259677 An educational curriculum to train medical students to evaluate asylum-seekers/torture survivors; learning domestic global health

Monday, October 29, 2012 : 12:48 PM - 1:06 PM

Ramin Asgary, MD, MPH , Dept of Medicine, and the Center of Global Health, The Mount Sinai School of Medicine, New York, NY
Pamela Saenger, BA , Medical Education, Mount Sinai School of Medicine, New York, NY
Beth Charpentier, MPH(c) , Program on Forced Migration and Health, Columbia University Mailman School of Public Health, New York, NY
Anna Goldman, MPA , Medical Education, Mount Sinai School of Medicine, New York, NY
Lucy Schulson, BA , Medical Education, Mount Sinai School of Medicine, New York, NY
Delia Burnett, MPH , Graduate School of Public Health, Mount Sinai School of Medicine, New York, NY
Loretta Jophlin, MD, PhD , Medicine, Mount Sinai School of Medicine, New York, NY
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.

Learning Areas:
Advocacy for health and health education
Clinical medicine applied in public health
Conduct evaluation related to programs, research, and other areas of practice
Other professions or practice related to public health
Program planning
Public health or related education

Learning Objectives:
a) To recognize the need to train doctors in global health challenges at home b) To discuss pillars and outcome of a comprehensive educational curriculum to teach medical students how to evaluate and care for asylum seekers and torture survivors

Keywords: Global Education, Human Rights

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I designed, implemented and evaluated this project. I analyzed data and drafted and finalized the abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.