Arkansas has one of the highest incidences of child abuse in the United States. Anita Akbar Ali, MD and others wanted to gauge how comfortable residents were in identifying and reporting child abuse and develop a curriculum to give them more confidence in recognizing and reporting abuse, in hopes of increasing reporting and ultimately reducing the rates of child abuse in the state. Dr. Akbar Ali’s poster, Child Abuse Curriculum for Anesthesiology Residents, presented at the 2020 ACGME Annual Educational Conference in San Diego, California in February, reports on the knowledge, attitude, confidence, and commitment residents had about reporting child abuse before and after participating in the curriculum.
Primary Author: Anita Akbar Ali, MD
Co-Authors: Michael E. Anders, PhD; Anna Marie Onisei, MD; Dyann Daley, MD
ACGME: Tell us about your academic and professional role.
Akbar Ali: I am a pediatric anesthesiologist at Arkansas Children's Hospital. I am also the program director for the pediatric anesthesiology fellowship. Arkansas Children’s Hospital, being the only tertiary care pediatric facility and Level I trauma center in the state of Arkansas, serves approximately 500,000 patients who have a wide variety of disease processes and backgrounds. As an academician, I personally feel privileged to have the opportunity to help our learners explore the interesting field of pediatric anesthesia and influence their learning experiences with life changing events.
ACGME: Can you briefly describe your project for us?
Akbar Ali: Our team has developed a child abuse curriculum for anesthesiology residents aiming to improve knowledge, attitude, confidence, and commitment in recognizing and reporting child abuse. It comprises of a pre- and a post-questionnaire, two simulation scenarios (one pre-operative and one intra-operative), and a peer instruction learning activity based on early childhood adverse experiences literature. Quantitative analysis is based on the pre- and post-questionnaires, whereas qualitative results are assessed by reviewing the video tapes of simulation sessions and debriefings.
ACGME: What inspired you to do this project?
Akbar Ali: Arkansas has one of the highest incidences of child abuse in the nation. This is one topic that is rarely taught formally as part of medical residency training. It can take up to three visits with the primary care physician to even suspect child abuse, which may be too late for a child to be saved. Also, reporting by physicians and medical personnel is not frequent, indicating the potential lack of knowledge and awareness on this topic. A child with abuse can present to any physician but certain groups like emergency medicine, general surgery, neurological surgery, orthopedics, and anesthesiology are a few that may encounter these victims in the hospital when they need medical care. Focusing the high incidence of child maltreatment in Arkansas and the fact there is no formal training for residents, we decided to develop this curriculum.
ACGME: What did you discover?
Akbar Ali: The majority of the residents were severely deficient in their knowledge regarding child abuse. It was surprising to see how many thought it was not their duty to report child abuse if suspected. The session did improve significantly the knowledge and confidence amongst residents evident by the post-test results.
ACGME: What was the main takeaway?
Akbar Ali: There is a severe deficiency of awareness on this important topic. Similar curriculum and sessions can be implemented across different specialties, institutions, and non-physician medical personnel as part of their formal training to help save this patient population.
ACGME: Who could benefit from this?
Akbar Ali: Child abuse victims as well as every patient who has risk factors. The overarching goal is to increase reporting and to eventually eliminate or minimize the risk factors responsible for such abuse. It will also benefit learners who develop confidence and professional satisfaction as they help prevent abuse and save these victims.
ACGME: Any additional follow-up plans?
Akbar Ali: Once we complete the anesthesiology residents’ trial, we plan to implement this curriculum to other specialties like general surgery, orthopaedics, emergency medicine, and pediatric medicine. Further extension is planned to work with non-physician medical personnel and with the Arkansas Commission on Child Abuse, Rape and Domestic Violence to help disseminate this training across the state.