Use of Metaphor as an Explanation Tool in Adverse Childhood Experiences Simulation Training.

INTRODUCTION: Adverse childhood experiences (ACEs) have profound implications for adult health. Health care practitioners need effective communication tools for trauma-sensitive inquiries with patients. This study aimed to describe characteristics of effective metaphor use by health care trainees when discussing ACEs and health with adult patients, and to provide example metaphors for clinicians to use to sensitively address ACEs. METHODS: Trainees engaged in a videorecorded simulation as part of a model to teach health care practitioners communication skills related to ACEs. Videos were identified in which the trainee used a metaphor to help explain ACEs during the encounter. Encounter segments that used metaphors were transcribed and metaphor type, duration, and recurrence were coded using a standardized rubric. Each metaphor was scored for effectiveness and basic statistical analysis was conducted. RESULTS: Of the 122 videos reviewed, 24 types of metaphors were used, with the most common being the overloaded backpack (n = 24). Mean metaphor duration was 37 s (SD = 24 s). Metaphors rated as effective were shorter and less variable in duration (31.8 s, SD = 14.7 s) than those rated as ineffective (39 s, SD = 34 s). No one metaphor performed significantly better and most of the metaphors were evaluated as being adequate or effective. CONCLUSION: Literary devices like metaphors may be efficient and effective explanatory tools to improve clinician communication skills and patient understanding in addressing sensitive topics, such as ACEs. Minimal time investment is required to employ metaphors in ACEs discussions. The authors found no single metaphor that to be clearly superior, indicating that patient-centered metaphor use may improve communication between clinicians and patients who experienced childhood trauma.

An evaluation of a simulation and video-based training program to address adverse childhood experiences.

Adverse Childhood Experiences (ACEs) are multiple sources of maltreatment and household dysfunction with tremendous impact on health. A trauma-informed (TI) approach is preferred when working with patients with ACEs. The Professional ACEs-Informed Training for Health© (PATH©) educational program and simulation experience using standardized patients (SP) was developed to help healthcare professionals address ACEs with adults. PATH© is a 3-4 hour curriculum comprised of lecture and discussion, video-based demonstration, simulation experience, and debriefing. It was first developed for primary care (PC) residents in family medicine and internal medicine, and subsequently modified for occupational therapy (OT) and physical therapy (PT) students. This study evaluates a preliminary dataset focusing on PATH© skills of PC residents and OT and PT students during simulation. Recordings of 53 learner-SP encounters from 15 OT and PT students and 38 PC residents were coded using standardized behavioral codes. A subset of ten recordings of PC residents who participated in simulations in the first and fourth year of the training program allowed for evaluation of training outcomes over time. Results showed that medical residents and OT and PT students demonstrated skills during SP encounters congruent with TI training on addressing ACEs with adults, particularly in explaining ACEs, demonstrating empathy, collaborative treatment planning, and stigma reduction. PC residents showed both positive and negative changes in PATH©-specific skills from year 1 to 4 of the training program. This study supports the PATH© model and simulation-based training in preparing clinicians to address ACEs with adults and provides insight into further curriculum improvement.

Using Social Simulation to Teach Rehabilitation Science Students About Adverse Childhood Experiences and Trauma Informed Care.

Recent research has identified the relationships between adverse childhood experiences (ACEs) and adult adoption of health risk behaviors, negative health outcomes, and measures of well-being. Given these findings, it is important to consider training models that educate allied health students about the relevance of ACEs to adult health across a myriad of practice settings and equip them with the skills necessary to help patients with a history of ACEs. Physical therapy (PT) and occupational therapy (OT) are key members of the health care team, well positioned to address ACEs with their patients. This study reports on the evaluation of an innovative simulation-based training program, Professional ACE-Informed Training for Health Professionals (PATH), conducted with 26 second-year PT and OT students. Pre- and post-training measures consisted of the General Self-Efficacy Scale, Adult Hope Scale, and a test of knowledge and familiarity with ACEs and trauma-informed care (TIC). Results indicate that self-efficacy, hope, and knowledge of ACEs and TIC increased from pre- to post-tests for both PT and OT students. Qualitative results demonstrate that PT and OT students appreciated participating in the training model and learned a great deal from their experiences; however, they would like even more information and instruction on how to work effectively with patients who have a history of ACEs. Implications of this study and a discussion of the importance of continuing and expanding such training in rehabilitation sciences education and training are provided.