the 56 therapists surveyed, 38 (or 68%) responded. The three self-generated topics mentioned most frequently by the therapists were (in decreasing order of frequency): reimbursement pressures, conflicts around goal setting, and patient/family refusal of team recommendations. The respondents were particularly interested in knowing more about patient-centered ethics topics, such as conflict resolution between teams and patients and the patient's role in decision making. Furthermore, they indicated a strong preference for interdisciplinary and interactive educational formats.