Fourth-Year Medical Student, Harvard Medical School.
Second-Year Resident, Department of Emergency Medicine, Beth Israel Deaconess Medical Center.
MedEdPORTAL. 2023 Jul 28;19:11327. doi: 10.15766/mep_2374-8265.11327. eCollection 2023.
Physicians often care for patients who have experienced traumatic events including abuse, discrimination, and violence. Trauma-informed care (TIC) is a framework that recognizes the prevalence of trauma, promotes patient empowerment, and minimizes retraumatization. There are limited education curricula on how to apply TIC to acute care settings, with simulation-based training presenting a novel educational tool for this aim.
Students participated in a didactic on TIC principles and its applications in acute care settings. Learners participated in three simulation cases where they performed physical exams and gathered history on patients with urgent medical needs related to intimate partner violence, transgender health, and health care discrimination. Debriefing followed each simulation.
Seventeen medical students participated across four sessions. The sessions were evaluated with pre- and postparticipation surveys, including Likert scales and free-response questions. After participation, individuals' self-assessed confidence improved across multiple domains, including identifying situations for trauma screenings, inquiring about trauma, and responding as a bystander. Learners also felt more familiar with TIC-specific history taking and physical exam skills. Finally, simulation was perceived as a beneficial educational tool. All findings were statistically significant ( ≤ .01).
Our simulation-based training enabled students to practice conversations and interventions related to trauma. This novel training represents a feasible and effective means for teaching TIC for acute care settings, including in the emergency department and in-patient settings. Development and evaluation were supported by the Society for Academic Emergency Medicine.
医生经常照顾经历过创伤事件的患者，包括虐待、歧视和暴力。创伤知情护理（TIC）是一种认识到创伤普遍性、促进患者赋权和最小化再创伤的框架。关于如何将 TIC 应用于急性护理环境，目前的教育课程有限，模拟培训为实现这一目标提供了一种新的教育工具。
学生参加了关于 TIC 原则及其在急性护理环境中的应用的讲座。学习者参与了三个模拟案例，他们对有紧急医疗需求的患者进行了体格检查，并收集了与亲密伴侣暴力、跨性别健康和医疗保健歧视有关的病史。每次模拟后都进行了汇报。
共有 17 名医学生参加了四个阶段的课程。课程评估采用了参与前后的问卷调查，包括李克特量表和自由回答问题。参与后，个体在多个领域的自我评估信心都有所提高，包括识别创伤筛查情况、询问创伤情况以及作为旁观者做出反应。学习者也对 TIC 特定的病史采集和体格检查技能更加熟悉。最后，模拟被认为是一种有益的教育工具。所有发现均具有统计学意义（≤0.01）。
我们的基于模拟的培训使学生能够练习与创伤相关的对话和干预。这种新颖的培训代表了一种可行且有效的方法，可用于教授急性护理环境中的 TIC，包括急诊科和住院部。该开发和评估得到了学术急诊医学协会的支持。
