Metz James, Stone Kimberly, Reid Jennifer, Burns Rebekah
Fellow in Child Abuse, University of Washington School of Medicine.
Associate Professor, Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine.
MedEdPORTAL. 2017 Mar 10;13:10552. doi: 10.15766/mep_2374-8265.10552.
Child abuse, also known as nonaccidental trauma (NAT), is an important cause of pediatric morbidity and mortality. The presentation of NAT is often confounded by unclear histories and victims who are unable to provide information. Medical students and trainees may fail to consider NAT as a diagnosis or be unfamiliar with the evaluation process.
This curriculum uses simulation, small-group discussion, and didactics to help medical students gain an understanding of presentation of NAT. Using the case of a 2-month-old boy presenting with altered mental status and seizure, participants practice the assessment and management of an acutely ill patient. Small-group discussions facilitate schema building to enhance each participant's ability to recognize and diagnose different diseases that may present as infant seizure and to identify the signs of NAT. Didactics solidify concepts addressed during the simulation and small-group discussions.
Medical students participating in this course reported that they felt better prepared for their internships and that working through a case with a large differential diagnosis was helpful for their understanding of causes of infant seizures, including abusive head trauma.
This curriculum is unique in that it uses one unifying case to allow participants to demonstrate an understanding of the evaluation and stabilization of a critically ill pediatric patient, develop a broad differential diagnosis for a nonspecific symptom, and prioritize and evaluate possible etiologies through the gathering and interpretation of data. This curriculum may be used independently or in conjunction with other learning activities as part of a pediatric boot camp.
虐待儿童，也称为非意外创伤（NAT），是儿童发病和死亡的重要原因。NAT的表现常常因病史不明以及受害者无法提供信息而变得复杂。医学生和实习生可能无法将NAT视为一种诊断，或者不熟悉评估过程。
本课程采用模拟、小组讨论和讲授法，帮助医学生了解NAT的表现。以一名出现精神状态改变和癫痫发作的2个月大男婴为例，参与者练习对急症患者的评估和管理。小组讨论有助于构建模式，以提高每个参与者识别和诊断可能表现为婴儿癫痫发作的不同疾病的能力，并识别NAT的体征。讲授法巩固了模拟和小组讨论中涉及的概念。
参加本课程的医学生报告说，他们对实习准备得更充分了，处理一个有多种鉴别诊断的病例有助于他们理解婴儿癫痫发作的原因，包括虐待性头部创伤。
本课程的独特之处在于，它使用一个统一的病例，让参与者展示对危重症儿科患者的评估和稳定处理的理解，为一种非特异性症状形成广泛的鉴别诊断，并通过收集和解释数据对可能的病因进行优先级排序和评估。本课程可以独立使用，也可以作为儿科新兵训练营的一部分与其他学习活动结合使用。
