Antonia Chiesa, MD, MD, University of Colorado Denver, Aurora, CO, Andrew Sirotnak, MD, University of Colorado Denver, Aurora, CO, Jennifer Soep, MD, University of Colorado Denver, Aurora, CO, Julie Noffsinger, MD, University of Colorado Denver, Aurora, CO
Background:Little has been published describing or evaluating how medical students are taught child maltreatment. In 2009, our group described a successful child abuse curriculum; however, it was noted that few students asked important social history questions during an Observed Structured Clinical Exam (OSCE). Identification of abuse is important, but screening for high risk factors is critical for prevention.
Methods:Our curriculum was modified from an on-line case/group discussion to an in-person problem-based learning (PBL) cases with faculty facilitated role play and group discussion. Performance on the OSCE checklist was compared for students in 2010 (old curriculum) and 2012 (new curriculum) using a Pearson Chi Square test (Ç2). For the new curriculum, student comfort level with child abuse issues was assessed with pre and post curriculum surveys using a 4 point Likert scale (1=strongly disagree, 4=strongly agree) and analyzed with a paired t-test. Results:After the new curriculum, there was an increased percentage of students asking about discipline (50% up from 35%; Ç2=4.28, p<0.04) as well as other risk factors for abuse including drinking and violence (69% up from 15%; Ç2=49.68, p<.0001). On the self-assessment surveys, there was improvement in students perceived comfort in identifying abuse (t=4.38,p<.0001), completing a social history (t=5.36,p<.0001), and ruling out mimics of abuse (t=6.95,p<.0001). Immediately after receiving the curriculum, 98% of students agreed or strongly agreed they felt comfortable with the training they had received, but three weeks later, after completing the OSCE, only 53% of those same students agreed or strongly agreed they had adequate training in child abuse.
Discussion:During PBL cases, students are able to identify child abuse risk factors and to role play taking a social history for these risk factors which seems to translate into improved performance for this skill in the OSCE. The difference in the students perception of their adequacy of training immediately after their training compared to after the OSCE likely reflects the discomfort in addressing this difficult topic in practice.