Hospital-based Child Abuse Team Clinical Rotation Learning Contract Trends of Self-identified Learning Needs

Background: Physicians are legally mandated to report reasonable suspicions for child maltreatment. At the present, medical education on child maltreatment topics varies among institutions. Aligning with principles of adult learning and recognizing the variability in the education and experiences of medical students, pediatric residents and fellows rotating with our hospital-based child abuse team, a learning contract (LC) was implemented in 2005. LCs enhance learning by personalizing the learning experience. Completed LCs were analyzed and explored for trends of self-identified learning objectives delineated by medical students and post-graduate trainees at the start of their clinical rotation.

Methods: This study was a retrospective review of 144 LCs completed by 44 medical students and 100 post-graduate trainees from October 2005 to February 2021. LCs were obtained as a standard practice during divisional rotations. The LCs were de-identified and assigned a unique identifier. The learner’s training level and date of the rotation were retained. Illegible LCs were excluded. Trainees identified their personal learning objectives, Likert rating of strengths/weakness, ACGME categorization of the learning objective, and the plan for achieving them during the rotation. Documented learning objectives were entered into a database and categorized by topics corresponding to self-identified learning needs.

Results: Of the 144 LCs completed and analyzed for learning objective trends. Medical students (MS) and post-graduate trainees (PG) shared similar learning objectives. MS (77.3%) and PG (71.0%) sought to improve physical exam skills. MS (65.9%) and PG (70.0%) wished to hone history taking and interview skills. MS (43.2%) and PG (37.0%) desired to learn more about the reporting process for child abuse, court testimonies, and medicolegal terminology. Approximately one-quarter of MS and PG inquired about other important topics such as identifying injuries, signs and symptoms of abuse, radiologic findings, the documentation process, and community resources.

Conclusion: Medical trainees rotating with a hospital-based child abuse pediatrics team self-identified many common basic learning objectives for their clinical rotation. The trending topics shared by most trainees included becoming proficient in history taking and physical exam skills and the medicolegal aspects of child maltreatment. Fulfillment of these objectives equips students and trainees with a toolkit to recognize and respond to patients who may have experienced maltreatment. The life-long impact of child maltreatment and physicians’ legal mandate to report it warrant the inclusion of child-abuse specific learning objectives in medical education. Since the subspecialty of child abuse pediatrics is small and exposure limited, achievement of these basic learning objectives should not be contingent upon completion of a child abuse pediatrics rotation. These trending self-identified learning objectives can be a guide to standardize curricula across institutions to better equip medical students and post-graduate trainees to care for child abuse victims in their future practices.