Teaching residents to work with torture survivors: experiences from the Bronx Human Rights Clinic.

Department of Medicine, Montefiore Medical Center, Bronx, NY, USA.
Journal of General Internal Medicine (Impact Factor: 3.28). 08/2008; 23(7):1038-42. DOI: 10.1007/s11606-008-0592-2
Source: PubMed

ABSTRACT Despite the 1984 United Nations's Convention Against Torture calling to train doctors to work with torture survivors, many physicians are unaware of their obligation and few are taught the requisite clinical skills.
To describe the development, implementation, and evaluation of a curriculum to teach residents to work with torture survivors.
Medicine residents in New York City
A 2-component curriculum consisting of a series of workshops and clinical experiences, which provide content, skills, and practices regarding the medical, psychological, ethical, and legal aspects of evaluating and caring for torture survivors. CURRICULUM EVALUATION: All 22 trainees received surveys before and after training. Surveys assessed residents' relevant prior experience, beliefs, skills, and attitudes regarding working with torture survivors. At baseline, 23% of residents described previous human rights trainings and 17% had work experiences with torture survivors. Before the curriculum, 81% of residents reported doctors should know how to evaluate survivors, although only 5% routinely screened patients for torture. After the curriculum, residents reported significant improvements in 3 educational domains-general knowledge, sequelae, and self-efficacy to evaluate torture survivors.
This curriculum addresses the disparity between doctors' obligations, and training to work with torture survivors. It is likely to achieve its educational goals, and can potentially be adapted to other residencies.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Seven to 12% of foreign-born patients in the United States has experienced torture. We aimed to teach medical students to identify and care for asylum seekers/torture survivors. Description: One hundred twenty-five students participated in a program consisting of a workshop covering sequelae of torture, asylum law, and an approach to patient evaluation; twice-monthly clinical sessions; and mentored preparation of medical affidavits. We observed clinical encounters; evaluated medical affidavits; and assessed students' knowledge, attitudes, and skills pre- and postcurriculum. Evaluation: Students successfully performed physical and psychological evaluations and prepared affidavits resulting in 89% asylum application approval. We observed improvement in student attitudes toward working with survivors (p < .05), knowledge of sequelae of torture (p < .001), and self-efficacy in clinical evaluation (p < .001). Conclusions: Medical students learned necessary skills to provide services for survivors, which will also serve them in caring for other vulnerable populations. As an advocacy, cultural competency, and domestic global health opportunity, this training was feasible and achieved its educational goals.
    Teaching and Learning in Medicine 25(4):348-357. · 0.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A significant number of asylum seekers who largely survived torture live in the United States. Asylum seekers have complex social and medical problems with significant barriers to health care access. When evaluating and providing care for survivors, health providers face important challenges regarding medical ethics and professional codes. We review ethical concerns in regard to accountability, the patient-physician relationship, and moral responsibilities to offer health care irrespective of patient legal status; competing professional responsibility toward society and the judiciary system; concerns about the consistency of asylum seekers' claims; ethical concerns surrounding involving trainees and researching within the evaluation setting; and the implication of broader societal views towards rights and social justice. We discuss contributing factors, including inadequate and insufficient provider training, varying and inadequate institutional commitment, asylum seekers' significant medical and social problems, and the broader health and social system issues. We review existing resources to address these concerns and offer suggestions.
    The American Journal of Bioethics 07/2013; 13(7):3-12. · 4.00 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective This study explores refugees' perspectives regarding the nature of communication barriers that impede the exploration of trauma histories in primary care.Method Brief interviews were conducted with 53 refugee patients in a suburban primary care clinic in the Midwest USA. Participants were asked if they or their doctors had initiated conversations about the impact of political conflict in their home countries. Qualitative data analysis was guided by grounded theory. Peer debriefings of refugee healthcare professionals were incorporated into the analysis.Results Two-thirds of refugee patients reported that they never shared how they were affected by political conflict with their doctors and that their doctors never asked them about it. Most refugees stated that they would like to learn more about the impact of trauma on their health and to discuss their experiences with their doctors.Conclusion Refugees are hesitant to initiate conversations with physicians due to cultural norms requiring deference to the doctor's authority. They also lack knowledge about how trauma affects health. Physicians should be educated to inquire directly about trauma histories with refugee patients. Refugees can benefit from education about the effects of trauma on health and about the collaborative nature of the doctor-patient relationship.
    Mental Health in Family Medicine 01/2012; 9(1):47-55.


Available from