Content area
Purpose
People with intellectual disability face extensive health inequality and premature mortality. Medical students have reported that they lack the skills, knowledge and confidence to work with those with intellectual disability and autism. This emphasises the need for tomorrow’s doctors to be adequately trained. This study aims to investigate students’ knowledge, skills and attitudes towards people with intellectual disability and autism, examining whether these outcomes change following curricula re-design and with implementation of an e-learning module.
Design/methodology/approach
The university curricula in intellectual disability and autism were re-designed and an e-learning module developed using co-production. This was delivered to fourth-year medical students with a subgroup receiving the additional e-learning. A controlled trial evaluated students’ knowledge, skills and attitudes using pre- and post-questionnaires. Statistical tests of difference were used to the scores obtained.
Findings
This study showed an improvement in knowledge, skills and attitudes with intellectual disability and autism after curricula engagement, with an incremental benefit observed for students also completing the e-learning module. There was significant difference in pre-and-post placement scores assessing student attitudes towards intellectual disability and autism teaching.
Originality/value
This study highlights the importance of a multi-faceted, co-produced curricula re-design in intellectual disability and autism. The benefit of the e-learning module holds hope that the newly introduced mandatory Oliver McGowan training will be beneficial in the development of tomorrow’s doctors. Effective training in intellectual disability and autism is vital to improve the care and support delivered and reduce unnecessary deaths.
Introduction
People with an intellectual disability (ID) have an increased likelihood to suffer from physical and mental health conditions than the general population yet face extensive health inequality and premature mortality. The diagnosis of intellectual disability itself renders those to whom the label is attached susceptible to a variety of inter-disciplinary systems and social responses (Foucault, 1972). Compared with the general population, people with intellectual disability encounter reduced access to preventative care, have significantly higher rates of undiagnosed disorders and suffer inappropriate treatment (Conway et al., 2019; Rimmer and Braddock, 2002; Iacono and Davis, 2003). Reports have shown that approximately half of all deaths of people with intellectual disability were preventable (Heslop et al., 2014; Mencap, 2007). These deaths are associated with dynamic or changeable factors (for example, health-care workers not providing care to people with intellectual disability in a manner than appropriately accounts for their health needs). These health inequalities are avoidable and therefore unjust, emphasising the need for tomorrow’s doctors, medical students, to be adequately trained to become competent and non-discriminatory towards people with intellectual disability.
In response to the Learning Disabilities Mortality Review report, the government set out their commitment to ensure mandatory training for health-care professionals (Health Education England, 2020). The Oliver McGowan Mandatory Training of Learning Disability and Autism is a standardised training package developed to meet the requirement for regulated service providers to ensure their staff receive training in intellectual disability and autism (Health Education England, 2020). The training emerged following inappropriate prescribing, emphasising the need to train staff in the needs of people with autism and intellectual disability.
In terms of training tomorrow’s doctors, Health Education England stated it will engage with employers, the General Medical Council (GMC), Medical Royal Colleges and representative bodies to ensure that the medical curriculum meets the needs of its patients and the National Health Service (NHS) going forward (2019). The GMC stipulates that UK medical graduates should be competent in assessing and communicating the needs of these patients (National Health Services, 2019; General Medical Council, 2018). However, developing a standardised training package that can meet the needs of multiple students and staff across a variety of settings is a challenge. Medical schools must adapt their curricular to include a diverse range of pedagogy that has been shown to be effective for developing tomorrow’s doctors’ knowledge, skills and attitudes.
Both medical students and current medical professionals have reported that they lack the skills, knowledge and confidence to work with those with intellectual disability (Millar et al., 2004; Phillips et al., 2004; Ryan and Scior, 2016). Around 2% of the population are diagnosed with an intellectual disability, outlining the importance of training and exposure to medical undergraduate and postgraduate doctors. There is a concern that lack of clinical experiences with people with an intellectual disability will perpetuate the cycle of difficulties and barriers faced by these patients when accessing health services.
Very few studies have examined how intellectual disability is being taught within medical schools internationally and how medical students are obtaining direct experience of working with people with ID and autism (Trollor et al., 2018). Research has recommended an extensive medical curriculum with integrated direct patient contact with people with disability (Campbell, 2009; Lennox and Diggens, 1999). Within this, the curricula should promote positive attitudes and minimise the biomedical understandings of disablement. These recommendations ensure that students will have the opportunity to develop the skills and attitudes required. In addition, the pedagogy used to facilitate learning is imperative. Studies have analysed didactic lecture-based teaching on medical students’ attitudes and knowledge, discovering that this format improved knowledge but attitudes remained unchanged (Sinai et al., 2013). The research emphasised the need for increased face-to-face contact and the development of a diverse array of pedagogical tools to teach medical students about intellectual disability. This is vital in improving competence and reducing discrimination.
Intellectual disability curricula development
The GMC sets the learning outcomes required of medical students and stipulates that medical school curricula must include the opportunity to gain knowledge and understanding of the needs of patients with a range of illnesses or conditions, and with protected characteristics (General Medical Council, 2015). Often the educational packages are developed from the core capabilities frameworks for supporting people with autism and/or intellectual disability, a framework aimed at setting out the essential capabilities necessary for all staff (Health Education England and Skills for Health, 2019). Although integral for ensuring staff have key capabilities, it may neglect the specific educational needs of medical students.
This project aimed to build on the curriculum design within the medical school hoping to incorporate additional resources to obtain a multi-faceted approach to intellectual disability exposure in undergraduate medical studies. As is the case with other medical schools, content is delivered within the psychiatry teaching modules and the exposure to intellectual disability patients taking place within mental health placements.
Previously, the intellectual disability curricula consisted of a mental health disability awareness day and direct patient contact whilst on mental health placement. The disability awareness day incorporated lecture-based teaching, interactive case-based scenarios and patient lived-experience discussions. Exposure to intellectual disability patients was embedded within the mental health placement blocks for students. However, attendance with an intellectual disability team was not a mandatory requirement within the curricula. Due to pressured medical curriculums and transformations in the structure and funding of psychiatric delivery, direct clinical experiences with mental health patients have become more limited (Thomson et al., 2011).
The re-design of the intellectual disability curriculum aimed to ensure guaranteed contact for undergraduate medical students with people with intellectual disability and autism (0.5 days of clinical exposure). Unfortunately, this was not always possible due to service availability in certain locations. In addition, other pedagogical tools were introduced to add to the limited learning experiences and broaden intellectual disability exposure. A case-based learning (CBL) module was designed with an adaptive learning approach for an intellectual disability and autism diagnoses, alongside the assessment and management of challenging behaviour. In addition, a self-directed electronic learning module was designed with the aim to provide a detailed overview, to complement the ID awareness day, and give preparatory material and skills for students prior to their placement. The e-learning modules were designed to ensure medical undergraduates are adequately trained to the standard outlined by Health Education England.
Direct clinical patient contact includes the central role of experiences within the learning process, but medical student education should comprise of more steps and facets of learning to be transformative. Reflecting upon one’s experiences is felt to be an integral aspect of the transformative learning process, alongside the additional steps of understanding and interpreting this new knowledge and allowing it to guide future actions and guide practice (Abdool et al., 2017; Kolb, 2015). A structured high-quality multi-faceted approach was adopted for curricula re-design to ensure the medical students are an active participant in their education, enabling students to critically evaluate their knowledge, understanding, problem-solving and clinical skills (Mann, 2011).
Self-directed electronic learning module
An electronic online learning moodle® (Modular Object-Oriented Dynamic Learning Environment) module was developed and co-produced within a multidisciplinary team consisting of relevant stakeholders (consultant psychiatrists, core psychiatry trainee doctors, medical students, mental health nurses, psychologists, occupational therapists, speech and language therapists and information technology developers). Moodle® is a freely available open-source e-learning platform (Khan, 2012). There have been studies in various specialities in medical education that have described using moodle®, reporting excellent feedback from students in conjunction with other teaching methods (Seluakumaran et al., 2011).
The content of the module was overseen to ensure empirical validation and suitability to GMC curricula. Co-production workshops were held at scheduled intervals to develop and refine the module content with relevant stakeholders. An iterative and collaborative approach was taken to module development, whereby each stakeholder was provided the opportunity to contribute to the pedagogical conceptualisation, content and module delivery. The module content was shared with medical students and trainee doctors, emphasising the value of learner engagement in the design and development of the e-learning module. Medical student and trainee doctor involvement aimed to consider these stakeholders as equal partners rather than consumers of the module, thus improving acceptability, feasibility and learner engagement.
The focus of the e-learning module was to develop knowledge and skills to communicate with people with intellectual disability and autism, impart ethical and safeguarding considerations, teach access to health care and the processes underpinning health inequalities and to evaluate legal issues and capacity in patients with intellectual disability and autism.
Aims
The aim of this study is to investigate medical students’ knowledge, understanding, skills and attitudes towards people with intellectual and autism and examine whether these outcomes change following curricula re-design and with or without implementation of an e-learning module. We hypothesise that following introduction of the e-learning module medical students, knowledge, skills and attitudes will improve towards intellectual and autism.
Methodology
Study design
This study was an exploratory research study investigating the effectiveness of the e-learning module. It used a mixed-method approach involving quantitative and qualitative data. The primary method was quantitative analysis through an online questionnaire. This study gathered data prospectively, evaluating students who received the e-learning module and students in a control group that did not. The study also gathered quantitative data that was made available through student feedback.
Sample
The sample consisted of fourth-year medical students. The intellectual disability teaching content under the new curricula was undertaken within the mental health placement in the medical schools in fourth year. The students’ mental health placement took place across the fourth year of study, allocated in eight cohorts of students over the course of the 2020 / 21 academic year. Internet access and technology devices are provided to all medical students, which permits access to electronic resources and teaching materials throughout their undergraduate training. This ensured that those sampled had access and were comfortable using the required technology.
Recruitment
A questionnaire was developed by the authors, which was regularly reviewed for applicability and relevance to intellectual disability and medical education as well as ensuring comprehensibility, psychometric quality and empirical validity. The questionnaire was made accessible for medical students online on the medical student learning portal and delivered via email. Upon delivery of the questionnaire to medical students, a statement establishing the benefit of participation was provided. This was done to achieve objectives of maximising response rate, and to improve questionnaire completion (McColl et al., 2001). Electronic questionnaires have been shown to improve response rate, reduce systematic errors and help to minimise interview bias (Shannon and Bradshaw, 2002).
Data collection – questionnaire
A questionnaire was developed to explore students’ knowledge and understanding of intellectual disability, questions on student’s perceived skills and on attitudes towards intellectual disability and towards teaching/clinical work. The questionnaire was measured using a four-point Likert scale (strongly disagree, disagree, agree and strongly agree). A Likert scale was used as it provided a meaningful response for students with an adequate range of positive and negative opinions.
Questions were chosen following literature review and discussion with relevant stakeholders (consultant psychiatrists, core psychiatry trainee doctors, medical students, mental health nurses, psychologists, occupational therapists, speech and language therapists). The questions aimed to assess knowledge and skills that were relevant to the learning outcomes within the medical school intellectual disability curricula. Questions on attitudes towards intellectual disability were formulated using reliable and validated scales that are commonly used in research concerning societies’ attitudes to people with intellectual disability (community living attitude scale, mental retardation attitude inventory, attitudes towards intellectual disability). Research has used thematic analysis to identify emergent themes in relation to student attitudes to intellectual disabilities (Patel and Rose, 2013). The main themes identified from this study were also used to develop our questionnaire to sufficiently represent measures of attitude towards intellectual disability.
Questions on attitudes on medical students training and careers with intellectual disability were also included within the questionnaire. This data examined the e-learning applicability and relevance to medical students within their undergraduate degrees and their careers.
Data collection – procedures
The questionnaire was delivered to fourth-year students prior to the mental health placement and engagement with learning resources (awareness day, CBL exercise and e-learning module). Each cohort of medical students was contacted prior to the mental health placement and asked to complete the pre-placement questionnaire.
Medical students were placed across four separate NHS trusts for their mental health placements. Students were randomly allocated to each one of the four NHS trust placements. One trust was chosen for the e-learning pilot. This was to provide a reliable delivery of the e-learning module to a controlled number of students. The questionnaire was readministered at the next academic year 2021 / 2022 and sent to all fourth-year students. Individual medical student responses were not paired before and after, i.e., individual student pre and post placement questionnaires were not paired. Average scores for each question on the questionnaire for the pre-and post-placement groups were calculated. Data was collected to investigate for difference between the groups of students who completed the e-learning modules and those who had the curriculum as normal.
Data analysis
Data on the response rate of the questionnaires was collected and analysed. This was recorded as a percentage and the response rate of the questionnaire given at different points of the study compared. Answers obtained from the Likert-scale questionnaire were converted into numerical data to permit quantitative analysis of the pre- and post-placement scores. This was performed overall and for each outcome (knowledge, understanding and skills and attitudes) to assess for any significant differences following implementation of the curricula. Negatively framed question scores were inverted for data analysis to allow for consistency across the data set.
Data was analysed to compare the e-learning module group with the control group. Statistical analysis was carried out using IBM SPSS Statistics software. Statistical tests in the form of an unpaired t-test were used to analyse the scores before and after for each question.
Ethical approval
Ethical approval was sought and granted by the University committee on research ethics. A participant information sheet was provided along with the online questionnaire, which outlined that consent is implied by completion of the questionnaire. Thus, completion of the questionnaire was taken as implicit consent for completion of the study.
Results
The total number of year four students that completed the pre-placement questionnaire was 22 (n = 22). A total of 19 (n = 19) students completed the post-placement questionnaire; 15 (n = 15) completed the questionnaire having not completed the additional e-learning, four (n = 4) completed the questionnaire having completed the e-learning.
A total of 187 students were sent the questionnaire for completion, pre-and post-placement. The adherence rate of the pre-placement questionnaire was 12% and the adherence rate of the post-placement questionnaire was 10%. Table 1 shows the average scores in each domain of the questionnaire (knowledge/skills, attitudes towards intellectual disability and attitudes towards intellectual disability teaching).
Knowledge and skills
Table 1 shows an improvement in the overall average scores before and after student engagement in the intellectual disability curricula. Table 2 below shows the average scores for each question aimed at assessing knowledge and skills within the questionnaire. There is incremental benefit observed for students also completing the e-learning module. There was a statistically significant difference (p < 0.05) between groups. On further statistical analysis examining differences between two groups, there was a significant difference observed before and after engagement in the intellectual disability curricula, with or without e-learning completion (p < 0.05). There was also a statistically significant difference in the scores observed on the post-placement questionnaire without completion of the e-learning and with completion of the e-learning.
Attitudes towards intellectual disability
There was an increase in the average score assessing student’s attitudes towards people with intellectual disability and autism following engagement in the curricula. There was an incremental benefit for those students that also completed the e-learning. The difference between groups was found to be statistically significant (p < 0.05). Further analysis revealed a statistically significant difference between score before engagement in the curricula and the post-placement questionnaire with or without the completion of e-learning (p < 0.05). There was no significant difference observed between the two post-placement questionnaires, with or without the completion of e-learning (p = 0.241). Table 3 shows the average scores for each question asked on the questionnaires examining attitudes.
Attitudes towards intellectual disability teaching
The scores of students’ attitudes towards intellectual disability teaching did not change from pre-placement to post-placement without completion of the e-learning module. There was a slight increase in mean score with completion of the e-learning module. There were no statistically significant differences observed between the groups (p = 0.371).
Table 4 shows the average scores for each question on the questionnaire domain assessing attitudes towards teaching on intellectual disability and autism.
Discussion
This study aimed to develop medical student intellectual disability curricula to meet the guidance stipulated by the GMC and Health Education England; to implement training for future doctors and NHS employees, aiming to improve the understanding of the needs for people with intellectual disability. To achieve this objective, the introduction of new teaching methods and increased exposure to patients are needed. This study used a rigorous and comprehensive approach (using an iterative and collaborative co-production model with multiple stakeholders and learner engagement), to design an e-learning module specifically for medical students. The addition of the module allowed for learning through an alternative and additional pedagogical tool, which was shown to add incremental benefit for students’ knowledge, skills and attitudes (General Medical Council, 2015; Health Education England and Skills for Health, 2019).
The results from this study highlight the importance of improving teaching on intellectual disability in the university curriculum and the inclusion of e-learning as a pedagogical tool for intellectual disability content. This is important considering the introduction of the standardised Oliver McGowan training package, which includes training through e-learning modules (Health Education England, 2020). An independent evaluation of the Oliver McGowan training highlighted the challenges of delivering a standardised package that is effective for large groups of staff in a variety of settings (National Development Team for Inclusion, 2022). There needs to be sufficient buy-in by all medical schools to incorporate the Oliver McGowan training into their curricula successfully alongside other meaningful pedagogy. This will ensure that medical students are trained effectively, and that positive change occurs for those with intellectual disability and autism.
Previous studies have highlighted medical student’s worries about working with intellectual disability patients, which in turn is congruous with students’ wishes to receive more intellectual disability education (Burge et al., 2008). Our results also show this, demonstrating that students tend to “strongly agree” that they would appreciate a greater quality/quantity of teaching and exposure to patients. This persisted post-placement, likely because of the challenges of ensuring clinical contact with patients for all medical students. A systematic review found that developing training packages in intellectual disability for professionals could help to prepare health-care professionals working with people with intellectual disability (Hemm et al., 2015). Following engagement in the intellectual disability curricula with additional completion of the e-learning module, students were less likely to feel they needed more exposure. This shows that the development of multi-faceted training package can help those working with intellectual disability feel prepared for that exposure (Hemm et al., 2015).
Recommendations for teaching have highlighted the range in differences in curriculum of medical schools, acknowledging that the GMC and Royal College of Psychiatrists do not make recommendations regarding the duration of intellectual disability teaching in medical schools (Spackman et al., 2016). An investigation into intellectual disability teaching content and delivery also demonstrated that most of the pedagogical content is didactic lecture-based teaching (Trollor et al., 2018). Medical schools should review how they teach intellectual disability, aiming to incorporate a diverse range of pedagogy to equip students to improve health outcomes for patients. Exposure to those with lived experience will be delivered through the Oliver McGowan training, however, exposure to patient with intellectual disability and autism should be what medical schools strive to achieve.
There is limited research into intellectual disability pedagogy overall, and specifically e-learning as a tool for teaching. Our study builds on previous research, demonstrating the benefit to students of a well-designed curricula re-structure and e-learning development. Ensuring the mandatory Oliver McGowan training fits within an evidence-based curricula is key for learner engagement and training effectiveness. Further areas to look at in future development of the curriculum could include simulation teaching. One study developed an intellectual disability course that showed a statistical improvement in health-care skills and confidence before and after the course (Billon et al., 2016). Diversity of pedagogical content is likely to improve students’ knowledge, skills, confidence and attitudes. However, this needs to be balanced against the educational needs of the student and GMC curricula guidance.
Limitations of the study
A limitation of our study is that the completion rate for the questionnaire was low. The authors used multiple methods to improve adherence rates across medical students. This is a common limitation in research conducted using questionnaires delivered to students. Pilot testing of the survey may reveal barriers to completion which can then be addressed prior to data collection. Future studies may also consider mixed-method qualitative research to ensure detailed feedback is obtained.
The small sample size may overestimate the benefits observed for the students, specifically those completing the e-learning module. Another limitation is the lack of qualitative feedback received from students. Studies have shown the importance of peer-review, assessment of outcomes and feedback to provide means to iteratively develop e-learning modules (Ruiz et al., 2006). Unfortunately, due to poor adherence and completion of the qualitative section of the questionnaire, the study obtained no qualitative feedback to allow for ongoing development of the module. To ensure ongoing student participation in e-learning module development, student feedback will be sought to ensure their involvement in ongoing module refinement.
Conclusions
The re-design of the intellectual disability curricula demonstrated improvement in medical students’ knowledge, skills and attitudes towards intellectual disability and autism. The addition of an e-learning module is a useful and pragmatic pedagogical approach that can provide additional learning content and virtual exposure to patients. Our e-learning module has been investigated empirically demonstrating incremental benefits in knowledge, skills and attitudes. The module also improved students’ perception of their exposure to intellectual disability and autism patients. Thus, the module evaluated may be a useful tool to provide an alternative to direct clinical experience with intellectual disability.
There is a need for long-term studies investigating whether the student curricula are providing effective teaching to students with sustained learning that improves the outcomes of patients with intellectual disability and autism. A positive change is needed to prevent failings in the care of people with intellectual disability and autism. To enact this change, ensuring effective training for those that will soon deliver care and support to people with intellectual disability and autism is vital.
Funding statement: This research received no specific grant from any funding agency, commercial or not-for-profit sectors.
Ethics statement: Ethical approval was obtained for the work by the University committee on research ethics.
Consent statement: A participant information sheet was provided along with the online questionnaire, which outlined that consent is implied by completion of the questionnaire. Thus, completion of the questionnaire was taken as implicit consent for completion of the study.
Author contribution statement: All authors meet ICJME criteria for authorship. Authors A.Ch., M.O., S.J., G.H., N.H., T.D. and M.A.C. all contributed to the development of the electronic learning module and concept formation. A.Ch., G.H., M.O. and S.J. were involved in developing research questions and methodology. Author A.Ch. completed the questionnaire distribution, data collection, data analysis and drafted the manuscript. Authors A.Ca., S.J., M.O. and G.H. edited the manuscript.
Data availability: The data that support the findings of this study are available on request from the corresponding author A.Ch.
Table 1
Average overall scores for each domain of knowledge, skills and attitude towards intellectual disability (ID), and attitude towards intellectual disability teaching
| Domain | Pre-placement | Post – no e-l | Post – with e-l | p-value |
|---|---|---|---|---|
| Mean (SD) | Mean (SD) | Mean (SD) | ||
| Knowledge/skills | 2.58 (0.80) | 3 (0.78) | 3.88 (0.34) | <0.001* |
| Attitudes | 2.6 (1.16) | 3.49 (0.69) | 3.9 (0.31) | <0.001* |
| Attitude ID teaching | 2.98 (0.96) | 2.98 (0.83) | 3.25 (0.73) | 0.371 |
Note:*p < 0.05
Source: Table by authors
Table 2
Average Likert score for knowledge and skills domain in intellectual disability (ID) and autism amongst medical students
| Knowledge and skills | Pre-placement | Post – no e-l | Post – with e-l |
|---|---|---|---|
| Mean (SD) | Mean (SD) | Mean (SD) | |
| 1. A person with a diagnosis of intellectual disability has an IQ of less than 70 with onset in childhood | 2.55 (0.67) | 3.27 (0.79) | 4 (0) |
| 2. To meet a diagnosis of intellectual disability you must have a significant impairment of functioning* | 3.55 (0.51) | 3 (0.89) | 4 (0) |
| 3. All those with autism also have a diagnosis of intellectual disability* | 2.55 (0.76) | 3.18 (1.08) | 3.75 (0.5) |
| 4. All those with autism have communication problems | 2.35 (0.67) | 2.72 (0.79) | 4 (0) |
| 5. I feel confident communicating with a person with ID and/or autism | 2.35 (0.67) | 2.63 (0.67) | 3.75 (0) |
| 6. I am not comfortable when I am with people with ID and/or autism | 2.8 (0.41) | 2.81 (0.40) | 3.75 (0.5) |
| 7. I cannot think of many barriers that people with ID or autism have in accessing health care* | 3.45 (0.81) | 3.18 (0.87) | 3.75 (0) |
| 8. The majority of people with an ID are able to make decisions about receiving medical care | 2.8 (0.52) | 3.18 (0.40) | 4 (0) |
Notes:Likert scores 1–4; *score inverted
Source: Table by authors
Table 3
Average Likert score for attitude towards intellectual disability (ID) and autism domain amongst medical students
| Attitude towards ID/Autism | Pre-placement | Post – no e-l | Post – with e-l |
|---|---|---|---|
| Mean (SD) | Mean (SD) | Mean (SD) | |
| 1. I would rather not have people with ID living in the same apartment building I live in* | 3.25 (0.44) | 3.45 (0.52) | 4 (0) |
| 2. The problem of prejudice towards people with ID and autism has been exaggerated * | 3.45 (0.51) | 3.09 (0.94) | 4 (0) |
| 3. It is beneficial to integrate people with ID and people who do not have ID into the same neighbourhoods | 3.35 (0.59) | 3.36 (0.81) | 3.75 (0.43) |
| 4. In my opinion, people with ID should have as much right as people who don’t have ID to make decisions about their life | 3.55 (0.60) | 3.91 (0.30) | 3.75 (0.43) |
| 5. In my opinion, children with ID should have the opportunity of attending a regular school | 3.4 (0.60) | 3.64 (0.50) | 4 (0) |
Notes:Likert scores 1–4; *score inverted
Source: Table by authors
Table 4
Average Likert score for medical student attitudes towards intellectual disability (ID) and autism teaching domain
| Attitudes towards ID/autism teaching | Pre-placement | Post – no e-l | Post – with e-l |
|---|---|---|---|
| Mean (SD) | Mean (SD) | Mean (SD) | |
| 1. I think having teaching on people with ID and autism is useful | 3.9 (0.31) | 3.55 (0.69) | 4 (0) |
| 2. I have had sufficient exposure to patients with ID in my medical school placements | 1.8 (0.62) | 2.9 (0.7) | 2.75 (0.96) |
| 3. I feel I need more exposure to patients with ID and autism | 3.4 (0.69) | 3.36 (0.5) | 2.75 (0.96) |
| 4. I would be interested in a career working with patients with ID and/or autism | 2.6 (0.82) | 2.27 (0.79) | 3.25 (0.5) |
| 5. I would be more likely to consider a career in ID if I had more clinical experiences in working with this patient group | 2.95 (0.83) | 3 (0.89) | 3.5 (0.58) |
| 6. I think experiences in ID and autism is transferable to my area of prospective specialisation | 3.2 (0.83) | 2.81 (0.87) | 3.25 (0.5) |
Notes:Likert scores 1–4; *score inverted
Source: Table by authors
© Emerald Publishing Limited.