Use of Videos as Disability Educational Tools for Medical Students

Abstract

People with disabilities (PWDs) face unique challenges in accessing equitable medical care, due in part to physicians’ limited training in disability-related competencies. This study explored a novel approach to bridging this gap by integrating selected videos and reflective essays into medical education. Third- and fourth-year medical students watched four videos depicting diverse experiences of PWDs and submitted reflective essays, resulting in the analysis of 90 essays by six investigators. Through thematic analysis, 50 concept codes were distilled into six key themes: recovery process, student insight, adjustment to disability, patient-doctor relationship, social model of disability, and support systems. The reflections revealed a growing awareness among students of the need to individualize care and address systemic barriers, though some medicalized views of disability were noted. These findings underscore the potential of video-based education to enhance disability competence in medical training by fostering critical reflection and empathy. However, to maximize impact, educators should prioritize diverse portrayals of disability and challenge sensationalized or “overcoming” narratives common in such media. Overall, this study demonstrates that widely available media can be a valuable, scalable tool for advancing disability education in medical curricula.

1. Introduction

Approximately 1.3 billion people worldwide have disabilities [1]. Despite how common disability is, our health care system is ill-equipped to provide care for people with disabilities (PWDs), which results in health disparities for this population. One-quarter of working-age PWDs lack a usual healthcare provider and are more likely to have unmet healthcare needs compared to people without disabilities [2]. PWDs are also more frequently diagnosed with chronic conditions such as heart disease and diabetes [1]. Social disparities contribute to this; for example, PWDs are less likely to be employed and more likely to have a household income below $15,000 [3], potentially contributing to their reduced likelihood of seeing a doctor due to cost concerns.

Misassumptions about the quality of life for PWDs may also contribute to disparities. 82% of physicians assume that PWDs have a poorer quality of life [4], but many PWDs report an excellent quality of life, a phenomenon referred to as the disability paradox [5]. This paradox may reflect the balance between PWDs’ physical and social environments [5]. The social model of disability provides a framework for understanding this relationship, suggesting that the limitations experienced by PWDs result from structural or attitudinal barriers rather than inherent deficits [6]. For physicians-in-training, understanding this model and its implications is important for delivering equitable and patient-centered care to PWDs [7,8].

Previous research indicates that at least 70% of practicing physicians feel there are gaps in the disability-related medical education they received in medical school, as disability topics are often underrepresented in medical curricula [9,10]. This lack of training is reflected in medical students’ performance on standardized assessments involving PWDs, where they consistently score lower [10,11,12,13,14]. In one study, students were two to four times less likely to order appropriate diagnostic workups for PWDs [13]. PWDs also report that healthcare providers’ preconceptions act as significant barriers to receiving proper medical management [12,15], as they often encounter providers who focus on disability as their defining characteristic, even in unrelated appointments [16].

To address these gaps, it is essential for medical schools to incorporate more disability education into their curricula, utilizing methods such as didactic lectures, PWDs as standardized patients, or videos [13,17,18]. For example, one study demonstrated that viewing the documentary “Crip Camp” was an effective educational intervention for health professions trainees [18]. However, barriers such as limited faculty expertise and the time constraints imposed by an already packed curriculum remain [13]. The Disability Integration Toolkit aims to address these challenges by offering pre-designed curriculum options, though its adoption still requires considerable faculty time for preparation and delivery [19].

This qualitative study explored an approach to improving disability competence in medical students by having students view a variety of videos featuring the lived experiences of people with disabilities (PWDs) and write reflective essays. This method helps to address several of the barriers often encountered in disability training, such as limited time (as videos can be viewed at home) and a lack of faculty expertise. We hypothesized that this approach would provide students with a more humanistic understanding of caring for PWDs, including an appreciation of their quality of life, insights from the social model of disability, and unique experiences in both healthcare and non-healthcare contexts. Previous research indicates that video-based cases can help medical students develop more realistic perspectives [18], while reflective essays have been shown to enhance empathy in students [18,20]. Together, these tools offer a promising way to introduce disability education into the curriculum without requiring significant adjustments to already constrained schedules or faculty resources.

2. Materials and Methods

2.1. Participants and Procedures

Participants were third- or fourth-year medical students enrolled in an elective Physical Medicine and Rehabilitation (PM&R) clerkship held virtually because of the COVID-19 pandemic. The virtual rotation included a variety of experiences, including participating in telemedicine appointments, longitudinal virtual cases and journal clubs, watching prerecorded lectures on specific topics, giving an oral presentation, and completing reflective essays on films about disability [21]. They were instructed to view four videos highlighting the experiences of PWDs and then write 350–500-word self-reflections for each video. The videos were between 25–125 min long (84.25 min long on average). This was part of a 4-week course designed to have parity with the clinical exposure and workload demand of in-person rotations [21]. As such, students reported spending approximately 40 h on related coursework each week. The pool of videos included 15 suggested videos highlighting the experiences of people living with spinal cord injury, locked-in syndrome, multiple sclerosis, limb amputation, and other impairments in mobility, as listed in

Table 1. Documentaries included in the educational experience for medical students (n = 27) enrolled in the University of Minnesota elective clerkship between 2020-2021.

Title of Educational Documentary	Description of Documentary	Video Length (minutes)	Number of Times Used in Reflective Essays
Any One of Us	Documentary about mountain biker Paul Basagoitia’s recovery from a spinal cord injury.	87	14
Coming to My Senses	Aaron Baker was paralyzed in a motocross accident and 16 years later intends to cross Death Valley unsupported on foot.	85	10
Crip Camp *	A summer camp for teens with disabilities inspires its members to join the disability rights movement.	102	8
The Diving Bell and the Butterfly	After a massive embolism, Jean-Dominique Bauby has ‘captivity syndrome’, only able to communicate by blinking his left eye.	112	8
Endless Abilities	Four best friends drive across the country in search of adaptive sports for individuals with physical disabilities.	76	3
Fresh Tracks	This documentary follows Paul Leimkuehler, an amputee who is opening a prosthetic business.	47	1
Luckey	Sculptor Tom Luckey falls through a window and becomes paralyzed. Tom and his son build an enormous sculpture.	84	1
The Many Lives of Nick Buoniconti	Life story of NFL Linebacker, lawyer, agent, executive, broadcaster, philanthropist, activist—Nick Buoniconti.	73	10
The Men *	Ken, an ex-GI, becomes paralyzed from a war injury and suffers from depression, struggling to accept his disability.	85	1
Murderball	Multiple adaptive athletes find their way to the Olympic rugby team from a multitude of backgrounds.	88	16
The Rebound	A wheelchair basketball story.	95	1
The Rider *	A young cowboy suffers a near-fatal head injury leaving him unable to continue competing in the rodeo and forcing him to look for a new life’s purpose.	104	1
Roll With Me *	A newly sober paraplegic attempts to save his nephew’s life by removing him from his gang-banger lifestyle and bringing him along on a 3100-mile wheelchair trek across the United States.	90	4
The Sea Inside	Based on a true Spanish story about a 30-year campaign to win the right to end his life with dignity.	125	1
Standing/Still Standing	Documentary about standing aids to enhance the lives of those with physical disabilities.	54	0
Stumped	Maureen was born missing her lower left arm and she shows off her incredible climbing skills.	25	4
Take a Look at this Heart *	Multiple stories about the journey of 17 people living with various disabilities, some highlighting the love between them and the partners who care for them, and others struggling to get by on their own.	100	3
Unbeaten	31 disabled athletes complete the toughest road race in the world, 267 miles, climbing over 10,000 vertical feet.	80	0
Walk. Ride. Rodeo.	After a rodeo accident, she can no longer use her legs. She decides to fight back by starting competitive barrel racing.	99	6
When I Walk	Jason DaSilva has multiple sclerosis and the documentary follows him as he navigates his life living with this illness.	74	8

* Self-selected documentary.

, as well as the option to propose other videos beyond the list. Most of these videos highlighted the experiences of people with acquired disabilities. Videos utilized included documentaries as well as films based on true stories. Following institutional IRB approval, students’ reflections written between 2020–2021 were retrospectively analyzed; since it was a retrospective review, informed consent was waived. The analyses were based on 100 video views from 25 students (2 students enrolled in the rotation did not complete the assignment). There were 90 essay reflections, as some students wrote a single essay reflection on their combined experience from multiple videos.

2.2. The Coding Process

This qualitative study utilized inductive coding to analyze the contents of 90 reflection papers [22]. Six investigators independently identified keywords and concept codes related to learning from an initial sample of 25 reflections. Subsequently, the investigators collaboratively created a list of overarching themes for keywords and concept codes identified in the initial sample of essays. Fifty individual codes were identified and grouped into six broad themes as shown in

Table 2. Codes and themes identified from reflections of medical students (n = 27) enrolled in the University of Minnesota elective clerkship between 2020–2021.

Themes	50 Unduplicated Codes
Recovery process	Challenges/Obstacles	Hope/Optimism
	Determination	Perseverance/Resilience
	Depression/Despair	Motivation
	Stepwise improvement	Vulnerability
	Anger	Disbelief
Student insight	Awareness/Understanding	Inspirational
	Educational	Impactful/Powerful
	Relatable/Connection	Important/Valuable
	Interesting
Adjustment to disability	Life altering	Mental health
	Limitations	Potential
	Exceeding/Defying expectations	Quality of life
	Acceptance	Setbacks/Failures acceptable
	Independence
Patient/Doctor relationship	Empathy	Proper communication
	Proper prognosis	Realistic expectations
	Avoiding preconceptions	Compassion
	Common goals	Each patient is unique
	Encouragement	Holistic treatment
	Shared decision-making	Patience
Social model of disability	Treated equally	Value of PWD
	Stereotypes/Assumptions	Need for accommodations
	Advocacy	Lack of resources
	Discrimination/Judgement
Support systems	General	Family
	Caregiver/Family impact	Interprofessional team
	Physician

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Using these identified codes and broader themes as a template, the remaining reflection papers were divided among six investigators such that each essay was independently assigned concept codes and corresponding themes by two investigators. A third investigator subsequently reviewed any discrepancies. Only codes agreed upon by at least two investigators were included. Investigators analyzed reflections on face value, focusing on explicit statements about learning. The aim was to use the writer’s own words and overt meanings rather than extrapolate [22].

3. Results

Participants included 27 medical students, predominantly in the fourth year of medical school (93%), visiting from Doctor of Osteopathic Medicine (DO) programs (70%), and self-identified as male (68%). Fifty individual codes were mentioned 848 times within 90 essays. Six overarching themes identified were: recovery process, student insight, adjustment to disability, patient/doctor relationship, social model of disability, and support systems. The frequency of each theme across all essays was as follows: recovery process (23.12%), student insight (19.69%), adjustment to disability (17.92%), patient-doctor relationship (15.92%), social model of disability (12.03%), and support systems (11.32%). Although some themes included many individual codes, this was not directly proportional to how often each theme was mentioned. For example, the patient/doctor relationship theme had the greatest number of ascribed codes (12) but was the fourth most mentioned theme. Below, we discuss each theme, and we provide example quotes from the student reflections in

Table 3. Sample quotes for themes identified from reflections of medical students (n = 27) enrolled in the University of Minnesota elective clerkship between 2020–2021.

Recovery Process

“Their determination in the face of life-changing adversity is something that I think is invaluable to their progress and their goals. Just like athletes wake up early every day for extra reps, these individuals are willing to dedicate themselves to accomplishing their goal. I want to be a part of their support team. I want to be behind the scenes of their story, working for their success.” “I got the sense that anger was a common theme throughout rehabilitation, and I hope this has taught me that really getting to know the life of our patient’s pre-trauma is the recipe to better serve our patients throughout rehabilitation and beyond.” “[the videos] … show the mindset of [the] tiny victories accomplished by these individuals. I felt moved by this daily battle mindset and needed to apply this to my current position as a medical student.”

Student Insight

“The effect this film had on me was nothing short of redefining my perception of those in wheelchairs.” “During my PM&R rotations where I have treated SCI patients, I took for granted their acceptance of their new role without fully appreciating the steps taken to get to this point, and what ‘acceptance’ meant to them.” “Being able to see his unique journey for a 2-year period was really important to me because it was like a long continuity of care that I don’t often get to experience as a medical student who is rotating month to month in different clinics.”

Adjustment to Disability

“This is a new way of living… it is a new lifestyle that they have to adjust to, through no choice of their own.” “The loss of independence and the feeling that something is wrong with them can send people down some dark roads with their mental health.”

Patient/Doctor Relationship

“We need to both provide realistic expectations for patients, such as the limitations of their injury; however, we need to also provide hope and encouragement…” “I think that our job as physician should not just limit what the patients can or cannot do, but we should explore options with the patients and discuss all the risks and benefits.” “Patient experience is incredibly unique, and no two individuals would have the same course.” “Every SCI is different, and although textbooks will say specifically what their limitations are, we need to realize that listening to our patients is more important than reading the textbook for what their injury entails.”

Social Model of Disability

“I was not aware of the immense barriers: physical, architectural, and mental that were placed on those with disabilities.” “At Camp Jened, there seemed to be a sense of acceptance and family for the group of individuals who often felt ostracized by society. This environment and the people around there opened up a new way for the kids to live, interact with others, view themselves, and express themselves.” “…listening to the camp director describe people [with] disabilities as the ones without problems and everyone else as the problematic people who need to change, is powerful.” “Their functional impairment does not invalidate the numerous aspects of life that remain.”

Support Systems

“Interdisciplinary teams and communication seemed like a cornerstone of PM&R.” “Through the help of their family, friends, therapist, and medical assistants, they became more determined to accept their current status and work their hardest to keep living their lives to the fullest.”

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3.1. Recovery Process

The recovery process emerged as a central theme, highlighting hope, perseverance, and determination. Students reflected on the emotional responses PWDs experienced, such as depression, disbelief, and anger, emphasizing the importance of understanding patients’ lives before their injury to better support their rehabilitation. Reflections also recognized the nonlinear nature of recovery, which often involves setbacks and plateaus alongside progress. The theme captured diverse aspects of the recovery experience, including challenges, motivation, vulnerability, optimism, and small victories.

3.2. Student Insight

This theme reflects students’ evolving perspectives on the lived experiences of PWDs. Many students described gaining greater awareness of the complexities of day-to-day life with a disability. They connected these insights to their clinical experiences, appreciating the depth of personal journeys behind their patients’ progress. One student noted that they had “taken for granted [patients’] acceptance of their new role without fully appreciating the steps taken to get to this point, and what ‘acceptance’ meant to them.” While this reflection illustrates meaningful growth in empathy and patient-centered thinking, it also reflects medicalized language, framing adjustment as acceptance of a “new role” rather than as a multifaceted, individual process influenced by broader social and systemic factors. The reflections often highlighted the value of continuity in care and the importance of understanding the broader context of disability. Key elements of this theme included students’ feelings of connection, and a deeper understanding of the personal and social dimensions of disability.

3.3. Adjustment to Disability

The adjustment to disability theme focused on how individuals navigate changes to their independence and quality of life. This theme also captured the emotional and social shifts PWDs face and their potential to lead fulfilling lives. The reflections emphasized the multifaceted nature of adjustment, recognizing challenges while also valuing moments of personal growth and redefined potential.

3.4. Patient/Doctor Relationship

This theme explored the dynamics of the patient/doctor relationship, emphasizing the need for healthcare providers to approach patients with empathy, respect, and a commitment to individualized care. Students reflected on the importance of avoiding assumptions and engaging in shared decision-making with hope and encouragement. The reflections underscored that each patient’s journey is unique, requiring a tailored and compassionate approach. This theme highlighted concepts such as holistic care, effective communication, and building trust to support PWDs in their health journeys.

3.5. Social Model of Disability

This theme highlighted the systemic and societal barriers that impact the lives of PWDs, aligning with the social model of disability [6]. Students reflected on the role of societal attitudes, lack of resources, and physical and structural challenges in shaping the experiences of PWDs. Many essays emphasized the importance of advocacy and creating inclusive environments to enable PWDs to thrive. This theme focused on the need for accommodations, equal treatment, and challenging stereotypes to foster a society that supports all individuals, regardless of ability.

3.6. Support Systems

The support systems theme emphasized the importance of community, family, and professional networks in promoting well-being for PWDs. Students recognized the multifaceted roles these systems play in recovery, adjustment, and daily life. Reflections highlighted the value of interprofessional collaboration in healthcare and the resilience of families and caregivers who support PWDs. This theme captured the collective effort required to create an environment that empowers individuals with disabilities to achieve their goals and maintain their quality of life.

4. Discussion

This qualitative evaluation highlights the potential utility of videos portraying the experiences of PWDs as an educational tool for medical students. The reflections extended beyond medical aspects of disability, providing a more holistic understanding of living with a disability. The documentaries drew attention to gaps in the healthcare system that could improve the experiences of PWDs. Students demonstrated increased insight into the process of adjusting to disability, spanning the time of injury, recovery, and long-term management. The reflections underscored the importance of addressing access to care, quality of care, and the physician’s role in supporting both mental and physical function. Students often acknowledged preconceptions held by healthcare providers and the need to individualize care for PWDs. However, responses also revealed some medicalized and pathologized understandings of disability. Many reflections exhibited a complex blend of harmful “overcoming” narratives with a growing recognition of the importance of avoiding preconceptions and partnering with patients. This duality presents both a challenge and an opportunity for educators, as the “inspirational” stereotype rooted in ableism could inadvertently harm PWDs [23,24].

The reliance on inspiration-based narratives in disability-related videos poses a challenge for video-based education. While such narratives may captivate audiences, they risk overshadowing systemic barriers and normalizing unrealistic expectations of heroism in response to disability. Moreover, complete recovery is often unattainable for many congenital or acquired disabilities, a reality that the healthcare system does not always adequately address [12,25]. To mitigate these challenges, educators should prioritize diverse portrayals of disability and foster discussions that challenge ableist ideologies. This study’s focus on PWDs with acquired physical disabilities limits its generalizability, as it does not capture the experiences of individuals with congenital, early-onset disabilities, or invisible disabilities.

Furthermore, the study was based on reflections from a self-selected group of advanced medical students participating in a single institution’s virtual PM&R clerkship during the COVID-19 pandemic, which may limit generalizability. Given their training, these students may primarily approach disability through a biomedical lens, potentially overlooking broader social, cultural, and political contexts. Students were also not surveyed on their baseline awareness of the themes explored, presenting an opportunity for future research to better understand the intervention’s impact. The authors, who are themselves physicians or physicians-in-training, acknowledge that their shared professional backgrounds may have influenced the thematic analysis, reinforcing medicalized interpretations and deficit-based models rather than emphasizing strengths, resilience, and agency. These potential biases could constrain the richness of findings and limit opportunities to challenge normative paradigms. Three of the authors were involved in the design of the virtual course and/or taught the students during the course, which may also introduce bias into the analysis.

Despite these limitations, reflective essays appear to be an effective tool for encouraging medical students to engage critically with their biases and assumptions about disability. By fostering empathy and a broader understanding, such exercises could enhance cultural competence and holistic patient care. Future iterations of this curriculum might benefit from incorporating feedback from individuals with disabilities to provide more balanced and inclusive perspectives. Exploring the introduction of this curriculum earlier in medical training, such as during pre-clerkship years, could also strengthen foundational knowledge and better prepare students for clinical encounters with PWDs. Although the use of videos could be a time-efficient method for delivering this educational content, a comparison between the total time spent by faculty and students (including time spent out of class reviewing videos) compared to time spent using other methods of delivery of this content warrants further investigation.

5. Conclusions

In conclusion, the increasing prevalence of disabilities and the healthcare disparities faced by PWDs underscore the need for improved disability education in medical curricula. This study suggests that videos and reflective essays are a valuable resource for fostering introspection and improving medical students’ understanding of disability. However, future work is needed to optimize the content, assess its long-term impact, and ensure that such interventions effectively address ableist ideologies within medical training. Collecting quantitative data in addition to qualitative analysis would assist with these goals.