Wen Frances K, Miller-Cribbs Julie E, Coon Kim A, Jelley Martina J, Foulks-Rodriguez Kristin A
1 Department of Family and Community Medicine, The OU-TU School of Community Medicine, Tulsa, OK, USA.
2 Anne and Henry Zarrow School of Social Work, University of Oklahoma, Norman, OK, USA.
Int J Psychiatry Med. 2017 May;52(3):255-264. doi: 10.1177/0091217417730289. Epub 2017 Sep 11.
Adverse childhood experiences (ACEs) are 10 categories of childhood abuse and maltreatment, which have a dose-response relationship with common adult health concerns seen in primary care including health risk behaviors, chronic disease, and mental illness. Many of the ACEs-associated biopsychosocial risk factors are modifiable. However, physicians may not address these issues for fear of opening "Pandora's Box", that is, a source of extensive problems for which they are not sufficiently prepared with training, resources, or time. Residents need training in how to conduct trauma-focused conversations within the limited scope of an office visit. To address this need, a 4-hour simulation and video-based training program was developed for primary care residents about how to conduct brief interventions connecting their patients' current health concerns with their experiences of ACEs. Resident participants have evaluated this program as preparatory for real-life encounters and as being designed to allow for educational mastery. This article describes a workshop presenting this training program which was given at the 37th Annual Behavioral Science Forum in Family Medicine. Five skills targeted in the program were presented and a demonstration was made of the components, that is, didactics, provider and patient videos, simulated patient encounters, trainee feedback, and facilitated discussion that encompasses targeted skills, clinical implementation, and self-care. Companion tools were shared, including the syllabus, evaluation rubric, and provider and patient resources. Participants practiced trainee feedback and discussed the challenges in implementation.
童年不良经历（ACEs）是10类儿童期虐待和 maltreatment，它们与初级保健中常见的成人健康问题存在剂量反应关系，这些问题包括健康风险行为、慢性病和精神疾病。许多与ACEs相关的生物心理社会风险因素是可以改变的。然而，医生可能因担心打开“潘多拉魔盒”而不解决这些问题，也就是说，这是一个会引发大量问题的源头，而他们在培训、资源或时间方面对此准备不足。住院医师需要接受如何在有限的门诊范围内进行以创伤为重点的对话的培训。为满足这一需求，针对初级保健住院医师开发了一个为期4小时的模拟和基于视频的培训项目，内容是如何进行简短干预，将患者当前的健康问题与其童年不良经历联系起来。参与培训的住院医师将该项目评价为对现实生活中的接触有准备作用，且设计得有助于实现教育掌握。本文描述了一个在第37届家庭医学年度行为科学论坛上举办的介绍该培训项目的研讨会。介绍了该项目所针对的五项技能，并展示了其组成部分，即教学内容、医护人员和患者视频、模拟患者接触、学员反馈以及包含目标技能、临床实施和自我护理的促进性讨论。还分享了配套工具，包括教学大纲、评估量规以及医护人员和患者资源。参与者练习了学员反馈并讨论了实施中的挑战。
