Sentinel Injury Recognition in Child Physical Abuse: A Tiered Complexity Simulation Curriculum

Introduction Medical training often incorporates limited content related to child abuse. Sentinel injuries are minor superficial injuries, frequently appearing as bruising and oral injuries, that may precede more severe abuse. Clinicians may be able to prevent escalating physical child abuse by correctly recognizing these injuries. Methods We created a 1-hour simulation curriculum for pediatric and emergency medicine residents and pediatric emergency medicine fellows that was tailored to level of training. The curriculum consisted of a simulation with debrief and didactic session. The simulation involved a 4-month-old infant with respiratory symptoms. Moulage was used to portray 1 of 3 sentinel injuries. Retrospective pre- and posttests were used to assess differences in comfort and knowledge regarding child abuse recognition and perceived curricular impact. Results There were 9 sessions reaching 43 residents and fellows with 40 linked surveys (93%) included in analysis. There were statistically significant increases in the percentage of knowledge-based questions answered correctly following participation. Only half (52.5%) of participants felt prepared to identify and manage a child with physical abuse prior to the session, but all (100%) participants indicated agreement that the curriculum increased their knowledge of the evidence behind sentinel injury recognition and screening. Discussion Educational exposure to child abuse in medical training is limited. Implementation of a child abuse simulation curriculum focused on experiential learning improves knowledge and comfort in recognizing and managing sentinel injuries.