Nutting Ruth, Nilsen Kari, Engle Rachel, Wells Kyle, Scoville Hannah
Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS.
Family Medicine Residency Program at Ascension Via Christi, Wichita, KS.
Kans J Med. 2023 Oct 30;16(3):264-267. doi: 10.17161/kjm.vol16.21000. eCollection 2023.
Screening for adverse childhood experiences (ACEs) is a significant component of trauma informed care (TIC), as intervention can mitigate negative health outcomes. However, as few as 4% of physicians with pediatric patients screen and intervene for all ACEs. The authors of this study sought to: 1) understand resident physicians' perceptions of TIC; 2) identify areas of training needed to improve screening and intervention of ACEs.
This descriptive study occurred in a large Midwestern Family Medicine residency and involved a convenience sample of 38 resident physicians. Participants completed a survey, which included a total of 22 Likert-scale and open-ended questions. Descriptive frequencies were used to represent Likert-scale responses, and the open-ended questions were analyzed utilizing a thematic analysis approach.
Participants identified screening for ACEs as useful. However, they reported a lack of confidence in their ability to screen and intervene. Barriers to screening and intervention also were noted and included lack of time, discomfort in assessment, perceived inability to help, insufficient knowledge and skills, and competing primary care recommendations.
Family Medicine residents identified the screening and intervention of ACEs to be important. However, lack of confidence, competing primary care recommendations, and concern for receptiveness can deter residents from screening and intervention. Based on this study's findings, the authors recommend that graduate medical education focuses on building systems of training that provide learners with the knowledge, skills, and resources to routinely screen and intervene for ACEs in primary care.
筛查儿童期不良经历（ACEs）是创伤知情护理（TIC）的重要组成部分，因为干预可以减轻负面健康结果。然而，在患有儿科患者的医生中，只有4%的人会对所有ACEs进行筛查和干预。本研究的作者旨在：1）了解住院医师对TIC的看法；2）确定改善ACEs筛查和干预所需的培训领域。
这项描述性研究在中西部一个大型家庭医学住院医师培训项目中进行，涉及38名住院医师的便利样本。参与者完成了一项调查，其中包括总共22个李克特量表问题和开放式问题。描述性频率用于表示李克特量表的回答，并采用主题分析方法对开放式问题进行分析。
参与者认为筛查ACEs是有用的。然而，他们报告称对自己进行筛查和干预的能力缺乏信心。还指出了筛查和干预的障碍，包括时间不足、评估时的不适感、认为无法提供帮助、知识和技能不足以及初级保健建议相互冲突。
家庭医学住院医师认为筛查和干预ACEs很重要。然而，缺乏信心、初级保健建议相互冲突以及对接受度的担忧可能会阻碍住院医师进行筛查和干预。基于本研究的结果，作者建议毕业后医学教育应侧重于建立培训体系，为学习者提供知识、技能和资源，以便在初级保健中常规筛查和干预ACEs。
