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Abstract Background Morning report is a fundamental component of internal medicine training and often represents the most significant teaching responsibility of Chief Residents. We sought to define Chief Resident behaviors essential to leading a successful morning report. Methods In 2016, we conducted a multi-site qualitative study using key informant interviews of morning report stakeholders. 49 residents, Chief Residents, and faculty from 4 Internal Medicine programs participated. Interviews were analyzed and coded by 3 authors using inductive reasoning and thematic analysis. A preliminary code structure was developed and expanded in an iterative process concurrent with data collection until thematic sufficiency was reached and a final structure was established. This final structure was used to recode all transcripts. Results We identified four themes of Chief Resident behaviors that lead to a successful morning report: report preparation, delivery skills, pedagogical approaches, and faculty participation. Preparation domains include thoughtful case selection, learning objective development, content editing, and report organization. Delivery domains include effective presentation skills, appropriate utilization of technology, and time management. Pedagogical approach domains include learner facilitation techniques that encourage clinical reasoning while nurturing a safe learning environment, as well as innovative teaching strategies. Moderating the involvement of faculty was identified as the final key to morning report effectiveness. Specific behavior examples are provided. Conclusion Consideration of content preparation, delivery, pedagogical approaches, and moderation of faculty participation are key components to Chief Resident-led morning reports. Results from this study could be used to enhance faculty development for Chief Residents.

Abstract A patient’s current or previous experience of trauma may have an impact on their health and affect their ability to engage in health care. Every year, millions of patients who have experienced physically or emotionally traumatic experiences present to emergency departments (ED) for care. Often, the experience of being in the ED itself can exacerbate patient distress and invoke physiological dysregulation. The physiological reactions that lead to fight, flight, or freeze responses can make providing care to these patients complex and can even lead to harmful encounters for providers. There is a need to improve the care provided to the vast number of patients in the ED and create a safer environment for patients and healthcare workers. One solution to this complex challenge is understanding and integrating trauma-informed care (TIC) into emergency services. The federal Substance Abuse and Mental Health Service Administration’s (SAMHSA) six guiding principles of TIC offer a universal precaution framework that ensures quality care for all patients, providers, and staff in EDs. While there is growing evidence that TIC quantitatively and qualitatively improves ED care, there is a lack of practical, emergency medicine-specific guidance on how to best operationalize TIC. In this article, using a case example, we outline how emergency medicine providers can integrate TIC into their practice.

Introduction The majority of medical schools utilize peer physical examination (PPE) as a teaching tool. In recent years, trauma-informed care (TIC) has been applied as a framework for physical examination to prevent patient retraumatization. Although medical students experience rates of trauma comparable to those of the general population, trauma-informed principles have not been integrated into PPE curricula. Methods We created a novel trauma-informed PPE (TIPPE) curriculum grounded in core principles of TIC for first-year medical students. Perceptions of safety, trust, and autonomy in PPE practice were compared between the 152 students participating in the TIPPE curriculum and a control group from the prior year. Results Twenty-nine percent of the 42 first-year medical student respondents in our sample endorsed a prior diagnosis with a mental health condition, and 33% endorsed a trauma history. Approximately 5% of student respondents (n = 5) in the interventional and control groups reported that PPE triggered recall of a prior traumatic event. Following participation in the TIPPE curriculum, familiarity with TIC principles rose significantly, although overall rating of the experience did not change. Thematic analysis of qualitative data highlighted students’ desire for earlier and increased inclusion of TIC principles in the curriculum. Discussion Our results demonstrate the necessity of adapting the standard PPE model in medical education in response to the real risk of student retraumatization. In sharing our curriculum, associated resources, and student-derived suggestions for further improvement, we provide a blueprint for other institutions seeking to train trauma-informed clinicians.

Introduction Trauma is prevalent in the general population in various forms and has lasting effects on health. Physicians routinely examine patients who have experienced trauma, although most providers lack training in trauma-informed care, a well-established framework for providing quality care to trauma survivors. To address this gap, we implemented a novel curriculum on trauma-informed physical examination skills for first-year medical students. Methods We held a large-group lecture for 148 first-year medical students and 40 faculty members to introduce a framework for a trauma-informed physical examination, using a standardized patient for demonstration. The framework included specific language and behaviors to employ before, during, and after the examination in order to enhance patients' sense of safety, control, and trust. Students then transitioned to small groups to practice performing vital signs using a trauma-informed approach, with supervision from MD faculty. Results Five-point scales were used to evaluate students' knowledge gained from the session and satisfaction with the session. Overall satisfaction with the session was rated as 4.08 (SD = 0.81), and students felt that the session was highly effective in defining a trauma-informed physical examination (4.29, SD = 0.70). Discussion The session was well received and effective in teaching future physicians trauma-informed skills. We offer other institutions a model for incorporating trauma-informed care into clinical skills curricula.

Introduction Intimate partner violence is a serious public health concern in the United States. Despite recommendations that physicians should routinely screen their patients, research has shown that lack of specific training has resulted in many health care professionals feeling unable to adequately perform this difficult but vital task. Though many educational resources exist to teach intimate partner violence screening, they often lack specific guidance on how to navigate this difficult conversation. In addition, they often lack formal teaching on how to counsel and refer patients who are victims of intimate partner violence. Methods This unique module, intended for a small-group setting of four to eight students, contains an intimate partner violence checklist with sample language that covers both screening and counseling using a motivational interviewing framework. Additional materials include a checklist companion for tips on how to navigate the conversation, two cases for role-play, a facilitator guide, and an objective structured clinical encounter case and assessment rubric. Results This module was given to 260 second-year medical students at the Warren Alpert Medical School between 2015 and 2017 and was rated highly by almost 90% of students. Discussion After completing this module, learners will be able to appropriately screen for intimate partner violence as well as counsel and refer patients who have screened positive. By implementing this module, educators can increase the number of health care professionals able to broach this difficult conversation with patients who may be in need of help and may otherwise go unaided.

Background: The Veterans Health Administration (VHA) entered the COVID-19 pandemic crisis with an existing and robust telehealth program, but it still faces a fundamental paradigm shift as most routine outpatient in-person care was converted to telehealth visits. Veterans are a highly trauma-exposed population, and VHA has long offered effective telemental health services. Natural disasters and pandemics like COVID-19 are known to be traumatic. Those with preexisting trauma exposure and mental health conditions are often at greater risk than the general population for long-term adverse health sequelae. Application of trauma-informed principles to telehealth care is critical and timely., Observations: Trauma-focused care (including telemental health) refers to evidence-based treatment models that directly facilitate recovery from trauma-related conditions like posttraumatic stress disorder. Despite the widespread availability of trauma-focused treatment in VHA, not all veterans chose to engage in it. In contrast, trauma-informed care (TIC) is a global, "universal precautions" approach to providing strengths-based, collaborative quality medical care in any discipline or location. In this article the authors, all primary care and mental health clinicians at VHA, advocate for the application of the 6 Substance Abuse and Mental Health Services Administration principles of trauma-informed care to telehealth. Using examples from telehealth research conducted in trauma-exposed patient populations, we illustrate the characteristics of telehealth that are well suited to delivery of trauma-informed care and suggest readily applicable strategies that can be used across disciplines including primary care and medical/surgical specialties. A primary care patient case scenario is included to illustrate how telehealth visits can be trauma-informed., Conclusions: Telehealth expansion has occurred nationally out of necessity during the COVID-19 pandemic. Trauma-informed virtual care has the potential to ensure and even expand continuity of medical care by fostering safe and collaborative interactions between patients and the health care team., Competing Interests: Author disclosures The authors report no actual or potential conflicts of interest with regard to this article., (Copyright © 2020 Frontline Medical Communications Inc., Parsippany, NJ, USA.)