Sherfinski Hannah, Condit Paige, Williams Al-Kharusy Samantha, Lasarev Michael, Thomas Makayla, Moreno Megan A, House Taylor R
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin,
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
WMJ. 2025;124(2):116-122.
Despite the negative health effects of adverse childhood experiences, few pediatricians regularly screen for them. We sought to investigate clinician and trainee knowledge and practices regarding adverse childhood experiences in Wisconsin clinics.
We undertook a sequential mixed methods study. We administered a cross-sectional, web-based survey to medical trainees and clinicians associated with the University of Wisconsin-Madison or subscribing to the Wisconsin chapter of the American Academy of Pediatrics. The survey was developed and pretested by experts in medical education and survey methodology. Data were analyzed descriptively and categorically. We then conducted semistructured interviews using thematic analysis and inductive and deductive coding to characterize facilitators and barriers to screening.
Survey respondents included 110 medical students, 103 attending physicians, 51 residents, and 10 advanced practice providers. Respondents were familiar with adverse childhood experiences, yet only 26% had adequate knowledge to impact their clinical practice. More residents (69%) and medical students (50%) received education about adverse childhood experiences than attending physicians (20%). Few respondents (13%) regularly screen for adverse childhood experiences, but the majority (80%) expressed interest in screening. Nine respondents completed interviews, revealing 3 themes: (1) knowledge is not enough; (2) demand for a multilevel approach; and (3) impact of systems of oppression.
Wisconsin trainees and clinicians have limited experience with adverse childhood experiences resulting in low screening rates but express a strong desire to learn more. Increasing screening practice will require targeted efforts to enhance clinician experiential learning, minimize systemic barriers, and address systems of oppression.
尽管童年不良经历对健康有负面影响，但很少有儿科医生定期对此进行筛查。我们试图调查威斯康星州诊所中临床医生和实习生关于童年不良经历的知识及做法。
我们进行了一项序贯混合方法研究。我们对与威斯康星大学麦迪逊分校相关或订阅美国儿科学会威斯康星分会刊物的医学实习生和临床医生进行了一项基于网络的横断面调查。该调查由医学教育和调查方法方面的专家制定并进行了预测试。对数据进行了描述性和分类分析。然后，我们使用主题分析以及归纳和演绎编码进行了半结构化访谈，以确定筛查的促进因素和障碍。
调查对象包括110名医学生、103名主治医生、51名住院医生和10名高级执业提供者。受访者熟悉童年不良经历，但只有26%的人具备足够的知识来影响他们的临床实践。接受过童年不良经历相关教育的住院医生（69%）和医学生（50%）比主治医生（20%）更多。很少有受访者（13%）定期筛查童年不良经历，但大多数（80%）表示有筛查的兴趣。9名受访者完成了访谈，揭示了3个主题：（1）知识不足；（2）对多层次方法的需求；（3）压迫制度的影响。
威斯康星州的实习生和临床医生对童年不良经历的经验有限，导致筛查率较低，但他们表示非常渴望了解更多。提高筛查实践将需要有针对性地努力，以加强临床医生的体验式学习，尽量减少系统性障碍，并解决压迫制度问题。
