Narayan Aditee Pradhan, Socolar Rebecca R S, St Claire Karen
Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA.
Pediatrics. 2006 Jun;117(6):2215-21. doi: 10.1542/peds.2006-0160.
Child abuse and neglect are leading public health problems with significant morbidity and mortality. Previous studies indicate that physicians often lack knowledge and confidence in addressing child abuse and neglect.
Our goal was to assess the child abuse and neglect curricula in pediatric residency programs as reported by chief residents and to identify levels of preparedness of residents to address child abuse and neglect on graduation. We analyzed variables related to preparedness.
A 28-item survey was sent to chief residents of all 203 Accreditation Council for Graduate Medical Education-accredited pediatric residency programs in the United States from 2004-2005. We performed descriptive, bivariable, and multivariable analyses.
The response rate was 71%. Most programs taught didactics on physical and sexual abuse, but only 54% included domestic violence. Ninety-three percent of respondents rated their didactics as useful or very useful. Forty-one percent of programs required mandatory clinical rotations in child abuse and neglect, 57% offered elective rotations, and 25% offered no rotations at all. Respondents rated the levels of preparedness of graduating residents to address child abuse and neglect as: very well (12%), well (54%), somewhat well (28%), or not well (6%). Preparedness was significantly associated with didactic usefulness, number of hours of didactics, total number of inpatient cases of child abuse and neglect seen, percent of residents completing mandatory rotations, number of sexual abuse cases during mandatory rotation, number of physical abuse cases during mandatory rotation, and length of mandatory rotation.
Mandatory clinical experiences in child abuse and neglect improve the preparedness of graduating residents to identify and evaluate patients for child abuse and neglect. Perhaps residency training in child abuse and neglect should be a required subspecialty rotation with more explicit curricular content than in the current mandates.
虐待和忽视儿童是主要的公共卫生问题，会导致严重的发病率和死亡率。以往研究表明，医生在处理虐待和忽视儿童问题时往往缺乏相关知识和信心。
我们的目标是评估住院总医师报告的儿科住院医师培训项目中有关虐待和忽视儿童的课程，并确定住院医师毕业时处理虐待和忽视儿童问题的准备程度。我们分析了与准备程度相关的变量。
向美国203个经研究生医学教育认证委员会认证的儿科住院医师培训项目的所有住院总医师发送了一份包含28个条目的调查问卷。调查时间为2004年至2005年。我们进行了描述性、双变量和多变量分析。
回复率为71%。大多数项目讲授了关于身体虐待和性虐待的教学内容，但只有54%的项目包含家庭暴力内容。93%的受访者认为他们的教学内容有用或非常有用。41%的项目要求进行虐待和忽视儿童方面的强制临床轮转，57%的项目提供选修轮转，25%的项目根本没有轮转。受访者对毕业住院医师处理虐待和忽视儿童问题的准备程度评价为：非常好（12%）、好（54%）、较好（28%）或不好（6%）。准备程度与教学内容的有用性、教学时长、所见到的虐待和忽视儿童住院病例总数、完成强制轮转的住院医师百分比、强制轮转期间的性虐待病例数、强制轮转期间的身体虐待病例数以及强制轮转时长显著相关。
虐待和忽视儿童方面的强制临床经验可提高毕业住院医师识别和评估虐待和忽视儿童患者的准备程度。或许虐待和忽视儿童方面的住院医师培训应成为一门必需的亚专业轮转课程，其课程内容应比当前要求更加明确。
