From the Division of Pediatrics, Department of Pediatrics, The Alpert Medical School of Brown University.
Division of Pediatric Emergency Medicine, Departments of Emergency Medicine and Pediatrics, Alpert Medical School of Brown University and Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI.
Pediatr Emerg Care. 2022 Jul 1;38(7):312-316. doi: 10.1097/PEC.0000000000002769. Epub 2022 Jun 10.
The objective of the current study was to examine (1) physician trainee interventions when confronted with a situation in which corporal punishment (CP) occurs in a simulated medical setting and (2) their knowledge, comfort, and experiences shared during a semistructured debriefing.
Themes were developed from simulation sessions from 2018 to 2019, where a convenience sample of training physicians was invited to participate. The simulation involved a medical visit where a caregiver becomes increasingly aggravated, eventually striking her child on the back of the head. There were a total of 7 simulations with one trainee participating while others observed. All trainees subsequently participated in a debriefing and educational session.
A total of 37 physician trainees participated. Themes of not having the wording to address CP, not knowing the distinction between CP and physical abuse, previous negative experiences discussing discipline with families, and fear of offending families negatively impacted trainees' ability to intervene during the simulation. Trainees were interested in future education including simulated medical encounters to improve their responses to CP in the future.
Trainees felt uncomfortable with intervening when CP was observed and did not know how to provide appropriate guidance to families on discipline. Moreover, performance during the simulation and discussions during the debriefings revealed knowledge gaps regarding the difference between CP and physical abuse, how to word recommendations about CP to caregivers, and what resources should be provided. These data suggest the need for education on CP and discipline to be integrated into pediatric training.
本研究旨在考察（1）当受训医生在模拟医疗环境中遇到体罚（CP）情况时所采取的干预措施，以及（2）他们在半结构化讨论中分享的知识、舒适度和经验。
本研究从 2018 年至 2019 年的模拟课程中提取主题，邀请了一批有代表性的培训医生参与。模拟场景包括一次医疗访问，在此过程中，一名照顾者变得越来越激动，最终打了孩子的后脑勺。共有 7 次模拟，每次有 1 名受训医生参与，其他医生则进行观察。所有受训医生随后都参加了讨论和教育课程。
共有 37 名医生受训者参与了研究。受训者在处理 CP 时缺乏适当的措辞、无法区分 CP 和身体虐待、以前在与家庭讨论纪律问题时的负面经历、以及害怕冒犯家庭，这些因素都严重影响了他们在模拟中的干预能力。受训者对未来的教育感兴趣，包括模拟医疗接触，以提高他们未来对 CP 的应对能力。
受训者在观察到 CP 时感到不自在，并且不知道如何为家庭提供关于纪律的适当指导。此外，模拟中的表现和讨论揭示了一些知识差距，包括 CP 和身体虐待之间的区别、如何向照顾者提出有关 CP 的建议，以及应该提供哪些资源。这些数据表明，需要将 CP 和纪律教育纳入儿科培训中。
