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Mosier-Mills A, Vagwala M, Potter J, Elisseou S. Respecting Body-Size Diversity in Patients: A Trauma-Informed Approach for Clinicians. Perm J 2024; 28:206-211. [PMID: 37981843 PMCID: PMC10940234 DOI: 10.7812/tpp/23.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
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Elisseou S, Shamaskin-Garroway A, Kopstick AJ, Potter J, Weil A, Gundacker C, Moreland-Capuia A. Leading Organizations From Burnout to Trauma-Informed Resilience: A Vital Paradigm Shift. Perm J 2024; 28:198-205. [PMID: 38332699 PMCID: PMC10940251 DOI: 10.7812/tpp/23.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Affiliation(s)
- Sadie Elisseou
- Department of Medicine, VA Boston Health Care System, Harvard Medical School, and Boston University School of Medicine, Boston, MA, USA
| | - Andrea Shamaskin-Garroway
- Departments of Psychiatry and Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Avi Joshua Kopstick
- Division of Pediatric Critical Care Medicine, Texas Tech University Health Sciences Center El Paso, Lubbock, TX, USA
| | - Jennifer Potter
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Amy Weil
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Constance Gundacker
- Department of Pediatrics—General and Community, Medical College of Wisconsin, Milwaukee, WI, USA
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Yang Y, Schulze A, Bekui AM, Elisseou S, Sun SW, Hay S, Moriarty JP, Holt SR. Chief resident behaviors that lead to effective morning reports, a multisite qualitative study. BMC Med Educ 2023; 23:789. [PMID: 37875921 PMCID: PMC10598973 DOI: 10.1186/s12909-023-04762-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/10/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Morning report is a fundamental component of internal medicine training and often represents the most significant teaching responsibility of Chief Residents. We sought to define Chief Resident behaviors essential to leading a successful morning report. METHODS In 2016, we conducted a multi-site qualitative study using key informant interviews of morning report stakeholders. 49 residents, Chief Residents, and faculty from 4 Internal Medicine programs participated. Interviews were analyzed and coded by 3 authors using inductive reasoning and thematic analysis. A preliminary code structure was developed and expanded in an iterative process concurrent with data collection until thematic sufficiency was reached and a final structure was established. This final structure was used to recode all transcripts. RESULTS We identified four themes of Chief Resident behaviors that lead to a successful morning report: report preparation, delivery skills, pedagogical approaches, and faculty participation. Preparation domains include thoughtful case selection, learning objective development, content editing, and report organization. Delivery domains include effective presentation skills, appropriate utilization of technology, and time management. Pedagogical approach domains include learner facilitation techniques that encourage clinical reasoning while nurturing a safe learning environment, as well as innovative teaching strategies. Moderating the involvement of faculty was identified as the final key to morning report effectiveness. Specific behavior examples are provided. CONCLUSION Consideration of content preparation, delivery, pedagogical approaches, and moderation of faculty participation are key components to Chief Resident-led morning reports. Results from this study could be used to enhance faculty development for Chief Residents.
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Affiliation(s)
- Yihan Yang
- Washington State University, Internal Medicine Residency Program - Everett, Everett, WA, USA
| | - Arian Schulze
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, USA
| | | | | | | | | | - John P Moriarty
- Yale Primary Care Internal Medicine Residency Program, Yale School of Medicine, New Haven, CT, USA
| | - Stephen R Holt
- Yale Primary Care Internal Medicine Residency Program, Yale School of Medicine, New Haven, CT, USA.
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Elisseou S. Trauma-Informed Care: A Missing Link in Addressing Burnout. J Healthc Leadersh 2023; 15:169-173. [PMID: 37637484 PMCID: PMC10455772 DOI: 10.2147/jhl.s389271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/04/2023] [Indexed: 08/29/2023] Open
Abstract
The Covid-19 pandemic and national movements for health equity have highlighted the impact of trauma on public health as well as on health worker well-being. As burnout rates across healthcare climb, we seek creative and effective solutions. Current anti-burnout strategies focus on much needed systems solutions for employee success; however, they often lack a trauma-informed approach. Trauma is highly prevalent in society at large, and health workers are further exposed to trauma in the course of their professional studies and duties. Common symptoms of burnout may actually be manifestations of traumatic stress. Trauma-informed care (TIC) is a strategic framework and growing social movement for providing quality care to survivors of individual, interpersonal, collective, and structural trauma. Importantly, TIC has practical applications to address our healthcare burnout epidemic. In this perspective piece, an expert describes a trauma-informed lens through which to view burnout solutions using SAMHSA's 4 Rs of a trauma-informed approach: 1) Realize the widespread impact of trauma, 2) Recognize the signs and symptoms in patients and staff, 3) Respond by integrating knowledge about trauma into practice, and actively 4) Resist re-traumatization. Moving forward, key stakeholders must collaborate to build and refurbish efficient systems alongside a trauma-informed organizational model. TIC can transform the healthcare experience for patients and employees alike by fostering community, empowerment, and healing.
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Affiliation(s)
- Sadie Elisseou
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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Ashworth H, Lewis-O'Connor A, Grossman S, Brown T, Elisseou S, Stoklosa H. Trauma-informed care (TIC) best practices for improving patient care in the emergency department. Int J Emerg Med 2023; 16:38. [PMID: 37208640 DOI: 10.1186/s12245-023-00509-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/03/2023] [Indexed: 05/21/2023] Open
Abstract
A patient's current or previous experience of trauma may have an impact on their health and affect their ability to engage in health care. Every year, millions of patients who have experienced physically or emotionally traumatic experiences present to emergency departments (ED) for care. Often, the experience of being in the ED itself can exacerbate patient distress and invoke physiological dysregulation. The physiological reactions that lead to fight, flight, or freeze responses can make providing care to these patients complex and can even lead to harmful encounters for providers. There is a need to improve the care provided to the vast number of patients in the ED and create a safer environment for patients and healthcare workers. One solution to this complex challenge is understanding and integrating trauma-informed care (TIC) into emergency services. The federal Substance Abuse and Mental Health Service Administration's (SAMHSA) six guiding principles of TIC offer a universal precaution framework that ensures quality care for all patients, providers, and staff in EDs. While there is growing evidence that TIC quantitatively and qualitatively improves ED care, there is a lack of practical, emergency medicine-specific guidance on how to best operationalize TIC. In this article, using a case example, we outline how emergency medicine providers can integrate TIC into their practice.
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Affiliation(s)
- Henry Ashworth
- Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA, USA.
| | | | - Samara Grossman
- Department of Psychiatry, Boston Public Health Commission, Boston, MA, USA
| | - Taylor Brown
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sadie Elisseou
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Hanni Stoklosa
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- HEAL Trafficking, Los Angeles, CA, USA
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Elisseou S, Holt SR. Effective Strategies for Planning and Facilitating Morning Report. J Grad Med Educ 2022; 14:260-264. [PMID: 35754651 PMCID: PMC9200236 DOI: 10.4300/jgme-d-21-01084.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sadie Elisseou
- Sadie Elisseou, MD, is Clinical Instructor of Medicine, Department of Medicine, Harvard Medical School
| | - Stephen R. Holt
- Stephen R. Holt, MD, MSc, is Associate Program Director, Yale Primary Care Internal Medicine Residency, and Associate Professor of Medicine, Department of Medicine, Yale School of Medicine
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Gerber MR, Elisseou S, Sager ZS, Keith JA. Trauma-Informed Telehealth in the COVID-19 Era and Beyond. Fed Pract 2020; 37:302-308. [PMID: 32908333 PMCID: PMC7473719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The Veterans Health Administration (VHA) entered the COVID-19 pandemic crisis with an existing and robust telehealth program, but it still faces a fundamental paradigm shift as most routine outpatient in-person care was converted to telehealth visits. Veterans are a highly trauma-exposed population, and VHA has long offered effective telemental health services. Natural disasters and pandemics like COVID-19 are known to be traumatic. Those with preexisting trauma exposure and mental health conditions are often at greater risk than the general population for long-term adverse health sequelae. Application of trauma-informed principles to telehealth care is critical and timely. OBSERVATIONS Trauma-focused care (including telemental health) refers to evidence-based treatment models that directly facilitate recovery from trauma-related conditions like posttraumatic stress disorder. Despite the widespread availability of trauma-focused treatment in VHA, not all veterans chose to engage in it. In contrast, trauma-informed care (TIC) is a global, "universal precautions" approach to providing strengths-based, collaborative quality medical care in any discipline or location. In this article the authors, all primary care and mental health clinicians at VHA, advocate for the application of the 6 Substance Abuse and Mental Health Services Administration principles of trauma-informed care to telehealth. Using examples from telehealth research conducted in trauma-exposed patient populations, we illustrate the characteristics of telehealth that are well suited to delivery of trauma-informed care and suggest readily applicable strategies that can be used across disciplines including primary care and medical/surgical specialties. A primary care patient case scenario is included to illustrate how telehealth visits can be trauma-informed. CONCLUSIONS Telehealth expansion has occurred nationally out of necessity during the COVID-19 pandemic. Trauma-informed virtual care has the potential to ensure and even expand continuity of medical care by fostering safe and collaborative interactions between patients and the health care team.
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Affiliation(s)
- Megan R Gerber
- and are Primary Care Physicians; and is a Hospice and Palliative Care Physician at the New England Geriatric Research Education and Clinical Center; all at the Veterans Affairs Boston Healthcare System in Massachusetts. is a Clinical Psychologist at Bay Pines Veterans Affairs Healthcare System and an Associate Professor of Psychology at the University of Central Florida College of Medicine in Orlando. Megan Gerber is an Associate Professor of Medicine at Boston University School of Medicine. Sadie Elisseou is an Instructor in Medicine and Zachary Sager is an Instructor in Psychiatry, both at Harvard Medical School in Boston
| | - Sadie Elisseou
- and are Primary Care Physicians; and is a Hospice and Palliative Care Physician at the New England Geriatric Research Education and Clinical Center; all at the Veterans Affairs Boston Healthcare System in Massachusetts. is a Clinical Psychologist at Bay Pines Veterans Affairs Healthcare System and an Associate Professor of Psychology at the University of Central Florida College of Medicine in Orlando. Megan Gerber is an Associate Professor of Medicine at Boston University School of Medicine. Sadie Elisseou is an Instructor in Medicine and Zachary Sager is an Instructor in Psychiatry, both at Harvard Medical School in Boston
| | - Zachary S Sager
- and are Primary Care Physicians; and is a Hospice and Palliative Care Physician at the New England Geriatric Research Education and Clinical Center; all at the Veterans Affairs Boston Healthcare System in Massachusetts. is a Clinical Psychologist at Bay Pines Veterans Affairs Healthcare System and an Associate Professor of Psychology at the University of Central Florida College of Medicine in Orlando. Megan Gerber is an Associate Professor of Medicine at Boston University School of Medicine. Sadie Elisseou is an Instructor in Medicine and Zachary Sager is an Instructor in Psychiatry, both at Harvard Medical School in Boston
| | - Jessica A Keith
- and are Primary Care Physicians; and is a Hospice and Palliative Care Physician at the New England Geriatric Research Education and Clinical Center; all at the Veterans Affairs Boston Healthcare System in Massachusetts. is a Clinical Psychologist at Bay Pines Veterans Affairs Healthcare System and an Associate Professor of Psychology at the University of Central Florida College of Medicine in Orlando. Megan Gerber is an Associate Professor of Medicine at Boston University School of Medicine. Sadie Elisseou is an Instructor in Medicine and Zachary Sager is an Instructor in Psychiatry, both at Harvard Medical School in Boston
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Elisseou S, Puranam S, Nandi M. A Novel, Trauma-Informed Physical Examination Curriculum for First-Year Medical Students. MedEdPORTAL 2019; 15:10799. [PMID: 30800999 PMCID: PMC6376894 DOI: 10.15766/mep_2374-8265.10799] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/06/2019] [Indexed: 05/13/2023]
Abstract
Introduction Trauma is prevalent in the general population in various forms and has lasting effects on health. Physicians routinely examine patients who have experienced trauma, although most providers lack training in trauma-informed care, a well-established framework for providing quality care to trauma survivors. To address this gap, we implemented a novel curriculum on trauma-informed physical examination skills for first-year medical students. Methods We held a large-group lecture for 148 first-year medical students and 40 faculty members to introduce a framework for a trauma-informed physical examination, using a standardized patient for demonstration. The framework included specific language and behaviors to employ before, during, and after the examination in order to enhance patients' sense of safety, control, and trust. Students then transitioned to small groups to practice performing vital signs using a trauma-informed approach, with supervision from MD faculty. Results Five-point scales were used to evaluate students' knowledge gained from the session and satisfaction with the session. Overall satisfaction with the session was rated as 4.08 (SD = 0.81), and students felt that the session was highly effective in defining a trauma-informed physical examination (4.29, SD = 0.70). Discussion The session was well received and effective in teaching future physicians trauma-informed skills. We offer other institutions a model for incorporating trauma-informed care into clinical skills curricula.
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Affiliation(s)
- Sadie Elisseou
- Assistant Professor of Clinical Medicine, The Warren Alpert Medical School of Brown University
| | - Sravanthi Puranam
- Medical Student, The Warren Alpert Medical School of Brown University
| | - Meghna Nandi
- Medical Student, The Warren Alpert Medical School of Brown University
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Schrier MW, Rougas SC, Schrier EW, Elisseou S, Warrie S. Intimate Partner Violence Screening and Counseling: An Introductory Session for Health Care Professionals. MedEdPORTAL 2017; 13:10622. [PMID: 30800823 PMCID: PMC6338198 DOI: 10.15766/mep_2374-8265.10622] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Intimate partner violence is a serious public health concern in the United States. Despite recommendations that physicians should routinely screen their patients, research has shown that lack of specific training has resulted in many health care professionals feeling unable to adequately perform this difficult but vital task. Though many educational resources exist to teach intimate partner violence screening, they often lack specific guidance on how to navigate this difficult conversation. In addition, they often lack formal teaching on how to counsel and refer patients who are victims of intimate partner violence. METHODS This unique module, intended for a small-group setting of four to eight students, contains an intimate partner violence checklist with sample language that covers both screening and counseling using a motivational interviewing framework. Additional materials include a checklist companion for tips on how to navigate the conversation, two cases for role-play, a facilitator guide, and an objective structured clinical encounter case and assessment rubric. RESULTS This module was given to 260 second-year medical students at the Warren Alpert Medical School between 2015 and 2017 and was rated highly by almost 90% of students. DISCUSSION After completing this module, learners will be able to appropriately screen for intimate partner violence as well as counsel and refer patients who have screened positive. By implementing this module, educators can increase the number of health care professionals able to broach this difficult conversation with patients who may be in need of help and may otherwise go unaided.
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Affiliation(s)
- Madeleine W. Schrier
- Resident Physician in Pediatrics, Warren Alpert Medical School of Brown University
| | - Steven C. Rougas
- Assistant Professor of Emergency Medicine and Medical Science, Warren Alpert Medical School of Brown University
- Corresponding author:
| | - Ellen W. Schrier
- Clinical Social Worker and Family Therapist, Private Practice in Monterey County, CA
| | - Sadie Elisseou
- Assistant Professor of Medicine, Warren Alpert Medical School of Brown University
| | - Sarita Warrie
- Assistant Professor of Medicine and Medical Science, Warren Alpert Medical School of Brown University
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