CME Objectives:

Upon completion of this article, the

reader should be able to: 1) Contrast Patient Care
strengths and weakness of current
disability attitudes surveys; 2) Identify
positive determinants of medical
students’ attitude towards patients with
disability; 3) Discuss the limitations
and applicability of voluntary survey
CME ARTICLE . 2011 SERIES . NUMBER 1
results to a broad population.
Level: Advanced
Accreditation: The Association of
Academic Physiatrists is accredited by Disability Attitudes in Health Care
the Accreditation Council for
Continuing Medical Education to A New Scale Instrument
provide continuing medical education
for physicians. The Association of
Academic Physiatrists designates this ABSTRACT
activity for a maximum of 1.5 AMA PRA
Category 1 Credit(s)TM. Physicians Chadd EH, Pangilinan PH: Disability attitudes in health care: a new scale
should only claim credit instrument. Am J Phys Med Rehabil 2011;90:47Y58.
commensurate with the extent of
their participation in the activity. Objective: The aims of this study were to develop and validate an instrument
measuring attitudes toward providing health care to patients with disability, to com-
Authors: pare the attitudes of preclinical and clinical medical students, and to examine whether
Edmund H. Chadd, MD sex, a background in disability, or career interest in physical medicine and rehabili-
Percival H. Pangilinan, MD
tation affect medical student attitudes toward working with patients with disability.
Affiliations: Design: A cross-sectional survey was conducted in an academic medical center
From the University of Michigan, with participants that included preclinical (n = 63) and clinical medical (n = 58)
Department of Physical Medicine and students, physical medicine and rehabilitation residents (n = 18), and internal
Rehabilitation, Ann Arbor.
medicine residents (n = 10). A 17-item Disability Attitudes in Health Care scale was
Correspondence: developed based on existing, validated geriatrics attitudes scales. Attitudes Toward
All correspondence and requests for Disabled Persons Form O scale was used for correlation testing. Background
reprints should be addressed to: demographic data collected from medical student respondents included sex,
Percival H. Pangilinan, MD, University
of Michigan, Dept. of PM&R, 325 E
previous personal or work experience with disability, and career interest in physical
Eisenhower Pkwy, Suite 100, Ann medicine and rehabilitation.
Arbor, MI 48108.
Results: The new scale demonstrated high reliability (Cronbach > = 0.74) and
Disclosures: criterion validity (correlation coefficient = 0.54 with the Attitude Towards Disabled
Financial disclosure statements have Persons scale). Attitudes were no different between preclinical and clinical medical
been obtained, and no conflicts of students. Male medical students had more negative attitudes than female students
interest have been reported by the
authors or by any individuals in control
did (P = 0.03). Students with a higher level of career interest in physical medicine
of the content of this article. Presented and rehabilitation scored higher than less interested students did (P = 0.015).
as a poster at the 2010 Association of
Academic Physiatrists Annual Meeting Conclusions: The new Disability Attitudes in Health Care scale developed in
in Florida. this study shows good internal consistency and criterion validity. Attitudes toward
caring for patients with disability seem to be unrelated to the standard medical
0894-9115/11/9001-0047/0
American Journal of Physical education curriculum or previous experience with disability. Specific educational
Medicine & Rehabilitation experiences may be designed to engender more positive attitudes toward pro-
Copyright * 2011 by Lippincott viding health care to this patient population.
Williams & Wilkins
Key Words: Education, Schools, Medical, Disabled Persons, Attitude
DOI: 10.1097/PHM.0b013e3182017269

www.ajpmr.com Disability Attitudes in Health Care 47

Copyright @ 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
 A physician’s attitude toward patients with dis-
ability (PWDs) can have important ramifications for
providing appropriate care, as well as the patient’s
responsiveness to treatment and treatment out-
comes.1 The degree to which a physician views
disability as a negative trait or views a patient with
a disability as different from an able-bodied patient
may affect the quality of care. Individual physician
attitudes can also impact policies at the institu-
tional or societal level regarding allocation of re-
sources toward PWDs.2,3 The importance of
cultural competency in dealing with disability will
grow in the coming years as the number of patients
with physical disability increases because of the
aging of the population and young, disabled ve-
terans returning from wars in Iraq and Afghani-
stan. Furthermore, communication with disabled
or chronically ill patients is necessary across all
medical specialties and is not limited to reha-
bilitation.4 As such, medical education has a vital
role in developing and strengthening an empa-
thetic and humanistic approach to the care of this
patient population for all future physicians.
To evaluate how well the medical education
process addresses this issue, a suitable instrument
must be used to measure attitudes toward disability.
This is not a new endeavor, and multiple instru-
ments have been previously developed. The most
commonly used instrument has been the Attitude
Towards Disabled Persons (ATDP) scale, developed
by Yuker et al. in 1960. However, this instrument
faces criticism of being outdated and insufficiently
multidimensional.3 Furthermore, it is designed to
measure general societal attitudes and is not spe-
cific to healthcare professionals.
These limitations notwithstanding, the ATDP
scale has been used extensively in multiple studies
examining the attitudes of medical students and
other healthcare professionals toward disability
with respect to year in school, sex, and personal
background in disability. These studies have had
inconsistent results. For instance, using the ATDP
scale, Paris1 found that fourth year medical students
held significantly more positive attitudes toward
disability than did first year students. In addition,
this study found that women scored higher on the
ATDP than men did and that the type of contact that
a respondent has with people with disabilities,
whether on an equal-status or nonYequal-status basis,
has an equivalent effect on attitudes. Duckworth2
administered the ATDP scale to first and fourth year
medical students, senior house officers, and mem-
bers of the general public and found no significant
48 Chadd and Pangilinan Am. J. Phys. Med. Rehabil. & Vol. 90, No. 1, January 2011
Copyright @ 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
differences between these groups or with respect to
sex or the subject’s personal experience with a per-
son with disability. Oermann and Lindgren5 inves-
tigated the effect of a disability educational program
for nursing students. At 1 yr follow-up, participants
in the program had more positive attitudes toward
disability on the ATDP scale as compared with before
the program and as compared with a control group
who did not participate in the program. This study
also examined the effect of students’ personal expe-
rience with friends or family members with disabil-
ity (equal-status contact) and found no difference
between students who did or did not have this per-
sonal contact with a person with a disability.
Tervo et al.3,6 used the ATDP scale in con-
junction with the Scale of Attitudes Toward Dis-
abled Persons and the Rehabilitation Situations
Inventory to examine the attitudes of medical stu-
dents and allied health professional students in
general. The Scale of Attitudes Toward Disabled
Persons measures attitudes toward people with dis-
ability as a group, whereas the Rehabilitation
Situations Inventory measures the perception of the
difficulty of dealing with various situations involving
PWDs especially in the inpatient rehabilitation set-
ting. Like the ATDP, the Scale of Attitudes Toward
Disabled Persons is not written specifically for health-
care professionals. In contrast, the Rehabilitation
Situations Inventory is very specific for rehabilitation
professionals and, therefore, may not be appropriate
for preclinical medical students who likely have not
had experience in the situations queried.
As mentioned previously, the bulk of work ex-
amining attitudes toward disability has used instru-
ments measuring general attitudes and has not
specifically addressed working with PWDs in the
healthcare setting. However, medical students’ atti-
tudes toward working with chronically ill patients
have been investigated, and this work has parallels to
working with PWDs. Students enter medical school
with overwhelmingly positive attitudes toward
working with the chronically ill, with less than 10%
of new students reporting that they would change
specialty plans if the incidence of chronically ill
patients increased in their chosen field.7,8 However,
this proportion increased to 25% of students after
completing their required clinical clerkships. The
authors hypothesize that this deterioration is a result,
in part, of negative role modeling experiences with
faculty or residents rather than negative interactions
with patients themselves.7
The purpose of this study was 2-fold. First, we
sought to develop a new instrument to measure
providers’ attitudes toward disability, specifically in
the healthcare setting. We then sought to use this
new instrument to investigate the predictors for
medical student attitudes toward working with
PWDs. On the basis of the chronic illness model, we
hypothesized that medical students’ attitudes to-
ward PWDs become more negative over the course
of their medical education.
METHODS
Overview
This study comprised three phases: (1) instru-
ment development, (2) a validation study with cur-
rent physical medicine and rehabilitation (PM&R)
and internal medicine residents, and (3) a cross-
sectional survey of preclinical and clinical medical
students. This study had institutional review board
approval, and all respondents gave consent. No
compensation was offered.
Instrument Development
Two existing validated survey instruments used
to measure attitudes toward caring for geriatric
patients, the University of California, Los Angeles
Geriatrics Scale9 and the Maxwell and Sullivan
Attitude Scale (MSAS),10 were modified to address
attitudes toward caring for PWDs. The MSAS
consists of 29 statements scored on a Likert scale.
It addresses five domains of caring for the elderly:
general attitudes, cost effectiveness, time and ener-
gy, therapeutic potential, and educational prepara-
tion. It has been used in multiple studies with high
reliability and validity, as well as serving as a template
for modification and subscale development.11Y13 The
UCLA scale is a 14-item Likert instrument. It has
demonstrated high reliability and known-groups
and construct validity.9,15,16 Known-groups validity
is the sensitivity of an instrument to measure a dif-
ference between groups known to vary in the out-
come being studied: in this case, geriatrics fellows
and faculty had higher scores on the UCLA scale than
did internal medicine residents.9 The UCLA scale has
also been modified for use internationally.17 A subset
of items from each of these scales was chosen. The
wording was modified from elderly patients to
patients with disability to create a 17-item, 5-point
Likert scale instrument, the Disability Attitudes in
Health Care (DAHC) scale. Participants rate each
statement from 1 (Bstrongly disagree[) to 5 (Bstrongly
agree[), with 3 being a neutral rating. This scale
consists of positively and negatively worded state-
ments, addressing similar domains as the MSAS.
Validation
Input on item selection from the UCLA scale
and MSAS to form the DAHC scale was sought from
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Copyright @ 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
attending physiatrists, rehabilitation psychologists,
and social workers. Items were selected to represent
each of the five domains as listed for the MSAS.
The DAHC scale was administered in conjunc-
tion with the ATDP Form O scale to house officers
in the PM&R and Internal Medicine departments at
the University of Michigan Medical Center. House
officer participants responded to electronic mail-
ings to their respective residency programs. The
scales were administered via a Web-based survey
program. Eligible respondents included 24PM&R
residents and 159 internal medicine residents.
Medical student responses (see Table 1) were
used to calculate the internal consistency of the DAHC
scale instrument. Medical students were also com-
pared with the subset of PM&R house officers to ad-
dress the known-groups validity of the DAHC scale.
Cross-Sectional Medical Student Survey
Subjects were medical students at the University
of Michigan Medical School who responded to Email
solicitation to participate in a Web-based survey of
attitudes toward disability (Appendix 1). Survey
responses were collected over a 3-mo period from
October to December. An in-person announcement
was also made to first and second year students before
a regularly scheduled classroom lecture. Eligible
respondents included 175 medical students per class
year. The survey included the DAHC scale and back-
ground demographic data on sex, year in school,
degree of career interest in PM&R (none/slight/
moderate/strong/very strong), previous volunteer or
paid work involving persons with disability (yes/no),
previous experience in caring for persons with dis-
ability (none/a little/somewhat/a lot/a great deal), and
training in medical school regarding disability (none/
a little/somewhat/a lot/a great deal).
Analysis
A standard composite score method was used for
the DAHC scale: summing the Likert scores of pos-
itively worded statements and the reversed Likert
scores of negatively worded statements (range,
5Y85).9,18 A higher score implies a more positive
attitude. Pearson correlation coefficient was calcu-
lated to compare scores between the ATDP and
DAHC scales from the house officer survey sample
set. Internal consistency was calculated using the
Cronbach coefficient alpha from the medical student
sample set. Medical student scores were compared
with PM&R house officer scores using two-tailed
t tests of item means.
A two-tailed t test was used to compare pre-
clinical vs. clinical medical student population
Disability Attitudes in Health Care 49
 means. Secondary outcome measures included the
influence of sex, previous work experience with
PWDs (either volunteer or paid), having a person
with disability who has been important to the re-
spondent, experience caring for a PWD, and interest
in PM&R as a career. A multiple linear regression
model was performed on the secondary outcome
measures to assess the association between these
predictor variables and the final attitude score.
To achieve 80% power to detect a medium ef-
fect size (a difference of 4 points in means between
preclinical and clinical students), a sample size of
64 is necessary for each group.
All statistical analyses were conducted using
Microsoft Office Excel 2007 (Microsoft Corp,
Redmond WA), and P G 0.05 was considered sta-
tistically significant.
RESULTS
Instrument Validity and Reliability
Face validity of the statements selected to com-
prise the DAHC scale was determined by consensus
opinion of attending physiatrists, rehabilitation psy-
chologists, and rehabilitation social workers. The
survey statements were felt to address several do-
mains of providing health care to PWDs, as had been
previously defined by the MSAS for treating elderly
patients. These include general attitudes toward
people with disability, therapeutic potential of treat-
ing PWDs, time and energy involved in treating
PWDs, just allocation of resources including cost
and compensation for treating PWDs, and educa-
tional preparedness for treating this population.
Twenty-eight house officers (18 PM&R and
10 internal medicine) completed both the new
DAHC scale and the existing, gold-standard dis-
ability attitudes scale (ATDP Form O). Correlation
was calculated between these two scales to address
construct validity. Pearson correlation coefficient
was 0.54.
The 121 medical student respondents were
used to calculate the internal consistency reliability
of the DAHC scale. Cronbach coefficient > was 0.74.
There was a nonsignificant trend toward higher
scores for PM&R house officers (mean score, 68.6)
as compared with fourth year medical students
(mean, 64.8; P = 0.08).
No respondent answered in a completely posi-
tive (ceiling) or negative (floor) way to all items.

TABLE 1 Medical student respondent demographic data

M1 M2 MD/PhD M3 M4 Total, n (%)
n 27 34 2 26 32 121
Sex
Male 11 10 0 13 15 49 (40)
Female 16 24 2 13 17 72 (60)
Career interest in PM&R
None 5 10 1 12 20 48 (40)
Slight 13 16 1 7 9 46 (38)
Moderate 7 8 0 7 2 24 (20)
Strong 2 0 0 0 0 2 (2)
Very strong 0 0 0 0 1 1 (1)
Previous work experience with PWDs (volunteer or paid)
Yes 21 22 1 10 16 70 (58)
No 6 12 1 16 16 51 (42)
Previous experience caring for a PWD
None 6 11 1 3 3 24 (20)
A little 10 16 1 17 17 61 (50)
Somewhat 8 7 0 4 6 25 (21)
A lot 3 0 0 1 4 8 (7)
A great deal 0 0 0 1 2 3 (2)
A person with disability important to you?
Yes 12 19 1 10 19 61 (50)
No 15 15 1 16 13 60 (50)
Training in medical school regarding PWD
None 15 15 1 4 3 38 (31)
A little 12 18 1 19 16 66 (55)
Somewhat 0 1 0 3 12 16 (13)
A lot 0 0 0 0 1 1 (1)
A great deal 0 0 0 0 0 0 (0)
M1 represents first year medical students; M2, second year medical students; M3, third year medical students; M4, fourth year
medical students; PM&R, physical medicine and rehabilitation; PWD, patient with disability.

50 Chadd and Pangilinan Am. J. Phys. Med. Rehabil. & Vol. 90, No. 1, January 2011

Copyright @ 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

TABLE 2 DAHC scores by year in medical
school
n Mean
M1 27 68.0
M2 34 65.2
MD/PhD 2 67
M3 26 67.3
M4 32 64.8
Preclinical 63 66.5
Clinical 58 65.9
DAHC indicates Disability Attitudes in Health Care; M1,
first year in medical school; M2, second year in medical
school; M3, third year in medical school; M4, fourth year in
medical school.
Cross-Sectional Medical Student Survey
A total of 130 medical students responded to
the survey, but 9 were discarded because of in-
complete responses. There were 121 complete sur-
vey respondents: 63 preclinical students (27 first
year, 34 second year, and 2 dual-degree MD/PhD
students) and 58 clinical students (26 third year and
32 fourth year). Table 1 describes the demographics
of the medical student respondents. Seventy-two
respondents were female. Overall, half of the stu-
dents reported a personal relationship with a person
with disability who was important to them. More
than half reported either volunteer or paid work
involving persons with disability. One-third of the
first year students expressed at least a moderate
interest in specialization in PM&R, compared with
24% of second year students, 27% of third year
students, and 9% of fourth year students. Less than
2% of the preclinical students reported receiving
more than Ba little[ training in medical school re-
garding persons with disability, as compared with
more than 25% of the clinical students.
Medical student scores were normally distrib-
uted, with the probability plot approximating a
straight line.
A t test was calculated for preclinical and clin-
ical students, and it was found that mean DAHC
scores were not significantly different between
SD these two groups. The average for preclinical stu-
6.0 dents was 66.5, whereas the clinical students’ av-
6.1 erage was 65.9 (Table 2). A separate analysis of the
1.4 first year class compared with the fourth year class
6.4
shows a trend toward lower scores for the fourth
8.1
6.1 year students, but this result did not reach statis-
7.4 tical significance (P = 0.09).
A multiple linear regression analysis on medi-
cal students’ attitude scores in relation to demo-
graphic variables showed the following results.
Female sex and degree of career interest in PM&R
were significant predictors of more positive atti-
tudes. Previous work experience with disability,
experience caring for a person with disability, or an
important relationship with a person with disability
were not found to significant predictors of attitude
scores (Table 3).
DISCUSSION
Healthcare providers occupy a pivotal role not
only in treating PWDs but also in working to over-
come negative societal attitudes toward disability
in general. Examining and measuring these atti-
tudes are necessary to design more effective disability
training programs for healthcare providers. Previous
studies examining the effects of training or other
predictors of disability attitudes have focused on
these general attitudes. Although important, a gen-
eral attitude may not accurately predict how an
individual would act in his/her professional setting.
We have sought to develop a new instrument tai-
lored to healthcare professionals to examine atti-
tudes toward disability specifically in the healthcare
setting.
We have modeled our new DAHC scale on two
existing geriatrics healthcare attitudes scales. The
basis of this survey instrument is to reflect the degree
to which a practitioner views a PWD as different or

TABLE 3 Multiple linear regression analysis of demographic data

Coefficient SE P
Female sex 2.66 1.22 0.03
Previous work experience with PWDs j1.21 1.34 0.18
Career interest in PM&Ra 1.82 0.71 0.015
PWD who has been important to the respondent? 1.10 1.30 0.40
Experience caring for a PWDb 2.11 1.49 0.15
Year in medical school (preclinical vs. clinical) 0.26 1.25 0.85
a
Career interest scored 1 through 5 (Bnone,[ Bslight,[ Bmoderate,[ Bstrong,[ and Bvery strong,[ respectively).
b
Dichotomous yes/no variable, where yes signifies Bsomewhat,[ Ba lot,[ or Ba great deal[ of experience.
PWD indicates patient with disability; PM&R, physical medicine and rehabilitation; Boldface values, most statistically significant.

www.ajpmr.com Disability Attitudes in Health Care 51

Copyright @ 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
 more negatively than an able-bodied patient, with a
higher score representing a more positive view. De-
signing an attitudinal scale in this way implies that
viewing a patient population as different from the
average patient reflects a perception that it is more
difficult or less appealing to provide health care to
such a patient.
Preliminary validation analysis of this new sur-
vey instrument demonstrates moderate correlation
with the standard disability attitudes scale, the
ATDP. The goal of developing a new, healthcare-
specific instrument is to address an aspect of dis-
ability attitudes that is not covered by the established
ATDP scale. Therefore, a moderate correlation be-
tween instruments is desirable: it provides criterion
validity of the new instrument without duplicating
the existing standard. The DAHC scale is reliable
and internally consistent, with Cronbach > 9 0.7.
Within the limitations of this study, as will be dis-
cussed, known-groups validity is suggested by a
trend toward more positive attitudes toward dis-
ability for PM&R house officers as compared with
fourth year medical students.
In addition to the validation support of this in-
strument, this study adds to the research regarding
predictors of medical students’ attitudes toward dis-
ability and the effect of medical training on these
attitudes. We hypothesized that medical student
attitudes toward working with PWDs would become
more negative over the course of their medical ed-
ucation, as has previously been shown in work ex-
amining medical students’ willingness to work with
patients with chronic illness.7 There was no signifi-
cant difference between preclinical and clinical year
students in this study. However, there was a trend
toward more negative attitudes among fourth year
students than among first year students, but it did
not reach statistical significance. Consistent with
findings in other studies involving medical students,
female students had more positive attitudes than
male students did.1,6 Male medical students, in par-
ticular, may have worse attitudes toward disability
as compared with men in other allied health pro-
fessions. One study including medical, nursing, and
other allied health professional students failed to
show a difference between sexes.3 Career interest in
PM&R was predictive of more positive attitudes
among medical students. This finding supports the
instrument’s known-groups validity.
Contrary to previous work,3 our study showed
no significant effect among medical students for
either a personal relationship with someone with a
disability (equal basis contact) or previous experi-
ence working with or caring for a PWD (nonYequal
52 Chadd and Pangilinan Am. J. Phys. Med. Rehabil. & Vol. 90, No. 1, January 2011
Copyright @ 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
status). In our sample, the preclinical students had
higher rates of previous work experience with
people with disabilities than the clinical students
did. Rates of equal-status contact with people with
disabilities, however, were consistent among class
years. Increasing students’ exposure to people with
disabilities may be advocated as a method to in-
crease interest in PM&R; however, this study dis-
putes a connection between increasing experience
with disability and improving attitudes toward
disability.
The limitations of this study should be noted. A
relatively small number of medical students at a
single center participated, with a response rate of less
than 20%. Given the voluntary participation, self-
selection bias among respondents must be consid-
ered. Solicitation for medical student respondents
clearly identified the survey as a disability attitudes
assessment tool, and this may have skewed partici-
pation toward those students who had familiarity or
previous experience with disability. Also, respon-
dents were disproportionately female, a group that
has been found in multiple studies to score higher on
disability attitude survey instruments.1,6 Further-
more, medical students, in general, can be a highly
motivated and idealistic group and, despite the
anonymous nature of this study, may hesitate to give
Bsocially unacceptable[ responses. For these rea-
sons, it is difficult to generalize the medical student
attitude responses or background demographics as
representative of medical students as a whole.
Based on this preliminary study, the survey
instrument itself may face the limitation of inflexi-
bility to measure differences between different pop-
ulations (known-groups validity), as demonstrated
by the lack of significant difference between the
medical student group and the PM&R house officers,
who may reasonably be expected to score higher on
this scale. However, the selection bias described
previously may have resulted in a more homogenous,
nonrepresentative medical student sample set with
respect to attitudes to disability. Possible selection
bias and the low response rate make it difficult to
assess the known-groups validity of this scale in-
strument within the current study design.
Further development and validity testing of the
scale will address these limitations in several ways.
We plan to validate the new scale further by use of
multi-institutional studies that will bolster the
correlation testing for house officer responses be-
tween the DAHC scale and the ATDP Form O scale.
Also, we plan a repeat administration of the scale to
the house officer sample set to determine the test-
retest reliability of the instrument. Because medical
student responses may be in flux as a result of the
effects of medical education, repeatability testing
with PM&R residents will be more useful because
the responses of those who have chosen a career in
rehabilitation will likely reflect more fixed attitudes.
A larger sample set will also facilitate an item-by-
item correlation analysis to determine whether
certain survey items are outliers or could be elim-
inated to make administration of the scale more
efficient without sacrificing validity. Further as-
sessment of medical student attitudes could include
longitudinal testing of a class over the course of
4 yrs of medical education. Longitudinal testing
would allow more analysis of the determinants of
changing attitudes, if any. Identification of such
factors could facilitate implementation of courses or
experiences as part of medical education to
strengthen the attitudes of medical students toward
PWDs, ultimately improving clinical treatment of
this growing patient population.
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Disability Attitudes in Health Care 53
 APPENDIX 1
Disability Attitudes in Health Care
DIRECTIONS: Please use the scale to indicate
the degree to which you agree or disagree with each
statement. There are no right or wrong answers.
The best response is the one that truly reflects your
personal opinion.
For purposes of this study, disability is de-
fined as an impairment in physical function due
to disease or injury particularly of the neurologic
or musculoskeletal system, for example, due to
stroke, amputation, spinal cord injury, multiple
sclerosis, traumatic brain injury, cerebral palsy
(and not due purely to visual, hearing, or cognitive
impairment).

Strongly Somewhat Somewhat Strongly

Disagree Disagree Neutral Agree Agree
1. People with disabilities are pleasant to be with. 1 2 3 4 5
2. If I have the choice, I would rather see able-bodied 1 2 3 4 5
patients than patients with disabilities.
3. It is society’s responsibility to provide care for its 1 2 3 4 5
persons with disabilities.
4. Patients with disability improve with treatment. 1 2 3 4 5
5. Medical care for people with disabilities uses up too 1 2 3 4 5
many resources.
6. Taking a medical history from a patient with disability 1 2 3 4 5
is frequently an ordeal.
7. People with disability, in general, do not contribute 1 2 3 4 5
much to society.
8. People with disability don’t contribute their fair share 1 2 3 4 5
towards paying for their health care.
9. I will welcome patients with disability into my practice. 1 2 3 4 5
10. If handled properly, the patient with disability can be 1 2 3 4 5
seen as quickly as any other patient.
11. Understanding my patients with disabilities is valuable 1 2 3 4 5
to me as a physician.
12. Patients with disability are better off in nursing homes. 1 2 3 4 5
13. Medicare offers adequate compensation for care of 1 2 3 4 5
patients with disability.
14. The treatment of patients with disability is too 1 2 3 4 5
time-consuming.
15. More training is needed to prepare health practitioners 1 2 3 4 5
to provide care to the patient with disability.
16. It is unglamorous to care for people with disability. 1 2 3 4 5
17. Treatment of people with disability is hopeless. 1 2 3 4 5

54 Chadd and Pangilinan Am. J. Phys. Med. Rehabil. & Vol. 90, No. 1, January 2011

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 CME SELF-ASSESSMENT EXAM

INSTRUCTIONS TO OBTAIN
CATEGORY 1 CME CREDITS:
1. Read the Designated CME
Articles in this issue.
2. Read the following CME Self-
Assessment Exam Questions.
3. Photocopy and complete the
CME Self-Assessment Exam
Answering Sheet and CME
Evaluation.
4. Send the completed Answering
Sheet and Evaluation to:
CME Department, AAP National
Office, 7250 Parkway Drive,
Suite 130, Hanover,
MD 21076.
AMERICAN JOURNAL OF PHYSICAL MEDICINE
& REHABILITATION
Vol. 90, No. 1 & January 2011
T his is an adult learning experience and there is no requirement for obtaining
a certain score. The objective is to have each participant learn from the total
experience of studying the article, taking the exam, and being able to immedi-
ately receive feedback with the correct answers. For complete information, please
see ‘‘Instructions for Obtaining Continuing Medical Education Credit’’ at the
front of this issue.
Every question must be completed on the exam answering sheet to be
eligible for CME credit. Leaving any item unanswered will make void the
participant’s response. This CME activity must be completed and postmarked by
December 31, 2012. The documentation received will be compiled throughout
the calendar year, and once a year in January, participants will receive a
certificate indicating CME credits earned for the prior year of work. This CME
activity was planned and produced in accordance with the ACCME Essentials.

CME Self-Assessment Exam Questions

CME Article 2011 Series Number 1: E. Chadd, et al. C. Previous work experience involving patients with
disability
1. What type of scale validation would be best supported by D. A personal relationship with a person with disability
residents in Physical Medicine & Rehabilitation (PM&R)
scoring higher than residents of other specialties on a 4. A voluntary survey, such as in this study, may commonly
scale measuring attitudes toward people with disability? face which limitation?
A. Construct validity A. Selection bias
B. Known groups validity B. Susceptibility bias
C. Face validity C. Recall bias
D. Reliability D. Omission bias

5. In this study, when comparing medical student attitudes

2. Potential shortcomings of utilizing the Attitudes Towards
Disabled Persons (ATDP) scale when examining medical
student attitudes towards the disabled include:
A. The ATDP scale is not written specifically for
healthcare professionals.
B. The ATDP scale is designed to measure general
societal attitudes.
C. The ATDP is insufficiently multidimensional as an
attitudes scale.
D. All of the above.
3. Which of the following is predictive of a more positive
attitude toward patients with disability among medical
students?
A. Male gender
B. Degree of career interest in PM&R
towards working with the disabled as measured by the
Disability Attitudes in Health Care (DAHC) scale, which
of the following is true:
A. Preclinical students were more positive towards
working with the disabled than clinical year students
B. Clinical year students were more positive towards
working with the disabled than preclinical students
C. Fourth year students were more positive towards
working with the disabled than first year students
D. First year students were more positive towards
working with the disabled than fourth year students
(Continued next page)

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 STANDARDIZED CME SELF-ASSESSMENT EXAM ANSWERING SHEET

The answers to any essay questions AMERICAN JOURNAL OF PHYSICAL MEDICINE

must be typed or computer printed & REHABILITATION
on a separate piece of paper and at-
tached to this page.
After finishing this exam:
1. Check your answers with the cor- Please photocopy this form and complete the information
rect answers on page 86. required for each CME Activity.
2. Photocopy and complete the CME
Evaluation and Certification on the
Journal Issue Month and Year
next page and mail to CME Depart-
ment, AAP National Office, 7250
Volume Number Issue Number
Parkway Drive, Suite 130, Hanover, CME Article Number
MD 21076. CME Article Author’s Name
3. This educational activity must be
completed and postmarked by De-
cember 31, 2012. AAP Members
may complete and submit this
Circle the appropriate answers.
CME Answering Sheet and the fol-
lowing Standardized CME Activity 1. A B C D
Evaluation page and Certification
page online through the members- 2. A B C D
only section of the AAP web page at
www.physiatry.org. 3. A B C D

4. A B C D

5. A B C D

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 American Journal of Physical Medicine & Rehabilitation - Standardized CME Activity Evaluation

Please photocopy this form and complete the information required for each CME Activity.

Journal Issue Month and Year Volume Number Issue Number

CME Article Number CME Article Author’s Name

Agree Neutral
The CME activity was consistent with the stated objectives. Ì Ì
The activity prepared me to achieve its stated objectives. Ì Ì
The activity enhanced my professional skills. Ì Ì
The activity confirmed the effectiveness of previous skills. Ì Ì
I learned new techniques or skills. Ì Ì
I learned new diagnostic strategies. Ì Ì
The activity was free of industry bias. Ì Ì
I acquired new skills and competencies not listed above Y Ì Ì
please list here:
Not
Disagree Applicable
Ì Ì
Ì Ì
Ì Ì
Ì Ì
Ì Ì
Ì Ì
Ì Ì
Ì Ì

These new skills will improve my work performance

and professional competencies in the following
areas:

(Check all that apply):

Ì Provision of patient care Ì Medical knowledge

Ì Communication with patients and families Ì Practice-based learning and improvement
Ì Teaching and educational tasks Ì Interpersonal and communication skills
Ì Administrative duties Ì Professionalism
Ì Research endeavors Ì Systems-based practice
Ì Team and co-worker interactions Ì Other Y please list here:

Please provide additional comments about the Activity and make any suggestions for improvement:

Please list any topics you would like to see presented in the future:

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 CME ACTIVITY CERTIFICATION

Please photocopy this form and complete the information required for each CME Activity.

Journal Issue Month and Year Volume Number Issue Number

CME Article Number CME Article Author’s Name

I, certify that I have met the criteria for CME

credit by studying the designated materials, by responding to the self-assessment questions, by reviewing
those parts of the article dealing with any question(s) answered incorrectly, and by referring to the
supplemental materials listed in the references.
This educational activity is designated for 11⁄2 category 1 CME credits.
Indicate total credits claimed: (maximum of 11⁄2 credits)
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