Resident, Departments of Internal Medicine and Pediatrics, Johns Hopkins University School of Medicine.
Associate Professor, Department of Medicine, Johns Hopkins Bayview Medical Center and Johns Hopkins University School of Medicine; Core Faculty, Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins University School of Medicine.
MedEdPORTAL. 2021 Nov 8;17:11193. doi: 10.15766/mep_2374-8265.11193. eCollection 2021.
Adverse childhood experiences (ACEs) and trauma are common and can negatively impact children's health. Standardized patient (SP) learning may provide trainees with knowledge and skills to screen for and manage ACEs, apply trauma-informed care approaches, and teach resilience strategies.
With content experts, we developed three SP cases based on common clinical encounters, as well as didactic and debriefing materials. Case 1 focused on somatic symptoms in an adolescent with ACEs, case 2 focused on an ACE disclosure by a parent, and case 3 focused on de-escalation. The workshop required facilitators, SPs, simulation exam room and meeting space, and audiovisual equipment. It lasted 4 hours and included an orientation (1 hour), the three SP cases (totaling 2 hours), and group debriefing (1 hour).
We conducted five identical workshops with 22 pediatric residents. Participants responded favorably to case fidelity and applicability to their clinical work. Resident mean self-assessment scores improved significantly from baseline. Specifically, we assessed comfort with inquiring about and discussing ACEs, explaining the health impacts of trauma, identifying protective factors, resilience counseling, and de-escalation. Over 90% of responses indicated that residents were likely to apply what they had learned to their clinical practice.
These findings demonstrate that our SP cases were well received and suggest that such curricula can help pediatric residents feel more prepared to address trauma and promote resilience. Future work will assess these outcomes, as well as behavior change, in a larger sample to further substantiate these promising findings.
不良童年经历（ACEs）和创伤很常见，会对儿童的健康产生负面影响。标准化患者（SP）学习可以为学员提供筛查和管理 ACEs、应用创伤知情护理方法以及教授韧性策略的知识和技能。
我们与内容专家一起，根据常见的临床情况，以及教学和汇报材料，开发了三个 SP 案例。案例 1 侧重于有 ACEs 的青少年的躯体症状，案例 2 侧重于父母披露 ACEs，案例 3 侧重于降级。该研讨会需要协调员、SP、模拟检查室和会议室以及视听设备。它持续 4 小时，包括介绍（1 小时）、三个 SP 案例（总计 2 小时）和小组汇报（1 小时）。
我们进行了五次相同的研讨会，共有 22 名儿科住院医师参加。参与者对案例的逼真性和对其临床工作的适用性反应良好。住院医师的自我评估平均得分从基线显著提高。具体而言，我们评估了他们询问和讨论 ACEs、解释创伤对健康的影响、识别保护因素、韧性咨询和降级的舒适度。超过 90%的回应表明，住院医师可能会将所学应用于临床实践。
这些发现表明，我们的 SP 案例受到了好评，并表明此类课程可以帮助儿科住院医师更有信心地处理创伤和促进韧性。未来的工作将在更大的样本中评估这些结果以及行为改变，以进一步证实这些有希望的发现。
