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Hall D, Smiley Y, Slovin A, Manget J, Bost JE, Chokshi B. Applying a Trauma-Informed Lens to Challenging Adolescent Encounters: A Faculty Development Session for Pediatricians. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2024; 20:11408. [PMID: 38957524 PMCID: PMC11219089 DOI: 10.15766/mep_2374-8265.11408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/29/2024] [Indexed: 07/04/2024]
Abstract
Introduction Patient encounters perceived to be challenging are common and contribute to both suboptimal patient health outcomes and provider burnout. A trauma-informed care (TIC) approach to these encounters is critical, as many of the characteristics associated with challenging patient encounters can be linked to a history of trauma exposure. Methods Our team created and delivered a 1-hour synchronous virtual session intended to bolster provider knowledge of TIC principles and their application to challenging adolescent encounters. Participants were all faculty and staff engaged in pediatric primary care at an urban academic center, including physicians, nurse practitioners, psychologists, and social workers. The content was rooted in adult learning principles and included didactic components anchored to case-based learning with facilitated group discussions and opportunities for reflection. We used paired pre- and postsession self-assessments of provider knowledge, confidence, and practice related to TIC using Likert-scale and free-text questions. Descriptive statistics and a paired t test were used to determine the impact of the session on these metrics. Results In 24 paired surveys, there were statistically significant increases (p ≤ .001) in participant perceived knowledge, confidence, and practice, with 100% of participants having a statistically significant improvement in one or more of these domains. There were also strongly positive Likert-scale and free-text responses regarding content relevance and delivery. Discussion We demonstrate that a brief session can create improvement in pediatric providers' perceived knowledge about the application of TIC principles to challenging adolescent encounters as well as confidence in their ability to put these into practice.
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Affiliation(s)
- Deborah Hall
- Assistant Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences
| | - Yael Smiley
- Assistant Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences
| | - Ariella Slovin
- Instructor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences
| | - Jaytoya Manget
- Assistant Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences
| | - James E. Bost
- Research Division Chief, Center for Translational Research, Children's National Hospital; Associate Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences
| | - Binny Chokshi
- Associate Professor, Division of Military Child and Family Research, Department of Pediatrics, Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine
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Howard MB, Fornari MJ, Colson CD, Ebner M, Jarvis LR. Intimate Partner Violence: Piloting an E-Module for Pediatric Staff. Clin Pediatr (Phila) 2024:99228241254911. [PMID: 38770966 DOI: 10.1177/00099228241254911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Mary Beth Howard
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Marci J Fornari
- Department of Emergency Medicine, Cooper University Health Care, Camden, NJ, USA
| | - Cindy D Colson
- Trauma and Burn Surgery, Children's National Hospital, Washington, DC, USA
| | - Megan Ebner
- School of Medicine & Health Sciences, The George Washington University, Washington, DC, USA
| | - Lenore R Jarvis
- School of Medicine & Health Sciences, The George Washington University, Washington, DC, USA
- Emergency Medicine and Trauma Services, Children's National Hospital, Washington, DC, USA
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McBain RK, Levin JS, Matthews S, Qureshi N, Long D, Schickedanz AB, Gilgoff R, Kotz K, Slavich GM, Eberhart NK. The effect of adverse childhood experience training, screening, and response in primary care: a systematic review. EClinicalMedicine 2023; 65:102282. [PMID: 38106557 PMCID: PMC10725064 DOI: 10.1016/j.eclinm.2023.102282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 12/19/2023] Open
Abstract
Background Adverse childhood experiences (ACEs) can have harmful, long-term health effects. Although primary care providers (PCPs) could help mitigate these effects, no studies have reviewed the impacts of ACE training, screening, and response in primary care. Methods This systematic review searched four electronic databases (PubMed, Web of Science, APA PsycInfo, CINAHL) for peer-reviewed articles on ACE training, screening, and/or response in primary care published between Jan 1, 1998, and May 31, 2023. Searches were limited to primary research articles in the primary care setting that reported provider-related outcomes (knowledge, confidence, screening behavior, clinical care) and/or patient-related outcomes (satisfaction, referral engagement, health outcomes). Summary data were extracted from published reports. Findings Of 6532 records, 58 met inclusion criteria. Fifty-two reported provider-related outcomes; 21 reported patient-related outcomes. 50 included pediatric populations, 12 included adults. A majority discussed screening interventions (n = 40). Equal numbers (n = 25) discussed training and clinical response interventions. Strength of evidence (SOE) was generally low, especially for adult studies. This was due to reliance on observational evidence, small samples, and self-report measures for heterogeneous outcomes. Exceptions with moderate SOE included the effect of training interventions on provider confidence/self-efficacy and the effect of screening interventions on screening uptake and patient satisfaction. Interpretation Primary care represents a potentially strategic setting for addressing ACEs, but evidence on patient- and provider-related outcomes remains scarce. Funding The California Department of Health Care Services and the Office of the California Surgeon General.
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Affiliation(s)
- Ryan K. McBain
- Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA
- Division of Healthcare Delivery, RAND Corporation, Washington, DC, USA
| | - Jonathan S. Levin
- Division of Healthcare Delivery, RAND Corporation, Washington, DC, USA
| | - Samantha Matthews
- Division of Healthcare Delivery, RAND Corporation, Santa Monica, CA, USA
| | - Nabeel Qureshi
- Division of Healthcare Delivery, RAND Corporation, Santa Monica, CA, USA
| | - Dayna Long
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Adam B. Schickedanz
- Department of Pediatrics, David Geffen School of Medicine and Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Rachel Gilgoff
- UCLA-UCSF ACEs Aware Family Resilience Network, Los Angeles, CA, USA
| | - Krista Kotz
- UCLA-UCSF ACEs Aware Family Resilience Network, Los Angeles, CA, USA
| | - George M. Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Nicole K. Eberhart
- Division of Healthcare Delivery, RAND Corporation, Santa Monica, CA, USA
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Manning A, Weingard M, Fabricius J, French A, Sendak M, Davis N. Be ExPeRT (Behavioral Health Expansion in Pediatric Residency Training): A Case-Based Seminar. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11326. [PMID: 37534018 PMCID: PMC10392710 DOI: 10.15766/mep_2374-8265.11326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 04/08/2023] [Indexed: 08/04/2023]
Abstract
Introduction Pediatric residents report behavioral or mental health (B/MH) assessment and treatment as a training gap and often feel ill-equipped to address these issues in clinical practice. We developed a novel interactive training program to improve resident confidence in managing common pediatric B/MH conditions. Methods The Be ExPeRT curriculum comprised a half-day interactive seminar on attention deficit hyperactivity disorder, anxiety, depression, and suicidality followed by monthly case-based discussions. Content included didactic material, role-play, and case discussion. The training was optional and open to pediatric or combined medicine-pediatrics trainees. Results Twenty-three residents (70% female) participated in four separate seminars over 2 years. Of the participants attending the seminars, 17 (74%) completed the presurvey, and 16 (70%) completed the postsurvey. Statistically significant improvement was noted in comfort treating major depressive disorder (41% pre, 94% post, p = .002), suicide risk (29% pre, 94% post, p < .001), and anxiety (24% pre, 94% post, p < .001) following program participation. Twelve (75%) of the 16 participants completing the survey rated the training in the top 5%-10% with respect to other resident learning experiences. Discussion We developed this curriculum to enhance trainee knowledge and comfort in addressing common pediatric B/MH conditions in primary care. Significant improvement was noted in self-reported comfort in treating major depressive disorder, suicide risk, and anxiety, and the program was well received. The curriculum can be adapted for use in any training program for primary care providers to provide B/MH education that may be lacking or supplement existing programming.
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Affiliation(s)
- Alison Manning
- Assistant Professor and Clinician Educator, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University
| | - Matthew Weingard
- Assistant Professor, Division of Pediatric Behavioral Health, Department of Pediatrics, University of Utah and Intermountain Primary Children's Hospital
| | - Jacqueline Fabricius
- Pediatric Rheumatology Fellow, Department of Pediatrics, Northwestern University Feinberg School of Medicine
| | - Alexis French
- Medical Instructor, Division of Child & Family Mental Health & Community Psychiatry, Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine
| | - Mya Sendak
- Consulting Associate, Department of Pediatrics, Duke University School of Medicine
| | - Naomi Davis
- Assistant Professor, Division of Child & Family Mental Health & Community Psychiatry, Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine
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Berman S, Brown T, Mizelle C, Diep T, Gerber MR, Jelley M, Potter LA, Rush P, Sciolla A, Stillerman A, Trennepohl C, Weil A, Potter J. Roadmap for Trauma-Informed Medical Education: Introducing an Essential Competency Set. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:882-888. [PMID: 36862618 DOI: 10.1097/acm.0000000000005196] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Research has established that trauma is nearly universal and a root cause of numerous health and social problems, including 6 of the 10 leading causes of death, with devastating consequences across the life course. Scientific evidence now recognizes the complex injurious nature of structural and historical trauma (i.e., racism, discrimination, sexism, poverty, and community violence). Meanwhile, many physicians and trainees grapple with their own trauma histories and face direct and secondary traumatization on the job. These findings substantiate the profound impact of trauma on the brain and body and why trauma training is critical to the education and practice of physicians. However, a critical lag remains in translating essential research insights into clinical teaching and care. Recognizing this gap, the National Collaborative on Trauma-Informed Health Care Education and Research (TIHCER) formed a task force charged with developing and validating a summary of core trauma-related knowledge and skills for physicians. In 2022, TIHCER released the first-ever validated set of trauma-informed care competencies for undergraduate medical education. The task force focused on undergraduate medical education so that all physicians would be taught these foundational concepts and skills from the outset of training, recognizing that faculty development is needed to achieve this goal. In this Scholarly Perspective, the authors offer a roadmap for implementation of trauma-informed care competencies starting with medical school leadership, a faculty-student advisory committee, and sample resources. Medical schools can use the trauma-informed care competencies as a scaffold to customize integration of curricular content (what is taught) and efforts to transform the learning and clinical environments (how it is taught). Using the lens of trauma will ground undergraduate medical training in the latest science about the pathophysiology of disease and provide a framework to address many of our greatest challenges, including health disparities and professional burnout.
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Affiliation(s)
- Sarah Berman
- S. Berman is a third-year psychiatry resident, Cambridge Health Alliance, Cambridge, Massachusetts; ORCID: https://orcid.org/0000-0003-1037-8798
| | - Taylor Brown
- T. Brown is a second-year emergency medicine resident, Beth Israel Deaconess Medical Center, Boston, Massachusetts; ORCID: http://orcid.org/0000-0002-1893-9142
| | - Cecelia Mizelle
- C. Mizelle is a third-year medical student, University of North Carolina, Chapel Hill, North Carolina; ORCID: http://orcid.org/0000-0003-4401-1927
| | - Thang Diep
- T. Diep is a youth engagement specialist, Center for the Pacific Asian Family, Los Angeles, California; ORCID: https://orcid.org/0000-0002-5256-0320
| | - Megan R Gerber
- M.R. Gerber is professor of medicine, Albany Medical College, Albany, New York; ORCID: https://orcid.org/0000-0002-8444-5554
| | - Martina Jelley
- M. Jelley is professor of medicine, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma; ORCID: https://orcid.org/0000-0002-7816-2865
| | - Laura A Potter
- L.A. Potter is a third-year medical student, University of California, Davis, Sacramento, California; ORCID: https://orcid.org/0000-0001-6912-9214
| | - Patricia Rush
- P. Rush is codirector, Center for Collaborative Study of Trauma, Health Equity, and Neurobiology (THEN), Chicago, Illinois; ORCID: https://orcid.org/0000-0001-9775-7541
| | - Andres Sciolla
- A. Sciolla is professor of psychiatry, University of California, Davis, Sacramento, California; ORCID: https://orcid.org/0000-0002-0713-2183
| | - Audrey Stillerman
- A. Stillerman is assistant professor of family medicine, University of Illinois, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-0713-2183
| | - Christopher Trennepohl
- C. Trennepohl is a second-year psychiatry resident, University of Illinois, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-1745-0908
| | - Amy Weil
- A. Weil is professor of medicine and social medicine, University of North Carolina, Chapel Hill, North Carolina; ORCID: https://orcid.org/0000-0002-7671-0397
| | - Jennifer Potter
- J. Potter is professor of medicine, Harvard Medical School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0002-6221-8895
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Burns CJ, Borah L, Terrell SM, James LN, Erkkinen E, Owens L. Trauma-Informed Care Curricula for the Health Professions: A Scoping Review of Best Practices for Design, Implementation, and Evaluation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:401-409. [PMID: 36538661 DOI: 10.1097/acm.0000000000005046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Trauma-exposed persons often experience difficulties accessing medical care, remaining engaged in treatment plans, and feeling psychologically safe when receiving care. Trauma-informed care (TIC) is an established framework for health care professionals, but best practices for TIC education remain unclear. To remedy this, the authors conducted a multidisciplinary scoping literature review to discern best practices for the design, implementation, and evaluation of TIC curricula for health care professionals. METHOD The research team searched Ovid MEDLINE, Cochrane Library, Elsevier's Scopus, Elsevier's Embase, Web of Science, and the PTSDpubs database from the database inception date until May 14, 2021. Worldwide English language studies on previously implemented TIC curricula for trainees or professionals in health care were included in this review. RESULTS Fifty-five studies met the inclusion criteria, with medicine being the most common discipline represented. The most prevalent learning objectives were cultivating skills in screening for trauma and responding to subsequent disclosures (41 studies [74.5%]), defining trauma (34 studies [61.8%]), and understanding trauma's impact on health (33 studies [60.0%]). Fifty-one of the studies included curricular evaluations, with the most common survey items being confidence in TIC skills (38 studies [74.5%]), training content knowledge assessment (25 studies [49.0%]), participant demographic characteristics (21 studies [41.2%]), and attitudes regarding the importance of TIC (19 studies [37.3%]). CONCLUSIONS Future curricula should be rooted in cultural humility and an understanding of the impacts of marginalization and oppression on individual and collective experiences of trauma. Moreover, curricula are needed for clinicians in more diverse specialties and across different cadres of care teams. Additional considerations include mandated reporting, medical record documentation, and vicarious trauma experienced by health care professionals.
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Affiliation(s)
- Courtney Julia Burns
- C.J. Burns is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-3216-5921
| | - Luca Borah
- L. Borah is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-8975-1051
| | - Stephanie M Terrell
- S.M. Terrell is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-7776-4621
| | - LaTeesa N James
- L.N. James is a health sciences informationist, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-5955-2876
| | - Elizabeth Erkkinen
- E. Erkkinen is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-3522-7286
| | - Lauren Owens
- L. Owens is assistant professor, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington; ORCID https://orcid.org/0000-0002-8277-2826
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Keesler JM, Purcell A, Thomas-Giyer J. Advancing trauma-informed care in intellectual and developmental disability services: A pilot study of a digital training with direct service providers. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:615-628. [PMID: 36811269 DOI: 10.1111/jar.13085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/21/2022] [Accepted: 02/03/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND As trauma-informed care advances in the service delivery system for people with intellectual and developmental disabilities, additional resources are needed to foster staff development. This article describes the development and pilot evaluation of a digital training on trauma-informed care among direct service providers (DSPs) in the disability service industry. METHOD Following an AB design, a mixed methods approach was used to analyse the responses of 24 DSPs to an online survey at baseline and at follow-up. RESULTS The training was associated with increased staff knowledge in some domains and greater alignment with trauma-informed care. Staff expressed a strong likelihood of using trauma-informed care in practice and identified organisational assets and barriers to implementation. CONCLUSIONS Digital trainings can facilitate staff development and the advancement of trauma-informed care. Although additional efforts are warranted, this study fills a gap in the literature regarding staff training and trauma-informed care.
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Affiliation(s)
- John M Keesler
- Indiana University Bloomington School of Social Work, Bloomington, Indiana, USA
| | - Alex Purcell
- Indiana University Bloomington School of Public Health, Bloomington, Indiana, USA
| | - Jen Thomas-Giyer
- Indiana University Bloomington School of Social Work, Bloomington, Indiana, USA
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Thang C, Kucaj S, Forkey H, Lopez N, Ocampo A, Inkelas M, Wilhalme H, Szilagyi M. Training Pediatric Interns to be Trauma-Responsive Providers by Adapting a National Evidence-Informed Curriculum for Pediatricians. Acad Pediatr 2023; 23:219-221. [PMID: 35259547 PMCID: PMC10376929 DOI: 10.1016/j.acap.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/17/2022] [Accepted: 02/26/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Christine Thang
- Department of Pediatrics, UCLA Mattel Children's Hospital (C Thang, S Kucaj, N Lopez, A Ocampo, M Szilagyi), University of California Los Angeles, Los Angeles, Calif.
| | - Samantha Kucaj
- Department of Pediatrics, UCLA Mattel Children's Hospital (C Thang, S Kucaj, N Lopez, A Ocampo, M Szilagyi), University of California Los Angeles, Los Angeles, Calif
| | - Heather Forkey
- Child Protection Program and Foster Children Evaluation Services and Department of Pediatrics (H Forkey), University of Massachusetts Memorial Children's Medical Center, Worcester, Mass
| | - Nathalie Lopez
- Department of Pediatrics, UCLA Mattel Children's Hospital (C Thang, S Kucaj, N Lopez, A Ocampo, M Szilagyi), University of California Los Angeles, Los Angeles, Calif
| | - Andrea Ocampo
- Department of Pediatrics, UCLA Mattel Children's Hospital (C Thang, S Kucaj, N Lopez, A Ocampo, M Szilagyi), University of California Los Angeles, Los Angeles, Calif
| | - Moira Inkelas
- Fielding School of Public Health (M Inkelas), University of California at Los Angeles, Los Angeles, Calif
| | - Holly Wilhalme
- Department of Medicine Statistics Core (H Wilhalme), University of California Los Angeles, Los Angeles, Calif
| | - Moira Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital (C Thang, S Kucaj, N Lopez, A Ocampo, M Szilagyi), University of California Los Angeles, Los Angeles, Calif
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Treme J, Quick C. Integrating Adverse Childhood Experiences Into Undergraduate Nursing Curriculum: A Scoping Review. J Nurs Educ 2022; 61:673-678. [PMID: 36475994 DOI: 10.3928/01484834-20221003-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are traumatic events occurring in childhood that can have severe effects on health throughout the life span. Quality nursing care includes the knowledge and skills to recognize patients who were exposed to ACEs and respond appropriately. METHOD A scoping review of the literature was conducted as the foundation for implementing ACEs into baccalaureate nursing curricula. RESULTS A total of 22 articles were examined and included 15 research studies, two literature reviews, one quality improvement project, and four discussion articles. The literature reflects a prevalence for case-based ACEs content and the importance of student safety measures during content implementation. CONCLUSION Knowledge derived from this review can assist nursing educators to integrate ACEs education into baccalaureate nursing curricula and identify research areas for further investigation. [J Nurs Educ. 2022;61(12):673-678.].
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Chokshi B, Pukatch C, Ramsey N, Dzienny A, Smiley Y. The Generational Trauma Card: A Tool to Educate on Intergenerational Trauma Transmission. JOURNAL OF LOSS & TRAUMA 2022. [DOI: 10.1080/15325024.2022.2091315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Binny Chokshi
- Department of Pediatrics, Division of Military Child and Family Health, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Catherine Pukatch
- Department of Pediatrics, Children’s National Hospital, Washington, District of Columbia, USA
| | - Natasha Ramsey
- Department of Adolescent Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Alexa Dzienny
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Yael Smiley
- Department of Pediatrics, Children’s National Hospital, Washington, District of Columbia, USA
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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Stout J, Martin AI. Trauma-Informed Care in the Classroom: Our Experience with a Content Warning in a Medical School Course. MEDICAL SCIENCE EDUCATOR 2022; 32:711-718. [PMID: 35818610 PMCID: PMC9270545 DOI: 10.1007/s40670-022-01559-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 06/03/2023]
Abstract
Trauma is now recognized as a common human experience that has consequences, including adverse effects on learning outcomes. Principles of trauma-informed care include awareness of the impact of trauma and use of strategies to prevent retraumatization. While well-described in medical and mental health care, these principles have been inconsistently applied in the medical education classroom. Content warnings can be part of a trauma-informed classroom approach that notifies learners about potentially distressing topics, allows individuals to employ self-care, and seeks to resist retraumatization. This article describes our experience integrating a content warning about reproductive topics in a second-year medical school course. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-022-01559-0.
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Affiliation(s)
- Julianne Stout
- Veterinary Administration Department, Indiana University School of Medicine-West Lafayette, Purdue University, 715 Clinic Drive Suite 2069, West Lafayette, IN 47907 USA
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12
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Steen M, Raynor J, Baldwin CD, Jee SH. Child Adversity and Trauma-Informed Care Teaching Interventions: A Systematic Review. Pediatrics 2022; 149:184788. [PMID: 35165742 DOI: 10.1542/peds.2021-051174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Health professionals need training to provide trauma-informed care (TIC) for children with adverse childhood experiences (ACEs), which can affect short- and long-term health. We summarize and evaluate published curricula for health professionals on ACEs and TIC. METHODS We searched PubMed, Embase, Web of Science, CINAHL, Cochrane Central Register of Controlled Trials, PsychInfo, and MedEdPORTAL through January 2021. Studies meeting the following criteria were included: Described teaching interventions on ACEs, TIC, and child abuse and maltreatment; included health care providers or trainees as learners; were written in English; included an abstract; and described a curriculum and evaluation. We reviewed 2264 abstracts, abstracted data from 79 studies, and selected 51 studies for qualitative synthesis. RESULTS Studies focused on ACEs/TIC (27), child abuse (14), domestic/intimate partner violence (6), and child maltreatment/parental physical punishment (4). Among these 51 studies, 43 were published since 2010. Learners included a mix of health professionals (34) and students (17). Duration, content, and quality of the 51 curricula were highly variable. An analysis of 10 exemplar curricula on ACEs and/or TIC revealed high and very high quality for methods and moderate to very high quality for curriculum evaluation, suggesting that they may be good models for other educational programs. Four of the 10 exemplars used randomized controlled trials to evaluate efficacy. Studies were limited to English language and subject to publication bias. CONCLUSIONS ACEs and TIC are increasingly relevant to teaching health professionals, especially pediatricians, and related teaching curricula offer good examples for other programs.
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Affiliation(s)
| | - Jennifer Raynor
- Edward G. Miner Library, University of Rochester Medical Center, Rochester, New York
| | | | - Sandra H Jee
- Division of General Pediatrics, Department of Pediatrics.,Center for Community Health and Prevention, Rochester, New York
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