Assistant Professor, Department of Pediatrics, University of California, Riverside, School of Medicine.
Resident Physician, Department of Pediatrics, UCLA Health, University of California, Los Angeles.
MedEdPORTAL. 2022 Mar 4;18:11224. doi: 10.15766/mep_2374-8265.11224. eCollection 2022.
Exposure to adverse childhood experiences (ACEs) can lead to a toxic stress response with impacts on health that affect health equity. As part of our Health Equity, Social Justice, and Anti-racism curriculum, our aim was to introduce second-year medical students to a case-based method using a template-based screening and application of toxic stress, buffering factors, and resiliency-fostering tools to address health disparities and inequities with a trauma-informed care approach.
We developed an asynchronous e-learning module that demonstrated the impact of ACEs by introducing students to screening for toxic stress response and buffering factors on health, their role as health equity determinants, and the use of brief in-clinic resilience-fostering tools in patient care. This was followed by a synchronous, facilitated, small-group, virtual discussion of a clinical case. Pre- and postworkshop surveys assessed changes in knowledge, skills, and attitudes. A 3-month follow-up survey assessed students' behavioral changes.
Sixty-four students completed the learning module. Paired -test analysis showed a statistically significant increase in students' knowledge, skills, and attitudes regarding the Educational Objectives, with a survey response rate of 98%. Three months after the workshop, a third of students were applying these concepts, with a survey response rate of 87%.
Implementing this case-based curriculum in trauma-informed patient care helped increase opportunities for equitable health in patient encounters by providing students with the skills to screen for toxic stress, buffering, and brief in-clinic resiliency-fostering tools. Such skills will become even more impactful as we emerge from the COVID-19 pandemic.
接触不良的童年经历（ACEs）会导致毒性应激反应，对健康产生影响，从而影响健康公平。作为我们健康公平、社会正义和反种族主义课程的一部分，我们的目标是向二年级医学生介绍一种基于案例的方法，使用基于模板的筛查和应用毒性应激、缓冲因素和促进恢复力的工具，以创伤知情护理方法解决健康差距和不平等问题。
我们开发了一个异步电子学习模块，通过向学生介绍筛查毒性应激反应和缓冲因素对健康的影响、它们作为健康公平决定因素的作用以及在临床实践中使用简短的促进恢复力的工具，向学生介绍 ACEs 的影响。随后，进行了一次同步的、有指导的、小组虚拟临床案例讨论。预调查和调查评估了知识、技能和态度的变化。3 个月的随访调查评估了学生的行为变化。
64 名学生完成了学习模块。配对检验分析显示，学生在教育目标方面的知识、技能和态度有统计学意义上的显著提高，调查回复率为 98%。在研讨会结束 3 个月后，三分之一的学生正在应用这些概念，调查回复率为 87%。
在创伤知情患者护理中实施这种基于案例的课程有助于通过为学生提供筛查毒性应激、缓冲和临床促进恢复力的简短工具的技能，增加患者就诊中公平健康的机会。随着我们从 COVID-19 大流行中走出来，这些技能将变得更加重要。
