Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
Acad Med. 2011 Sep;86(9):1171-8. doi: 10.1097/ACM.0b013e3182264a25.
The problems adults with disabilities face obtaining quality primary care services are persistent and undermine national efforts to improve the health status of this group. Efforts to address this issue by providing disability-related training to physicians are hampered by limited information about what generalist physicians need to know to care for patients with disabilities. The authors consider the desired outcomes of disability-related training for generalists by exploring the contributions of the domains of knowledge, attitudes, and skills to patient-directed behavior and summarizing the empirical data.Because disability reflects a complex interplay among individual, interpersonal, institutional, community, and societal factors, generalist physicians can promote and protect the health of adults with disabilities by interventions at multiple levels. Thus, the authors use the social-ecological framework, an approach to health promotion that recognizes the complex relationships between individuals and their environments, to delineate the recommended knowledge, attitudes, and skills in the context of primary care. The importance of role models who demonstrate the three domains, the interactions among them, and issues in evaluation are also discussed. This clear delineation of the recommended educational outcomes of disability-related training in terms of knowledge, attitudes, and skills will support efforts to better prepare generalist physicians-in training and in practice-to care for adults with disabilities and to evaluate these training strategies.
残疾人在获得优质初级保健服务方面面临的问题持续存在，这破坏了国家改善这一群体健康状况的努力。通过向医生提供与残疾相关的培训来解决这个问题的努力受到了限制，因为缺乏关于普通医生需要了解哪些知识才能照顾残疾患者的信息。作者通过探索知识、态度和技能领域对面向患者的行为的贡献，并总结经验数据，来考虑普通医生进行残疾相关培训的期望结果。由于残疾反映了个人、人际、机构、社区和社会因素之间的复杂相互作用，普通医生可以通过在多个层面进行干预来促进和保护残疾成年人的健康。因此，作者使用社会生态框架（一种认识到个人与其环境之间复杂关系的健康促进方法）来描绘初级保健背景下推荐的知识、态度和技能。还讨论了榜样的重要性，他们展示了这三个领域、它们之间的相互作用以及评估中的问题。明确划分残疾相关培训在知识、态度和技能方面的推荐教育成果，将有助于更好地培训普通医生（包括在培训中和在实践中），以照顾残疾成年人，并评估这些培训策略。
