Adverse Childhood Experiences and Trauma-Informed Care: An Educational Module for Pediatric Residents

Purpose: The epidemic of adverse childhood experiences (ACEs) and toxic stress has many known health consequences to children, families and communities. Extensive literature exists linking ACEs to increased morbidity and mortality. Pediatricians are in a pivotal position to help families understand ACEs and their impact, and to practice trauma informed care (TIC). Despite the significance of ACEs and TIC, structured education was not available to pediatric residents within our program. Residents' understanding, comfort, and perceived importance of these topics is currently unknown. Therefore, our objectives were to (1) identify pediatric residents' baseline understanding, comfort, and perceived importance of ACEs and TIC; (2) develop an online educational module to improve understanding of and comfort with ACEs and TIC; and (3) measure the impact of the module on residents' under1standing, comfort, and perceived importance of ACEs and TIC. Methods: Module developers attended an ACE training session and reviewed published research. A self-directed, interactive module was designed, edited by stakeholders, and embedded into the required week-long Child Advocacy rotation for second year pediatric residents. Pre- and post-module surveys using a 5 point Likert Scale (1: low, 3: neutral, 5: high) were administered to assess knowledge and confidence levels both before and 1 to 3 months after module completion. The results are shown as the median response number on the 5 point Likert Scale (pre-module n=29 and post-module n=11). Results: The pre-module survey demonstrated that residents do not feel confident in discussing ACEs, TIC or resiliency (median = 2/5, slightly confident) with patients and families and report mediocre knowledge of these issues (median = 3/5, neutral). Residents reported rarely discussing these topics with families in their continuity clinic (median = 1 or 2/5, no visits or rare visits) despite considering the topic very important to discuss (median = 5/5, very important). Post-module surveys showed significant improvement in residents' knowledge and confidence (median = 4/5, somewhat confident p