Injury prevention education in United States medical school curricula

Pediatric Health Care Provider Perspectives on Injury Prevention Counseling in Acute and Primary Care Settings

The objective of this study was to characterize how pediatric primary care and emergency medicine health care providers and trainees engage in injury prevention counseling and assess perceptions toward injury prevention resources. We surveyed physicians, advanced practice providers, and trainees in the Emergency Department, Primary Care Network, and Pediatric Residency Program at Children's Hospital of Philadelphia from September to November 2019. Of the 578 eligible participants, 208 (36.0%) completed the survey. When asked to rank the suitability of alternative personnel for providing counseling, 63.0% of the participants selected an injury prevention specialist as best suited. Seventy-six percent of the providers considered a tablet or mobile device used before a patient encounter to be a helpful resource. Variability existed in provider comfort, knowledge, and frequency of counseling by injury topic. Free-text responses cited time as a barrier to counseling. Opportunities exist to improve the provision of injury education through the utilization of novel resources and personnel.

Injury Prevention in Medical Education: A Systematic Literature Review

OBJECTIVE

Traumatic injury is the first cause of death for Canadians aged 1 to 44 years old. To reduce the global burden of injury, the need for healthcare professionals with injury prevention proficiency is growing. The aim of this study was to review the literature to identify and analyze current injury prevention curriculums amongst medical undergraduate and residency programs.

DESIGN

A systematic literature review (no date restriction was used) was conducted using Embase, Medline, ERIC, and CINAHL. Three reviewers independently selected studies, extracted data, checked accuracy, assessed risk of bias, and assessed quality. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline was followed. The study was registered with PROSPERO, #CRD42016048805.

PARTICIPANTS

Articles were included if they were peer-reviewed, published in the English language, and reported data on injury prevention and control curriculum.

RESULTS

Eight hundred and twenty-four articles were identified with the initial search strategy. Internal consistency reliability, generalizability, evidence for content, criterion-related and construct validity was performed. The systematic review synthesized the characteristics (population, intervention type, outcome measures) described in the literature. This review is the first step in identifying gaps in injury prevention teaching and curriculums for medical students and residents.

CONCLUSION

The number of studies reporting the incidence and/or effectiveness of injury prevention and control curriculum is limited across the literature. Therefore, there is a knowledge gap in providing injury prevention education. Given that physicians play a vital role in the prevention or control of injuries, further development of medical undergraduate and residency programs to include core concepts of injury prevention would be unquestionably paramount.

Status and risk factors of unintentional injuries among Chinese undergraduates: a cross-sectional study

Background

Injuries affect all age groups but have a particular impact on young people. To evaluate the incidence of non-fatal, unintentional, injuries among undergraduates in Wenzhou, China, assess the burden caused by these injuries, and explore the associated risk factors for unintentional injuries among these undergraduates, we conducted a college-based cross-sectional study.

Methods

Participants were selected by a multi-stage random sampling method, and 2,287 students were asked whether they had had an injury in the last 12 months; the location, cause, and consequences of the event. The questionnaire included demographic and socioeconomic characteristics, lifestyle habits, and the scale of type A behaviour pattern (TABP). Multivariate logistic regression models were used; crude odds ratios (ORs), adjusted ORs and their 95% confidence intervals (CIs) were estimated, with students having no injuries as the reference group.

Results

The incidence of injuries among undergraduates in Wenzhou was 18.71 injuries per 100 person-years (95%CI: 17.12~20.31 injuries per 100 person-years). Falls were the leading cause of injury, followed by traffic injuries, and animal/insect bites. Male students were more likely to be injured than female students. Risk factors associated with unintentional injuries among undergraduates were: students majoring in non-medicine (adjusted OR: 1.53; 95% CI: 1.19-1.96); type A behaviour pattern (adjusted OR: 2.99; 95% CI: 1.45-6.14); liking sports (adjusted OR: 1.86; 95% CI: 1.41-2.45).

Conclusions

Injuries have become a public health problem among undergraduates. Falls were the major cause of non-fatal injury. Therefore, individuals, families, schools and governments should promptly adopt preventive measures aimed at preventing and controlling morbidity due to non-fatal injury, especially among students identified to be at high-risk; such as male students with type A behaviour pattern who like sports.

Strengthening public health medicine training for medical students: development and evaluation of a lifestyle curriculum

BACKGROUND

Lifestyle factors are major determinants for health and safety. Although many graduates lack interviewing and observational skills for prevention and student lifestyle often deteriorates during training, few medical schools teach comprehensive assessment of lifestyle, particularly in the context of the home environment.

AIMS

A lifestyle curriculum was developed to teach basic causality and provide practical experience in assessing nutrition, exercise, safety, tobacco addiction, and food hygiene, together with generic skills in history taking, on-site observation, researching and presenting.

METHODS

Lifestyle has been integrated into the first-year curriculum, evaluated, and improved at the United Arab Emirates University since 2001. After an introduction to determinants of health, students conduct a home interview and observational survey for family residential and traffic safety, smoking, and food hygiene. For nutrition and exercise, students assess personal lifestyle. Generic skills are developed in the context of lifestyle. Evaluations were by faculty and students, including assessed impact on knowledge, skills, and personal lifestyle. The lifestyle curriculum was compared with other countries by detailed search.

RESULTS

Detailed evaluation found strong agreement/agreement among students that knowledge had improved on: counselling of patients and families 97%, promoting healthy lifestyles 100%; interviewing 88%; history taking 84%; using research for medical practice 89%; and importance of prevention 96%. Eighty six percent were stimulated to think in new ways about health. Improved personal diet was reported by 60% (p < 0.0004) and exercise by 55% (p < 0.0004), while 36% of non-users started wearing a safety belt in front (p < 0.0004) and 20% in the rear (p = 0.008). Literature review found comprehensive lifestyle curricula to be rare.

CONCLUSIONS

A lifestyle curriculum developed prevention-oriented history-taking and observation skills for health maintenance, addressing health priorities, improving medical student lifestyle, and strengthening generic skills. Since lifestyle is a major determinant of health, medical schools should consider development of an appropriate curriculum to address their local and national health priorities.

Competency-based strategies for injury control and prevention curriculums in undergraduate medical education

Injury, including unintentional injury and intentional injury, is the leading cause of death in people aged<or=44 years. Doctors often treat acute injuries, assist in the rehabilitation process and provide injury prevention guidance to patients. Current undergraduate medical school curriculums lack content and consistency in providing training in this area. A matrix to show the integration of injury control and prevention principles into existing undergraduate medical school curriculums is proposed.

Injury prevention education in medical schools: an international survey of medical students

BACKGROUND

Injuries account for an estimated 9% of global mortality. Health professionals worldwide receive little formal injury prevention training, especially in developing countries.

OBJECTIVE

To identify injury prevention training topics taught in a sample of medical schools throughout the world.

DESIGN AND SETTING

Cross sectional survey of 82 medical schools from 31 countries. Based on a convenience sample, respondents recalled the injury prevention concepts they were taught, estimated the time dedicated to these topics, specified the courses and rotations where these concepts were taught, and noted whether they were compulsory or elective sessions.

PARTICIPANTS

Medical students in their last year of medical training.

MAIN EXPOSURE MEASURES

Student recall of classes and rotations where topics of injury prevention and control were discussed.

RESULTS

Basic injury prevention concepts including risk factors for injuries and injury classification systems were not covered in 60% of medical schools. Concepts related to child abuse and neglect and emergency care were more commonly taught than others such as traffic injury prevention and youth violence prevention. In general, injury prevention and control concepts were less frequently taught in Middle Eastern and African universities compared with other regions and some topics such as violence prevention were more frequently taught in medical schools in the Americas. Injury prevention concepts were taught most frequently in preventive medicine, forensic medicine, emergency medicine, surgery and pediatrics courses, and rotations.

CONCLUSIONS

Injury prevention and control education is infrequent and fragmented in medical schools around the world. Inclusion or further development of curricula on this subject could benefit prevention and control efforts.

Surgeons and injury prevention: what you don't know can hurt you!

BACKGROUND

The most effective treatment for traumatic injuries is to prevent them from occurring. Currently, few surgeons receive any formal training in injury' control and prevention. This study was designed to test the knowledge of injury prevention principles among practicing surgeons, in order to identify areas in need of intensified educational efforts.

STUDY DESIGN

Survey questions designed by members of the American College of Surgeons Committee on Trauma were programmed into a specialized touch-screen computer, which was displayed at four different surgery and trauma meetings, including the ACS Clinical Congress in 1999 and 2000. Participants were questioned about their knowledge of trauma epidemiology, bicycle helmet effectiveness, child safety seat usage, suicide, and domestic violence.

RESULTS

Seventy-nine surveys were completed by surgeons, including 33 specializing in trauma care, and by 106 nurses attending trauma courses. Overall, the percentage of correct answers was 50%. There were no significant differences in survey scores between trauma surgeons and general surgeons, although both scored higher than trauma nurses. Areas where knowledge deficits were the most apparent included proper use of child safety seats, the effectiveness of airbags, the prevalence of suicide, and the annual cost of injury in America.

CONCLUSIONS

The majority of practicing surgeons and nurses, including those working at trauma centers, are unaware of the basic concepts of injury prevention. Advancements in the field of injury control will require efforts to educate medical professionals and the public.

Surgical residents' knowledge of injury prevention principles

BACKGROUND

Injury prevention is not routinely taught in medical school or surgical residency curricula. Because of the integral role surgeons play in the diagnosis and treatment of trauma, we sought to determine the knowledge base of injury prevention concepts of surgical residents training in a state's level 1 trauma centers.

METHODS

A written survey was given to general surgery residents at our state's three level 1 trauma centers. Twenty-one questions related to injury prevention were asked in addition to demographic data. Basic concepts of injury prevention, statistical knowledge of injury patterns, and knowledge of intentional violence were tested.

RESULTS

Sixty-two residents completed the survey. Only 9 respondents reported prior formal instruction in injury prevention. Overall performance was (mean +/- SD) 10.6 +/- 2.5 of 31 possible points, for a mean average score of 34% correct answers. Postgraduate year level, prior medical school instruction in injury prevention or months of experience on a trauma service did not correlate with improved scores. Specific question performance ranged from 2% to 82% correct responses. Questions regarding domestic violence (60%), risk of burns (65%), and incidence of trauma deaths (82%) were answered correctly most often, while injury prevention theory questions, such as components of the Injury Prevention Triangle (5%), definition of YPLL (2%), and annual cost attributable to injury (19%) were least often answered correctly.

CONCLUSIONS

These data indicate that general surgery residents are poorly educated regarding basic concepts of injury prevention. Importantly, a majority of respondents (69%) felt formal instruction in injury prevention should be included in their surgical residency curriculum.

Injury-prevention counseling among residents of internal medicine

BACKGROUND

The U.S. Preventive Service Task Force's Guide to Clinical Preventive Services and Healthy People 2000 recommend that physicians participate in various counseling activities, including injury prevention. Despite recommendations, rates of physician counseling, particularly injury prevention, are low. This study assessed clinical preventive services and attitudes among physicians. Furthermore, the study illustrates how physicians prioritize injury-prevention counseling relative to other prevention recommendations.

METHODS

Personal characteristics (i.e., demographics, specialty orientation, attitudes toward prevention, and personal health behaviors) of the residents were collected by a self-administered survey. We performed a 12-month retrospective chart review of 184 new doctor-patient encounters to determine rates of clinical preventive services that included four injury-prevention services: the use of seatbelts, helmets, and smoke detectors; and the safe storage of firearms.

RESULTS

Overall, attitudes toward injury prevention in the context of other clinical preventive services were low. Seatbelt counseling was the only injury-prevention service documented in the charts, and was performed at only one of four clinic sites.

CONCLUSIONS

Clinic site as a key predictor of preventive practice may be suggestive of the importance of organizational priorities and professional norms. Future injury-prevention education efforts must aim at improving attitudes of current and future physicians to facilitate positive professional norms.