Dichter Melissa E, Teitelman Anne, Klusaritz Heather, Maurer Douglas M, Cronholm Peter F, Doubeni Chyke A
University of Pennsylvania Perelman School of Medicine, Department of Family and Community Medicine.
University of Pennsylvania Perelman School of Nursing.
Fam Med. 2018 Sep;50(8):617-622. doi: 10.22454/FamMed.2018.505481.
Experiences of psychological trauma are common among primary care patient populations, and adversely affect patients' health and health care utilization. Trauma-informed care (TIC) is a framework for identifying and responding to patients' experiences of psychological trauma to avoid retraumatization. The purpose of this study was to evaluate the current state of TIC training in family medicine residency programs in the United States in order to identify opportunities for and barriers to TIC training.
Items addressing the four core domains of TIC were incorporated into the 2017 Council of Academy Family Medicine Educational Research Alliance (CERA) survey of program directors. The items assessed the presence, content, and sufficiency of TIC curriculum, as well as barriers to further integration of TIC training.
Approximately 50% of programs responded to the survey. Of 263 respondents, 71 (27%) reported TIC training in their curriculum, but the majority devoted less than 5 hours annually to core content. The content most commonly addressed recognizing signs of trauma, most frequently using didactic formats. Overall, just over one-half of the programs reported that their curriculum met patients' TIC needs "somewhat" (48.5%) or "a great deal" (4.6%). Lack of a champion followed by lack of time were the most commonly cited barriers to integrating TIC training.
Despite the acknowledged importance of effects of trauma in health care, this study identified insufficient exposure to training in the core TIC domains in family medicine residency programs, underscoring a need for greater integration of TIC training during residency.
心理创伤经历在初级保健患者群体中很常见，并对患者的健康和医疗保健利用产生不利影响。创伤知情护理（TIC）是一种用于识别和应对患者心理创伤经历以避免再次创伤的框架。本研究的目的是评估美国家庭医学住院医师培训项目中TIC培训的现状，以确定TIC培训的机会和障碍。
将涉及TIC四个核心领域的项目纳入2017年美国全科医学研究院教育研究联盟（CERA）对项目主任的调查中。这些项目评估了TIC课程的存在情况、内容和充分性，以及TIC培训进一步整合的障碍。
约50%的项目回复了调查。在263名受访者中，71名（27%）报告其课程中有TIC培训，但大多数每年用于核心内容的时间不到5小时。最常涉及的内容是识别创伤迹象，最常用的形式是讲授式。总体而言，略超过一半的项目报告其课程“一定程度上”（48.5%）或“很大程度上”（4.6%）满足了患者的TIC需求。缺乏倡导者，其次是缺乏时间，是整合TIC培训最常被提及的障碍。
尽管创伤对医疗保健的影响已得到公认，但本研究发现家庭医学住院医师培训项目中对TIC核心领域的培训接触不足，强调在住院医师培训期间需要更大程度地整合TIC培训。
