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All residents Adult-focused residents Pediatric-focused residents Difference in proportions or means (95% CI) Cohen d p Valuea Participants,b n 423 293 127 Mean age (range) 29.10 (23.00–38.00) 28.97 (24.00–38.00) 29.42 (23.00–38.00) 0.09 Sex, n (%) 0.01 Female 248 (60) 157 (55) 88 (71) Male 159 (38) 124 (43) 35 (28) Other 2 (1) 2 (1) 0 (0) Prefer not to answer 6 (1) 5 (2) 1 (1) Median PGY level PGY-2 PGY-2 PGY-2 0.60 Treated at least 1 patient with IDD, n (%) 406 (96) 278 (95) 125 (98) 0.04 (−0.01 to 0.07) 0.09 Formal education dedicated to IDD, n (%) 104 (25) 29 (10) 74 (60) 0.50 (0.40 to 0.59) <0.01 Mean amount of prior experience interacting with people with IDD (95% CI)
[4-point scale, higher = more experience]2.45 (2.38–2.52) 2.30 (2.23–2.38) 2.79 (2.65–2.92) 0.48 (0.33 to 0.63) 0.70 <0.01 Mean comfort level interacting with people with IDD (95% CI)
[6-point scale, higher = more comfortable]3.88 (3.76–4.01) 3.71 (3.56–3.85) 4.28 (4.06–4.51) 0.58 (0.31 to 0.84) 0.46 <0.01 Mean comfort level treating people with IDD (95% CI)
[6-point scale, higher = more comfortable]3.73 (3.61–3.85) 3.57 (3.44–3.71) 4.08 (3.86–4.30) 0.51 (0.25 to 0.77) 0.42 <0.01 Mean IDP scale score (95% CI)
[lower score = less discomfort]66.80 (65.74–67.86) 67.70 (66.49–68.92) 64.71 (62.59–66.83) −2.99 (−5.43 to 0.55) −0.27 0.02 Abbreviations: IDD = intellectual and/or developmental disability; IDP = Interactions with Disabled Persons; PGY = postgraduate year.
↵a p Values noted for differences between adult-focused and pediatric-focused residents; t test for continuous variables, χ2/Fischer exact test for categorical variables, and Wilcoxon test for the median PGY level.
↵b Residency specialty information was missing for 3 participants.
Type of experience n (%) Mean comfort level interacting with people with IDD (95% CI) Difference in means (95% CI) Cohen d p Value Treated an inpatient with IDD Yes 321 (76) 3.96 (3.82–4.10) 0.30 (0.58 to 0.02) 0.24 0.04 No 102 (24) 3.66 (3.41–3.90) Had a k-12 classmate with IDD Yes 186 (44) 4.08 (3.90–4.25) 0.34 (0.10 to 0.58) 0.27 0.01 No 237 (56) 3.73 (3.57–3.90) Treated an outpatient with IDD Yes 166 (39) 4.14 (3.94–4.33) 0.42 (0.17 to 0.67) 0.33 <0.01 No 257 (61) 3.72 (3.57–3.87) Member of an organization that serves people with IDD Yes 108 (26) 4.43 (4.18–4.68) 0.73 (0.44 to 1.01) 0.53 <0.01 No 315 (74) 3.70 (3.56–3.83) Has a family member with IDD Yes 73 (17) 4.34 (4.04–4.64) 0.55 (0.23 to 0.88) 0.44 <0.01 No 350 (83) 3.79 (3.66–3.92) Has a neighbor with IDD Yes 55 (13) 4.24 (3.88–4.59) 0.41 (0.03 to 0.78) 0.32 0.04 No 368 (87) 3.83 (3.70–3.96) A friend's family member has IDD Yes 49 (12) 4.22 (3.89–4.56) 0.38 (0.02 to 0.75) 0.31 0.04 No 374 (88) 3.84 (3.71–3.97) Knows a person with IDD in their religious community Yes 45 (11) 4.38 (4.04–4.72) 0.55 (0.19 to 0.92) 0.46 <0.01 No 378 (89) 3.83 (3.70–3.95) Has a friend with IDD Yes 42 (10) 4.14 (3.70–4.58) 0.29 (−0.17 to 0.74) 0.22 0.21 No 381 (90) 3.86 (3.73–3.98) Had a college classmate with IDD Yes 23 (5) 4.35 (3.79–4.91) 0.49 (−0.08 to 1.06) 0.38 0.09 No 400 (95) 3.86 (3.73–3.98) Abbreviation: IDD = intellectual and/or developmental disability.
- Table 3
Spearman and Partial Spearman Correlations for Comfort Interacting With and Treating People With IDD
Variable Comfort measure Spearman correlation coefficient (95% CI) p Value Partial Spearman correlation coefficienta (95% CI) p Value Amount of prior experience interacting with people with IDD [rated on 4-point Likert scale] Comfort interacting 0.45 (0.37 to 0.53) <0.01 0.42 (0.33 to 0.49) <0.01 Comfort treating 0.42 (0.33 to 0.50) <001 0.38 (0.29 to 0.46) <0.01 Pediatric-focused residency program Comfort interacting 0.18 (0.09 to 0.28) <0.01 0.03 (−0.07 to 0.13) 0.55 Comfort treating 0.18 (0.08 to 0.28) <0.01 0.06 (−0.04 to 0.16) 0.25 Amount of formal education about caring for patients with IDD Comfort interacting 0.18 (0.08 to 0.28) <0.01 0.04 (−0.06 to 0.14) 0.39 Comfort treating 0.15 (0.05 to 0.25) <0.01 −0.00 (−0.10 to 0.10) 0.97 Current year of medical training Comfort interacting 0.05 (−0.05 to 0.14) 0.36 −0.03 (−0.13 to 0.07) 0.61 Comfort treating 0.07 (−0.03 to 0.17) 0.16 0.00 (−0.10 to 0.10) 0.98 Age Comfort interacting 0.08 (−0.02 to 0.18) 0.10 0.05 (−0.05 to 0.15) 0.33 Comfort treating 0.12 (0.01 to 0.21) 0.03 0.08 (−0.02 to 0.18) 0.11 Sex Comfort interacting 0.06 (−0.04 to 0.16) 0.23 0.09 (−0.01 to 0.19) 0.07 Comfort treating 0.05 (−0.05 to 0.16) 0.29 0.09 (−0.01 to 0.19) 0.09 Abbreviation: IDD = intellectual and/or developmental disability.
↵a Partial Spearman correlation controls for all the other variables in the first column.
Barrier Mean (95% CI) Lack of knowledge about available resources to recommend 3.22 (3.14–3.29) Difficulty understanding the patient's level of functioning 2.77 (2.70–2.84) Difficulty communicating with a person with IDD 2.69 (2.62–2.77) The time it takes to see a patient with IDD 2.62 (2.53–2.70) Lack of ability to control difficult behaviors 2.55 (2.46–2.64) Lack of knowledge about childhood-onset conditions 2.53 (2.45–2.61) The amount of paperwork involved 2.50 (2.41–2.59) Difficulty obtaining details about care of their childhood-onset conditions 2.49 (2.41–2.56) Difficulty with thorough physical examination because of physical barriers 2.43 (2.34–2.52) Reliance on caregivers to provide medical history 2.40 (2.31–2.48) Patients with IDD have many other doctors (i.e., specialists) involved in their care 2.34 (2.26–2.42) Lack of comfort interacting with people with IDD 1.98 (1.90–2.06) Clinic/hospital level concerns about lower reimbursement potential for patients with IDD 1.24 (1.18–1.30) Abbreviation: IDD = intellectual and/or developmental disability.
Scale: 1 = not at all a barrier, 2 = a little bit of a barrier, 3 = somewhat of a barrier, 4 = very much a barrier.
Intervention Mean (95% CI) Dedicated support staff to navigate services for patients with IDD 3.74 (3.69–3.79) Having a doctor who specializes in caring for patients with IDD in my clinic/department to talk through cases 3.49 (3.42–3.55) More interactions with people with IDD 3.05 (2.98–3.13) More didactic sessions/lectures about IDD 2.76 (2.68–2.84) A dedicated rotation about care for patients with IDD 2.68 (2.58–2.77) Online resource with facts and practice guidelines about patients with IDD 2.58 (2.49–2.67) Abbreviation: IDD = intellectual and/or developmental disability.
Scale: 1 = not at all, 2 = a little, 3 = somewhat, 4 = very much.
Name Location Contribution Hannah F. Johnson Shapiro, MD Department of Neurology, Boston Children's Hospital, MA Drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data Julia S. Frueh, MD Department of Neurology, Boston Children's Hospital, MA Drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data Madeline Chiujdea Department of Neurology, Boston Children's Hospital, MA Drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data Stefan Sillau, PhD Department of Neurology, University of Colorado School of Medicine, Aurora Drafting/revision of the manuscript for content, including medical writing for content; analysis or interpretation of data Jessica Solomon Sanders, MD Department of Neurology, and Department of Pediatrics, University of Colorado School of Medicine, Aurora Drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data
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