An educational curriculum to train medical students to evaluate asylum-seekers/torture survivors; learning domestic global health

Background: It is estimated that 7-12% of non US-born patients and 90% of asylum seekers have experienced torture. Yet, there is currently little formal training that equips medical students with the skills necessary to evaluate this population. Methods: We developed and implemented an educational curriculum that includes: 1) an introductory workshop covering medical and psychological sequelae of torture, asylum law, and the approach to clinical evaluation, 2) twice-monthly clinic sessions involving the medical and psychological evaluation of an asylum seeker, and 3) longitudinal mentored affidavit-writing. Pre- and post-curriculum questionnaires evaluating attitudes, knowledge, and self-efficacy of the participants were administered. Results: Since 2008, 125 trainees participated and 86 completed the full curriculum. Post-intervention, medical students were more likely to recognize their professional obligations (p<0.01) and to have knowledge of the most common sequelae of torture (p<0.0001). Medical students' attitudes toward working with torture survivors improved (p<0.05) including having confidence in using the diagnostic criteria for PTSD (p<0.0001). Their self-efficacy in clinical evaluation improved (p<0.0001), including identifying populations at risk for torture, evaluating physical and psychological sequelae of torture, and having applied the PTSD criteria to assess a patient (p<0.0001). Conclusion: Despite limited clinical experience, medical students showed significant improvement in attitudes towards working with torture survivors as well as self efficacy to evaluate them, which will likely serve them in caring for other vulnerable populations. The curriculum was feasible to implement, achieved its educational goals, and addressed the disparity between doctors' professional obligations and current clinical training.