Background: Two decades ago, the medical literature reported an association between adverse childhood events (ACEs) and poor adult health outcomes. In 2012, the AAP issued a policy statement calling attention to toxic stress. Yet, a majority of pediatricians rated themselves as “not familiar” with childhood trauma in national surveys. Despite its importance, there is no standard structured curriculum for educating residents and medical students on these topics. A review of the medical education literature reveals a handful of medical schools and residency programs with independent lectures, but none with a cohesive curriculum. The AAP with the Department of Pediatrics at the University of California Los Angeles (UCLA) and the University of Massachusetts, with funding from the Substance Abuse and Mental Health Services Administration, implemented a national educational program titled Pediatric Approach to Trauma, Treatment, and Resilience (PATTeR) for practicing pediatricians. A secondary project goal was to educate pediatric trainees. The curriculum was adapted for pediatric trainees to develop familiarity with childhood trauma, its clinical presentation, its effects on children, and resilience promotion. The curriculum was trialed with UCLA pediatric interns. Methods: 28 categorical pediatric interns at UCLA attended the adapted PATTeR training during their required four-week Developmental-Behavioral Pediatrics rotation beginning in January 2020. The original six-session Level 1 Trauma Aware PATTeR curriculum was adapted into two three-hour in-person sessions for pediatric trainees, maintaining the mentored case-based learning approach. A pediatric faculty member and clinical psychologist with certification in trauma-informed mental healthcare delivered and facilitated each session. Trainees were asked to complete pre- and a post-participation electronic surveys based on the Kirkpatrick Education Model. They rated their self-assessed knowledge and skills acquisition on 20 course topics that included the physiology of traumatic stress, the clinical presentation of trauma in pediatrics, and the elements of responsive care. Excel was used to analyze survey responses. Additional free response questions inquired about lessons learned and whether and how participating interns applied course material into clinical practice. Results: As of April 30, 2020, 15 of 28 pediatric interns have completed the course. Analysis of pre- and post-self-assessments of knowledge and skills acquisition in physiology of trauma, clinical presentation, and responsive care, demonstrated increased proficiency of an average of 1.8 levels across items (Figure 1). Participants’ self-reflection of course impact and implemented changes in care were captured in the free response section (Table 1). Conclusions: The adapted PATTeR curriculum provides a feasible standardized educational modality for pediatric trainees. Adoption of a comprehensive standardized curriculum about trauma-informed care and resilience promotion enhanced resident self-reported knowledge and skills. The PATTeR curriculum could reduce the variation in education about this important topic nationally if implemented in pediatric residency programs and result in a new generation of trauma-responsive clinicians.
Training Pediatric Interns to Be Trauma-Responsive Providers By Adapting A National Curriculum for Pediatricians
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Christine K. Thang, Moira Szilagyi, Samantha Kucaj, Nathalie Lopez, Andrea Ocampo, Moira Inkelas, Heather Forkey; Training Pediatric Interns to Be Trauma-Responsive Providers By Adapting A National Curriculum for Pediatricians. Pediatrics March 2021; 147 (3_MeetingAbstract): 91–92. 10.1542/peds.147.3MA1.91
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