Vicarious Trauma and Natural Disasters: A Transcendental Phenomenological Analysis of the Experiences of Families of Typhoon Haiyan Survivors

Using transcendental phenomenology, we examined the experience of vicarious trauma in the context of natural disasters. We specifically looked at the narratives of domestic migrants whose family members were Typhoon Haiyan survivors. Findings show that the survivors’ families experienced painful and intrusive psychological distress. The gravity of the pain and loss experienced by the participants was relative to the amount of pain, loss, or damage sustained by the subject of their attachment. Vicarious trauma was experienced as a void-filling phenomenon occupying the emotional space created by the physical distance of the participants from their families experiencing the disaster. This phenomenon and the concurrent traumatic experience improved as the participants made sense of the significance of the event in their lives. Our findings may help in developing interventions to address the effects of vicarious trauma on families of disaster victims and survivors

Development of a Patient-Centered Communication Curriculum for Medical Residents Targeting Educational Equity for International Medical Graduates

Introduction: International medical graduates (IMG) account for 46.5% of all internal medicine residency matches in 2022 and up to 25% of practicing licensed doctors. They face unique challenges, among which communication was noted by both trainees and program directors. Patient-centered communication (PCC) is a method of clinician-patient interaction that has been shown to improve patient outcomes and satisfaction. Short trainings have been shown to improve knowledge and confidence while producing enduring effects of patient-centeredness for the learner. However, little has been described in the literature about designing PCC curricula for IMGs. Objective: To demonstrate the process of creating a multimodal PCC curriculum for an internal medicine residency program with a high proportion of IMGs Methods: Kern’s Six Steps of Curriculum Development was performed for an Internal Medicine Residency Program. Survey-based needs assessments identified gaps in communication skills. Pedagogical interventions included communication workshops, flipped classroom didactics, clinical observation tools, and associated faculty development. Immediate and delayed post-surveys were administered. Results: Residents were least prepared for encounters involving sexual history, chronic pain, and substance use, with IMGs less prepared for sexual concerns (p=0.023), substance use (p=0.049), eliciting emotional context (p=0.012), and medication non-adherence (p=0.024). IMGs reported significantly less communication skills training time (p=0.002) and skills practice (p=0.008) before residency than non-IMGs. English proficiency and cultural differences were not statistically significant barriers. Didactics significantly increased preparedness in substance use (p=0.001), sexual histories (p=0.002), and chronic pain (p=0.011). Delayed posttest was performed at the end of the academic year. Residents felt that the QEC didactics had a positive impact on their future patient interactions: 44% of residents rated “a great deal”, and 52% rated “a moderate amount”. There was no statistically significant difference between IMGs and non-IMGs. Compared to last year, 65.5% of residents reported that their PCC skills have improved, 17.2% greatly improved, and 17.2% slightly improved. There was no statistically significant difference between IMGs and non-IMGs. There was no statistically significant improvement in all communication themes (p>0.05): agenda setting, eliciting emotional context, adherence, shared decision-making, lifestyle modification, health literacy, chronic pain, sexual concerns, and substance use. This is likely due to residents’ overestimation of their communication skills at baseline whereas training increased awareness of areas for improvement. Conclusion: Effective communication is one of the unique challenges faced by IMGs. With the development of a multimodal communication curriculum, significant improvements in knowledge and skill can be achieved for both IMGs and US medical graduates. This not only improves patient outcomes but helps to reduce education inequities. Desired Impact: The goal of this project is to increase local awareness and skill in evidence-based patient-centered and relationship-centered communication skills, and thereby improve the quality of patient-centeredness and humanistic care in our health system. In particular, IMGs comprise a valuable and significant portion of the US healthcare workforce, and innovative multi-pronged curricula are needed to reduce the disparity of communication skills training for this group. Key Words: Patient-centered communication, IMG, Curriculum Development<p/