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Adverse childhood experiences in osteopathic medical students: Implications for wellness, resilience, and future training

Quijada, C.
Woodard, C.
Habel, J.
Donaldson, Vanessa
Ditren Santos, A.
Landrith, W.
Vazquez Sanroman, Dolores
Introduction: Disturbingly high levels of burnout such as emotional exhaustion among medical trainees have prompted calls for action focusing on changing approaches to medical education. While many medical students appear resilient, research has identified personal characteristics associated with increased risk of poor mental health, including female gender, and those of ethnic minority. However, a personal history of childhood adversity is a risk factor that remains understudied.
Objective: The primary purpose of the study was to assess the prevalence of adverse childhood experiences (ACEs) in a cohort of osteopathic medical students and characterize their childhood protective factors. Also, provide a basic knowledge of ACEs and their effects on the brain.
Methods: The authors developed a 45-minute talk about ACEs and their effects on the brain as well as an adapted ACEs anonymous survey that was distributed to osteopathic medical students from all levels of training in the Tulsa and Tahlequah campuses. The survey included the 10-item ACE Study questionnaire, a list of childhood protective factors (CPF), and questions to assess students’ perception of the impact of ACEs on their physical and mental health. The medical school’s IRB approved the student survey as an exempt study. The authors computed descriptive and comparative statistical analyses.
Results: A total of 88 participants from the Osteopathic Medical School were surveyed, 77.3% from Tulsa and 22.7% from Tahlequah. Of those 12.5% were American Indian, 10.2% black. Demographics race was 67% white, 12.5% Hispanic and 80.7% not Hispanic. Participants came from 60.2% urban and 39.8% rural background. Our surveyed population was equally gender with 56.8% male and 43.2% female. 95.5% of our participants expressed having siblings and 95.5% of them were not fulfilling any caregiver responsibilities, suggesting full-time commitment to medical school.
43% of students surveyed scored mild anxiety, 47% moderate anxiety, and 9% moderately severe anxiety. There were no significant differences between females (6.82) and males (6.10) participants, on the average score of GAD7 anxiety self-report.
All participants (88 students) completed the ACES questionnaire. Fourteen students (15%) reported zero exposure ACES score, sixteen students (18%) reported at least one ACE exposure, forty-nine students (55%) reported ≥ 4 exposures, and nine students (10%) reported ≥ 6 exposures. The latter were all female. Female medical students showed significantly higher ACE score values than their male counterparts [One-way ANOVA [F=9.68, df(1,86), p<0.01)] post-Tukey HD p<0.001]. No significant correlations were found between ACE scores and GAD7 self-report levels.
Before the ACES and brain effects talk, 42% of participants considered that the ACES impact on brain and behavior was important for their knowledge as future clinicians, after the training, 95% of participants considered that ACES have an impact on the brain and behavior, and it is very important to train and educate future clinicians on how to identify ACES.
Conclusions: A sizeable group of medical students reported exposure to multiple ACEs. Our findings, if replicated, suggest a significant vulnerability of these medical students to health risk behaviors, particularly in the female population. When asked, the majority of participants demonstrated interest in including ACES training in their curriculum as osteopathic medical students.