[tetramer]

I'll finish up my fellowship this summer and it will have been a solid 10 years from when I started medical school. The vast majority of people have no idea what goes into medical training (even my own parents remain confused) - and that's okay, there's no need for everyone to know these ins-and-outs, but when we're passing judgment on the medical curriculum and adding additional things, it does become important.

You can talk about adding a class in medical school addressing neurodivergence and disability, but how do you really address that spectrum of diversity in a single class? And what aspects do you really retain a decade out when patients with neurodivergence can be relatively rare (depending on your specialty)?

In the end, I think the best learning comes from seeing patients (especially, again, as the spectrum of what these patients experience is so diverse and individual). I am always grateful to patients who provide guidance along with parents or caregivers and nurses who had often cared for that patient before for their advice on how to approach a specific patient, along with individual behavior plans if in place.

[therealcamino]

Not to diminish the difficulty of the existing curriculum, but it doesn't seem fair or sustainable to ask for patients to train and guide each physician they see in how to work with neurodivergent individuals. I'm sure there is much from formal education that new physicians don't retain, but that doesn't mean it is not worth teaching.

[tetramer]

I see neurodivergent individuals (or at least, significantly neurodivergent that a more individualized approach is needed) relatively rarely in my field of work (adult oncology, where the average patient is much older and has often had significant exposure to the healthcare system). Every patient I've seen has been very different in terms of needs and their prior experiences and so I have difficulty imagining a "standardized" curriculum for these patients that is specific enough to add value but broad enough to apply to every medical student, but I'm happy to be corrected on this.

And, I mean, if we're talking about neurodivergence more broadly and including people who generally "pass" as neurotypical, then that's a huge chunk of the population. Really, any time you talk to a patient, you should be assessing where they're at, in terms of general understanding and preferences, and should always tailor your approach to an individual.

[calamari4065]

As an autistic person, it unfortunately does not work like that. Every single neurodiverse person has their own unique needs. There is no one size fits all technique, not even close. The best you can do is teach some general strategies and an awareness of the fact that these people have unique needs. And generally we do teach these things.

It unfortunately is up to the individual to work with their practitioner to come up with an individualized plan of care. It really can't be any other way. Any attempt you make to come up with a universal standard of care for neurodiverse patients will necessarily exclude and likely harm people on other parts of the spectrum.

Over-generalizing these things sounds like a good idea up front, but it ends up causing more harm overall. We get stuck with narrow and rigid standards of care that just don't work for more than a small subset of people. This has been a real problem with autism in particular: until very recently the diagnosis and treatments were only concerned with young white boys. There's a very serious problem with women, adults, and all other groups being drastically under-diagnosed and left untreated. More generally, there are very few resources for autistic adults because of this. It's very slowly changing though

[conductr]

Seems like the most obvious solution would be to have some sort of case manager/continuum of care type support for these types of individuals. I’m pretty sure this already exists for geriatric patients but maybe not widespread enough?

There’s too many particularities that can come up with individuals that are “non standard” for whatever reason. Any new physician for a particular patient could easily get up to speed on those particularities at the time it’s needed and not have to fumble through the friction it presents AND they don’t need any extra training to do so (probably?).