'We Need to Really Up Our Game' - Trainee and Clinician Perspectives on Adverse Childhood Experiences Screening.

Introduction: Despite the negative health effects of adverse childhood experiences, few pediatricians regularly screen for them. We sought to investigate clinician and trainee knowledge and practices regarding adverse childhood experiences in Wisconsin clinics.

Methods: We undertook a sequential mixed methods study. We administered a cross-sectional, web-based survey to medical trainees and clinicians associated with the University of Wisconsin-Madison or subscribing to the Wisconsin chapter of the American Academy of Pediatrics. The survey was developed and pretested by experts in medical education and survey methodology. Data were analyzed descriptively and categorically. We then conducted semistructured interviews using thematic analysis and inductive and deductive coding to characterize facilitators and barriers to screening.

Results: Survey respondents included 110 medical students, 103 attending physicians, 51 residents, and 10 advanced practice providers. Respondents were familiar with adverse childhood experiences, yet only 26% had adequate knowledge to impact their clinical practice. More residents (69%) and medical students (50%) received education about adverse childhood experiences than attending physicians (20%). Few respondents (13%) regularly screen for adverse childhood experiences, but the majority (80%) expressed interest in screening. Nine respondents completed interviews, revealing 3 themes: (1) knowledge is not enough; (2) demand for a multilevel approach; and (3) impact of systems of oppression.

Conclusions: Wisconsin trainees and clinicians have limited experience with adverse childhood experiences resulting in low screening rates but express a strong desire to learn more. Increasing screening practice will require targeted efforts to enhance clinician experiential learning, minimize systemic barriers, and address systems of oppression.