Background
Trauma-informed care (TIC) is an approach that assumes every patient has probably experienced some traumatic event in their lifetime. Studies have shown that 63% - 89% of people living in the United States have experienced at least one traumatic event in their lifetime, which is evidence that supports the importance of this assumption. TIC is also an approach that recognizes common signs and symptoms of trauma that a patient may present with, such as dissociation, hypervigilance, or self-harm. Furthermore, TIC acknowledges that past traumas could still influence patients' current lives regarding their mental, physical, social, emotional, or spiritual well-being. For example, trauma can lead to the development of post-traumatic stress disorder (PTSD), which has been associated with an increased risk of chronic mental and physical health conditions such as substance use, depression and anxiety, diabetes, and cardiovascular disease. Trauma-informed care integrates these ideas and overall knowledge of trauma into practice and policy so that practitioners can proactively avoid retraumatizing patients while providing patients with the care they need.

Methods 
To promote the use of trauma-informed care by medical students at the University of Cincinnati College of Medicine (UCCOM), we decided to incorporate it into the preclinical curriculum. We revised the instructional packets used to teach physical exam skills to first-year medical students within the clinical skills course. These revisions included revised informational packets that included suggestions for how to drape patients during exams, how to approach sensitive topics or exam maneuvers, and other TIC practices. At the beginning of the academic year, first-year students were asked to respond to the statement “I feel confident in my ability to provide trauma-informed care.” Responses were based on a 5-point Likert scale from strongly agree (5) to strongly disagree (1). 

Results
After the introduction to TIC through the clinical skills course materials, the number of students who responded “agree” or “strongly agree” (likert rating of 4 or 5, respectively) increased from 20% to 76%. Additionally, the number of students who responded “disagree” or “strongly disagree” (likert rating of 2 or 1, respectively) decreased from 57.5% to 16%. The average rating increased from 2.45 to 3.76.

Conclusion
Students reported overall increased confidence in their abilities to provide trauma-informed care after exposure to TIC practices and suggestions during their preclinical courses. Based on these results, we intend to continue the integration of TIC into the preclinical curriculum for the upcoming academic year and hope to elicit more student feedback using existing evaluations collected by UCCOM for further improvement.

Incorporating Trauma-Informed Care into the Preclinical Curriculum

Abstract Title: 
The Single Assessment Numeric Evaluation (SANE), PROMIS-UE, & QuickDASH for Elective Hand Surgeries
Background:
Validated patient-reported outcome measures provide important insight into condition-specific clinical outcomes, but they place a considerable time burden on patients, clinicians, and other staff. In response, efforts have been made to validate single-question surveys, such as the Single Assessment Numeric Evaluation (SANE) score, across orthopedic conditions, but few prospective studies have evaluated the SANE questionnaire for hand conditions specifically. Therefore, the purpose of this study was to validate the use of the SANE score in patients undergoing routine elective hand surgeries. We hypothesized that SANE scores would positively correlate with two other validated upper extremity surveys, PROMIS-UE and Quick-DASH. 
Methods:
Patients scheduled to undergo carpal tunnel release and trigger finger release surgery completed three surveys (SANE, the Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS-UE) item bank, and the shortened Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire) preoperatively and at two postoperative time points (2-4 weeks postop and >90 days postop). Based on an a priori power calculation and values from previous studies, a minimum sample of 82 patients was needed to achieve 80% power to detect a change after treatment or intervention of the minimal clinically important difference (MCID) or greater on the QuickDASH with a 2-sided level of significance of .025.
Results:
A total of 89 patients completed all three timepoints. There were strong positive correlations between the changes in QuickDASH scores and the changes in PROMIS-UE scores between all three timepoints, which we expected since these surveys served as our controls. There was also a strong positive correlation between the changes in the SANE scores and the changes in QuickDASH scores when comparing early post-op to late post-op (Pearson coefficient 0.529187631, p-value <0.0001). All other timepoint comparisons had a moderate positive correlation between SANE and the validated surveys. 
Conclusion:
One possible explanation as to why most of our correlations were moderate rather than strong is because of the difference in scaling. SANE’s 0%-100% scale allowed for a much larger percent change than the other two surveys’ (SANE's percent change range was 0-2900%, whereas QuickDASH's was 0-115.8% and PROMIS-UE's was 0-154.2%). Future studies are recommended to determine if changing the SANE scale to 1-10 would remedy this and lead to stronger correlations. With this in mind, our data still suggest that SANE can successfully evaluate elective hand surgery outcomes in the early and late postoperative periods.

The Single Assessment Numeric Evaluation (SANE), PROMIS-UE, and QuickDASH for Elective Hand Surgeries

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Gabrielle Notorgiacomo

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Incorporating Trauma-Informed Care into the Preclinical Curriculum

The Single Assessment Numeric Evaluation (SANE), PROMIS-UE, and QuickDASH for Elective Hand Surgeries

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