Criterion A Trauma Exposures in Medical Education

Friday, November 11, 2022

11:00 AM – 12:30 PM

Location: Room 209-211

Presenting Author(s)

Isabella Kratzer, MD

Child & Adolescent Psychiatry Fellow
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania

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Co-Author(s)

Paul Lakin, MS

Biostatistician
CorEvitas, LLC
Arlington, Massachusetts
Karen Lewicki, MD, JD

Medical Director, Inpatient Psychiatry
Veterans Health Administration
White River Junction, Vermont
Terry Rabinowitz, MD, DDS, FACLP, FAPA, FATA

Professor, Departments of Psychiatry and Family Medicine
Larner College of Medicine at the University of Vermont
Burlington, Vermont

Abstract:

Background: While clinical trauma exposures are ubiquitous in medicine, studies focus on posttraumatic stress disorder (PTSD) rates and query patients or attending physicians. Few studies quantify these exposures or compare their incidence across medical student education (Haglund, 2009). This study aimed to determine the prevalence of clinical setting Criterion A trauma exposures throughout medical student training; we hypothesized the data would demonstrate need for institutional changes in student support and trauma-focused curricula.

Methods: We electronically distributed an original, IRB-exempted, cross-sectional REDCap survey to medical students and recent graduates in the classes of 2019-2022, assessing respondents’ experience with clinical setting trauma exposures. We adopted DSM-5 parameters for Criterion A trauma exposures, defining a set of exposures necessary but not sufficient to diagnose PTSD (APA, 2013). The sums of exposures were described by mean, standard deviation, median, and 25^th and 75^th percentiles. Bias-corrected and accelerated bootstrap confidence intervals were used to avoid parametric assumptions about distribution.

Results: Across class cohorts, 78 responses revealed an average of 17.62 (95% CI: 13.92, 22.92) clinical trauma exposures per respondent. Respondents from the most senior class of 2019 had experienced an average of 45.67 (30.00, 65.00) exposures, compared to 22.71 (17.43, 33.52), 16.43 (11.41, 27.35), and 2.86 (1.21, 7.20) for the classes of 2020, 2021, and 2022, respectively.

Discussion: In our study population, we observed a mean number of clinical-setting Criterion A trauma exposures well above values established by limited available studies on this subject (Haglund, 2009). Our data revealed an increase in average exposures positively correlated with time spent in clinical settings. Given medical training’s well-established psychological stressors (Dyrbye, 2006), clinical trauma exposures appear to represent further threat to trainee wellbeing. Many medical students rotate on Consultation-Liaison (CL) Psychiatry services, providing opportunities for intervention and transformation of the ways in which we address trauma in medical education.

Conclusions: Given the CL psychiatrist’s role in assessing the impact of traumatic medical events and hospital courses, they are uniquely poised to debrief these events with trainees and advocate for institutional action to better support medical students and prepare them for healthy careers as physicians.

References:

American Psychiatric Association. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders Fifth Edition.; 2013. doi:10.1176/appi.books.9780890425596.744053

Dyrbye, L. N., Thomas, M. R., & Shanafelt, T. D. (2006). Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. In Academic Medicine. https://doi.org/10.1097/00001888-200604000-00009

Haglund, M. E. M., Aan Het Rot, M., Cooper, N. S., Nestadt, P. S., Muller, D., Southwick, S. M., & Charney, D. S. (2009). Resilience in the third year of medical school: A prospective study of the associations between stressful events occurring during clinical rotations and student well-being. Academic Medicine. https://doi.org/10.1097/ACM.0b013e31819381b1