As a fifth year Child Neurology resident, I am completing my ninth year of medical training after graduating college. While finishing this process and beginning my experience with LEND, I cannot help but think about how difficult it has been to find resources that allow me to prepare for caring for people with disabilities up until this point. During my first year of medical school, after completing a week-long course on cystic fibrosis, a condition that impacts 1 in 3,000 white newborns and is even more rare in non-white populations, we spent an hour learning about both ADHD and autism , conditions that each affect many more individuals. The National Health Interview Survey (NHIS) had the prevalence of ADHD in children 4-17 years old as around 10.2% of the population in 2016 and the CDC reported that in 2018 that the prevalence of autism was 1 in 44 children. I remember angrily googling these statistics at the end of the lecture and feeling so hopeless. I continued searching for the disability education I wanted and found some during my pediatrics rotation. I loved neurology and was planning to care for adults with disabilities with a focus on autism through a neurology residency. I told one of the adult neurology residents this and she responded, “we don’t do that – maybe you should do pediatric neurology.” A brief panic attack followed as it was close to residency application time, but it led me to the pediatric neurologist at my medical school who fortunately had a passion for caring for autistic adults.
I came into medical school knowing that I wanted to complete my training and care for people with disabilities, but most people come into medical school not knowing what they want to do and use the training received to pick a specialty. When thinking about the long waitlists to see child neurologists, developmental behavioral pediatricians, and child psychiatrists because of workforce shortages, I wonder if this is because of the way we are taught from our first year of medical school. How would someone develop an interest in autism if they have barely heard about it? I received most of my training on autism in pediatrics rotations and with the child neurologist. It was very clear to me throughout my training that there was a perception that only pediatricians need to know about autism.
There have been studies on trainee knowledge of autism that have shown shocking limitations of graduating medical students and residents. One study at the University of Alabama looked at medical students and pediatric residents and their comfort with caring for a child with autism in an acute care setting. It found that in both pediatric residents and medical students, more than 85% of responders felt less than somewhat informed on management of acute illness in autistic patients. In other words, only 15% of pediatric residents and medical students felt comfortable taking care of autistic patients. There have been other studies based on surveys of pediatric residents, but studies have not focused on the knowledge base of adult practitioners. Based on my experience, I suspect the results would be quite alarming. There have been efforts to create a curriculum for clinicians including the Autism Case Training: Developmental Pediatrics Curriculum which has been piloted in several pediatrics residencies with success. This is very exciting change in the right direction. The next step should be moving this curriculum earlier in training to the medical students so that all future providers will know that no matter what specialty you choose, you need to learn about autism. I think this early introduction can also serve as a form of recruitment to convince medical students to pursue disability focused specialties that have waitlists that last longer than a year.
References:
1. AMA J Ethics. 2015;17(4):318-322. doi: 10.1001/journalofethics.2015.17.4.medu1-1504.
2. Austriaco, Kristine, et al. "Contemporary trainee knowledge of autism: how prepared are our future providers?." Frontiers in Pediatrics 7 (2019): 165.
3. Dhuga, Yasmin, et al. "Developing undergraduate autism education for medical students: a qualitative study." BMJ paediatrics open 6.1 (2022).
