scholarly journals 3311 Trauma Informed Care Needs Assessment of Internal Medicine Residents

2019 ◽  
Vol 3 (s1) ◽  
pp. 76-76
Author(s):  
Jenny Xin Wen ◽  
Colleen Christmas ◽  
Anika Alvanzo
Keyword(s):  
Internal Medicine ◽  
Partner Violence ◽  
Online Survey ◽  
Medical Training ◽  
Underserved Populations ◽  
Nonparametric Tests ◽  
Additional Training ◽  
Trauma Informed Care ◽  
Internal Medicine Residents ◽  
Trauma Informed

OBJECTIVES/SPECIFIC AIMS: In the US, 60-90% of adults have experienced emotional trauma-- defined as an event or series of events (such as abuse, loss, or chronic stressors) that negatively affect health. Trauma exposure is strongly associated with proportional increases in chronic diseases, behavioral health disorders, and risky behaviors. These negative sequelae disproportionately affect ethnic minorities and urban, underserved populations. Physicians and healthcare providers can play important roles in intervention or re-traumatization of victims. However, current standard medical training does not include trauma or Trauma Informed Care (TIC). We aimed to examine the knowledge, attitudes, perceived skills, and behaviors of internal medicine residents regarding managing patients with histories of trauma, as well as residents’ desires for additional training in trauma informed care. METHODS/STUDY POPULATION: We conducted an online survey of residents enrolled in 4 internal medicine programs in Baltimore, Maryland to assess the following behaviors: recognizing, screening, managing, and referring patients with trauma histories. The questionnaire was based on PREMIS (Physician Readiness to Manage Intimate Partner Violence Survey) and addressed residents’ knowledge, attitudes, self-assessed preparedness, and close personal experiences with trauma. Nonparametric tests (Kruskal-Wallis, Fisher’s exact, and Wilcoxon rank sum) were used for analysis. RESULTS/ANTICIPATED RESULTS: Of the 168 residents who responded to the survey (54% response rate), 44% were female, 55% White, 28% Asian, 4% Black and 13.2% unknown/other. Knowledge and preparedness were very limited. 83% percent of respondents underestimated trauma prevalence; 31.7% felt inadequately prepared to appropriately respond to positive disclosures. 59.5% reported they seldom asked about trauma in the past 6 months, and 8.8% never asked. Factors significantly associated with higher frequency of screening patients include greater perceived preparedness to identify, respond to, and refer patients (p =.0001 −.012); familiarity with referral resources (p=.005); comfort in discussing trauma with patients (p =.003); and perceived faculty (p =.001) and workplace support (p =.038). 68.7% had previous training on some trauma-related topics in medical school, and 42.2% did in residency; 91.8% wished for additional training on trauma and trauma informed care. Differences among genders, races, years in training, and program sites were minimal. DISCUSSION/SIGNIFICANCE OF IMPACT: Internal medicine residents in Baltimore had very limited knowledge about trauma prevalence and risks for comorbidities. Although most residents feel TIC is relevant to clinical practice, they feel unprepared to identify, respond to, manage, and refer patients with histories of trauma. Our results support the need for integration of trauma and Trauma Informed Care training into graduate medical education for internal medicine residents.

Learning Electrocardiogram Interpretation: Insights from Residents and a Proposed Solution in an Observational Study (Preprint)

2020 ◽  
Author(s):  
Mohammad Alakchar ◽  
Abdisamad M. Ibrahim ◽  
Mohsin Salih ◽  
Mukul Bhattarai ◽  
Nitin Tandan ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Correlation Coefficient ◽  
Online Survey ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Resident Attitudes ◽  
Internal Medicine Residents ◽  
Life Threatening ◽  
Degree Of Participation ◽  
Electrocardiogram Interpretation

BACKGROUND Interpretation of electrocardiograms (EKG) is an essential tool for every physician. Despite this, the diagnosis of life-threatening pathology on EKG remains suboptimal in trainees. The purpose of this study is to study resident attitudes and behaviours towards EKGs, and describe an innovative way to teach EKGs. OBJECTIVE Study attitudes and behaviours towards EKGs. Describe an innovative way to teach EKGs. METHODS Design: An observational cross-sectional study through an anonymous online survey of resident attitudes and comfort with EKG interpretation. This was followed by creation of a WhatsApp group for discussion and interpretation of EKGs with peers. At the end of the day, the official EKG interpretation was posted. Setting: Internal medicine residency at Southern Illinois University. Participants: Internal medicine residents Interventions: Creation of WhatsApp group to aid with EKG interpretation Measurements: A 17 item questionnaire, followed by detection of degree of participation in a WhatsApp group. RESULTS Forty-one out of 63 residents (65%) completed the survey. 85% of respondents thought that an interactive way to teach EKGs is the best method of teaching, and 73% did not feel confident interpreting EKGs. 30% often rely on automated EKG interpretation. Further analysis indicated that PGY-1 residents reported ordering fewer EKGs (correlation coefficient -0.399, p = 0.012) and were uncomfortable diagnosing QT prolongation on an EKG (correlation coefficient -0.310, p = 0.049). Residents in the third or greater year of training ordered more EKGs (correlation coefficient 0.379, p = 0.015), less frequently relied on the computer for EKG diagnosis (correlation coefficient 0.399, p = 0.010), and were comfortable diagnosing an acute myocardial infarction and atrial arrhythmias. CONCLUSIONS In conclusion, most IM trainees do not feel comfortable interpreting EKG, however, this does improve with PGY year. WhatsApp is a possible platform for teaching EKGs.

scholarly journals Perception of usefulness of laboratory tests ordering by internal medicine residents in ambulatory setting: A single-center prospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0250769
Author(s):  
Dimitria Doi ◽  
Romulo Ribeiro do Vale ◽  
Jean Michell Correia Monteiro ◽  
Glauco Cabral Marinho Plens ◽  
Mario Ferreira Junior ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Laboratory Tests ◽  
Medical Training ◽  
Outpatient Service ◽  
Ambulatory Setting ◽  
Subjective Perception ◽  
Internal Medicine Residents ◽  
Co Morbidity ◽  
Test Ordering

The demand for high value health care uncovered a steady trend in laboratory tests ordering and inappropriate testing practices. Residents’ training in laboratory ordering practice provides an opportunity for quality improvement. We collected information on demographics, the main reason for the appointment, preexisting medical conditions and presence of co-morbidities from first-visit patients to the internal medicine outpatient service of our university general hospital. We also collected information on all laboratory tests ordered by the attending medical residents. At a follow-up visit, we recorded residents’ subjective perception on the usefulness of each ordered laboratory test for the purposes of diagnosis, prognosis, treatment or screening. We observed that 17.3% of all ordered tests had no perceived utility by the attending resident. Tests were usually ordered to exclude differential diagnoses (26.7%) and to help prognosis estimation (19.1%). Age and co-morbidity influenced the chosen category to legitimate usefulness of tests ordering. This study suggests that clinical objectives (diagnosis, prognosis, treatment or prevention) as well as personalization to age and previous health conditions should be considered before test ordering to allow a more appropriate laboratory tests ordering, but further studies are necessary to examine this framework beyond this medical training scenario.

From the DSP Perspective: Exploring the Use of Practices That Align With Trauma-Informed Care in Organizations Serving People With Intellectual and Developmental Disabilities

2020 ◽  
Vol 58 (3) ◽  
pp. 208-220
Author(s):  
John M. Keesler
Keyword(s):  
Organizational Culture ◽  
Developmental Disabilities ◽  
Online Survey ◽  
Intellectual And Developmental Disabilities ◽  
Organizational Practices ◽  
Trauma Informed Care ◽  
Trauma Informed ◽  
Current Practices

Abstract Trauma-informed care (TIC) is a systemwide approach that emphasizes organizational practices based upon principles of safety, choice, collaboration, empowerment, and trustworthiness. It is intended to influence an entire organization, with implications for clients and the workforce. The present study explored the extent to which IDD organizations utilize practices that align with TIC with their DSP workforce. Through an online survey, 380 DSPs (84% women; 82% white) responded to a trauma-informed organizational culture measure. Results demonstrated variability across items and significant differences between TIC principles with safety most strongly scored, and collaboration least strongly scored. Perception of organizational practices differed by ethnicity, with non-white DSPs having more favorable responses. Current practices with DSPs align with TIC, however, increased attention through explicit trauma-informed initiatives is warranted.

scholarly journals Promoting Quality Care for Recently Resettled Populations: Curriculum Development for Internal Medicine Residents

2014 ◽  
Vol 6 (2) ◽  
pp. 310-314 ◽  
Author(s):  
Marina MacNamara ◽  
April Wilhelm ◽  
Geolani Dy ◽  
Sarah Andiman ◽  
Carol Landau ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Focus Groups ◽  
Medical Training ◽  
Quality Care ◽  
Hospital Staff ◽  
Online Information ◽  
Preliminary Assessment ◽  
Internal Medicine Residents ◽  
Adequate Education ◽  
Survey Results

Abstract Background Residents report they lack preparation for caring for an increasingly diverse US population. In response, a variety of curricula have been developed to integrate cultural competency into medical training programs. To date, none of these curricula has specifically addressed members of recently resettled populations. Methods A preliminary assessment was conducted among internal medicine (IM) residents at 1 program (N  =  147). Based on 2 conceptual frameworks and the survey results, a pilot curriculum was developed and integrated into the interns' ambulatory block education within the general IM track (n  =  9). It included (1) online information made available to all hospital staff; (2) 4 interactive didactic sessions; and (3) increased exposure to newly arrived patients. The curriculum was qualitatively evaluated through 2 focus groups. Results The preliminary assessment was completed by 101 of 147 residents (69%), with 61% of respondents indicating they felt that they received less than adequate education in this area. Eight of the 9 interns exposed to the new curriculum participated in the focus groups. Overall, respondents reported they thought patient care had improved for recently resettled populations and across their patient panels after exposure to the curriculum. Conclusions This study demonstrated that an intervention that included didactics and enhanced exposure to a diverse population improved IM interns' perceptions of care for all patients, including recently settled individuals.

Sexual Assault

2018 ◽  
Author(s):  
Nisha Verma ◽  
Celeste S Royce
Keyword(s):  
Sexual Assault ◽  
Partner Violence ◽  
Post Traumatic Stress ◽  
Sexually Abusive ◽  
Trauma Informed Care ◽  
Trauma Informed ◽  
Post Traumatic ◽  
Physical Effects ◽  
The Many

Sexual assault affects as many as one-third of women around the world. Sexual assault includes individual traumatic events as well as chronic sexually abusive relationships, and can involve a partner, acquaintance, or stranger. Many women who have experienced sexual assault develop long-term mental and physical effects of their sexual trauma, including post-traumatic stress disorder, alcohol abuse, and dyspareunia. OBGYNs are able to have long-lasting impacts on the many survivors of sexual assault by screening effectively and providing compassionate, trauma-informed care. This review contains 10 figures and 33 references. Keywords: human trafficking, intimate partner violence, primary care, rape, sexual assault, sexual violence, trauma-informed care, women

Human Trafficking

2018 ◽  
Author(s):  
Nisha Verma ◽  
Celeste S Royce
Keyword(s):  
Human Trafficking ◽  
Partner Violence ◽  
Sex Trafficking ◽  
Healthcare Providers ◽  
Health Clinics ◽  
Trauma Informed Care ◽  
Trauma Informed ◽  
The Many ◽  
Modern Day Slavery

Human sex trafficking, often referred to as modern-day slavery, is a major global human rights problem with at least 4.5 million people trafficked for commercial sex annually. Many of these women interface with the medical system regularly, often in women’s health clinics and the emergency departments. Therefore, it is important for healthcare providers to be able to identify red flags for human trafficking, to be able to screen effectively, and to know how to connect patients with resources in the community. It is also important for healthcare providers to be aware of the many long-term health effects related to sexual trauma that victims of human trafficking may develop. OBGYNs are able to have long-lasting impacts on the many survivors of human sex trafficking by screening effectively and providing compassionate, trauma-informed care. This review contains 4 figures, and 3 tables, and 40 references. Keywords:  Sexual assault, sexual violence, Intimate partner violence, Human trafficking, Rape, Trauma-informed care, Women, Primary Care, Obstetrics and Gynecology.

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