GME Patient Safety Quality and Innovation Symposium

Kelsey B. Loeliger, MD, PhD¹, Zoe Matticks, MPH², Hannah Begna, MSc³, Maud Arnal, PhD⁴, Eleanor Bimla Schwarz, MD, MS³, Megha Shankar, MD⁵

¹ Division of Complex Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego

² University of California, San Diego School of Medicine

³ Department of Medicine, University of California, San Francisco

⁴ Department of Sociology, Herbert Wertheim School of Public Health & Human Longevity Science, University of California, San Diego

⁵ Department of Medicine, University of California, San Diego

Background:

Although people seeking family planning services are often at risk for trauma, there are no clear clinical guidelines around trauma screening, inquiry, and response in family planning settings. The Trauma and Resilience-informed Inquiry for Adversity, Distress, and Strengths (TRIADS) framework emphasizes an empathetic, respectful, and equity-based approach of addressing trauma. This project 1) identifies training needs in family planning settings regarding trauma inquiry and response, and 2) evaluates whether the TRIADS framework can be effectively applied to meet these needs.

Methods:

We conducted an online survey of first-year family planning fellows nationally to assess baseline comfort in trauma inquiry and response. We then conducted a narrative literature review and environmental scan on trauma inquiry and response in reproductive health settings. Findings were mapped to the TRIADS framework as (1) inquiring about adversity (2) assessing signs of distress, or (3) identifying patient strengths and resilience. We summarized best clinical practices within each category and designed a case-based webinar and workshop series demonstrating the application of TRIADS in family planning for California family planning clinicians. A post-webinar online survey was conducted to assess confidence in applying the TRIADS framework to clinical practice.

Results:

Among 22 of 28 eligible first-year family planning fellows who completed the survey, some were comfortable inquiring about trauma (64%), responding to trauma (77%), and performing a trauma-informed pelvic exam (64%). Although all reported caring for high-risk populations, 27-41% had received minimal to no formal training in trauma-informed care and 91% were interested in additional training. Our literature review and baseline survey data support the use of a TRIADS-like framework in addressing trauma history. Among 300 family planning clinicians who attended the webinar, the 120 who completed a post-webinar survey demonstrated high confidence with trauma inquiry and response as well as a high likelihood of using the TRIADS framework in clinical practice.

Conclusions:

The TRIADS framework may be a useful tool in family planning settings that can enhance provider competence, strengthen the patient-clinician relationship, and build patient skills to improve reproductive health outcomes. Next steps include modifying the training workshop to specifically meet trainee needs, administering the training to family planning fellows, and conducting a post-training survey of family planning fellows to understand the effect of training on trainee knowledge, attitudes, and skills in trauma inquiry and response.