Department of Pediatrics, George Washington University School of Medicine and Health Sciences and Children's National Hospital, Washington, DC.
Department of Human and Organizational Learning, George Washington University Graduate School of Education and Human Development, Washington, DC.
Perm J. 2021 Dec 14;25:21.032. doi: 10.7812/TPP/21.032.
Trauma-informed care (TIC) acknowledges that childhood traumas can profoundly affect health outcomes and aims to creates a safe, nurturing medical environment. TIC curricula in graduate medical education are limited and lacking in assessment of the application of TIC in practice.
This mixed-methods study followed implementation of a 4-hour required training session for 91 internal medicine residents at George Washington University Hospital. Pre- and posttests were administered to determine change in knowledge, attitude, and confidence. Six weeks after the training, individual participant interviews were conducted to ascertain how TIC is practiced in the clinical setting.
For the 47 participants with matched pre- and posttest data available, there was a statistically significant score improvement after the session on 13 of 16 items (excluding only 3 attitude items). Six themes emerged: 1) patient characteristics trigger recognition to utilize TIC; 2) time plays a critical role; 3) the acute medical setting is a barrier; 4) the patient-doctor relationship impacts TIC application; 5) concern about next steps influences TIC use; and 6) incorporating TIC requires repetition, practice, and supervisor support.
This study demonstrated that a 4-hour TIC session can promote growth in resident knowledge and confidence related to TIC. The findings highlight that TIC education needs to account for contextual factors that can impact its clinical application. A focus on work environment factors such as time, resources, and supervisory support can help to maximize TIC learning, retention, and application in practice.
创伤知情护理（TIC）承认，儿童时期的创伤会深刻影响健康结果，并旨在营造一个安全、培育的医疗环境。研究生医学教育中的 TIC 课程有限，并且缺乏对 TIC 在实践中应用的评估。
这项混合方法研究遵循了对乔治华盛顿大学医院的 91 名内科住院医师进行 4 小时必修培训课程的实施。进行了预测试和后测试，以确定知识、态度和信心的变化。在培训后的六周，对个别参与者进行了个人访谈，以确定 TIC 在临床环境中的实践方式。
对于 47 名具有匹配的预测试和后测试数据的参与者，在课程结束后，有 13 项中的 16 项（仅排除 3 项态度项）的得分显著提高。出现了 6 个主题：1）患者特征触发识别以利用 TIC；2）时间起着关键作用；3）急性医疗环境是一个障碍；4）医患关系影响 TIC 的应用；5）对下一步的关注影响 TIC 的使用；6）纳入 TIC 需要重复、实践和主管支持。
这项研究表明，4 小时的 TIC 课程可以促进住院医师在 TIC 相关知识和信心方面的增长。研究结果强调，TIC 教育需要考虑到可能影响其临床应用的背景因素。关注工作环境因素，如时间、资源和主管支持，可以帮助最大限度地提高 TIC 的学习、保留和在实践中的应用。
