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Session: ePoster: Education, Training Assessment, and Practice Management 1 (Sun8)

EP287 - The Impact of a Trauma-Informed Digital Anorectal Exam Workshop on Resident Comfort and Confidence

Sunday, May 11, 2025
9:38 AM – 9:43 AM PT
Location: Monitor 5, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Kera L. Kwan, MD

    General Surgery Resident
    University of California Los Angeles
    Los Angeles, CA, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • Tara A. Russell, MD, MPH, PhD (she/her/hers)

    Assistant Professor
    University of California Los Angeles
    Los Angeles, California, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • FC

    Formosa Chen, MD

    Associate professor
    David geffen UCLA school of medicine
    Sylmar, California, United States

    Disclosure information not submitted.

  • AL

    Amanda Labora, MD

    Resident Physician
    UCLA
    Los Angeles, California, United States

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Kera L. Kwan, MD: This individual has no financial relationships with ineligible companies.
Tara A. Russell, MD, MPH, PhD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: The digital anorectal exam (DARE) is a valuable diagnostic tool used to evaluate patients with various anorectal complaints, including symptoms concerning for rectal cancer such as rectal bleeding or changes in stool habit. Despite being a quick, valuable, and cost-effective exam maneuver, the DARE is underutilized. This is especially alarming given the rising rates of rectal cancer in patients < 50 years old, who are more likely to present with advanced disease. Providers cite concerns about patient discomfort and lack of confidence in their ability to perform the exam effectively. Trauma-informed care, which focuses on creating a safe and supportive environment to avoid re-traumatizing patients, can help address these concerns by emphasizing trust and patient-centered communication. However, educational resources that highlight a trauma-informed approach are scarce. Thus, this study aims to evaluate the impact of a single educational workshop on improving resident physician knowledge, comfort, and confidence with respect to the DARE.

Methods/Interventions: Residents from multiple disciplines including surgery, internal medicine, and family medicine will participate in an educational session focused on trauma-informed techniques for performing the DARE. This 30-minute session covers the principles of trauma-informed care and how it may be applied to the DARE, outlines the technical steps of how to set up and perform the exam, and reviews photos of common anorectal pathologies. Residents are also provided with sample scripts for patient communication and examples of thorough documentation. Surveys assess resident knowledge, comfort, and confidence before the workshop, immediately after, and six weeks post-training. The lecture and surveys were developed by a multidisciplinary working group of colorectal surgeons, internal medicine physicians, and residents.

Results/Outcomes: We anticipate a sample size of 150 resident physicians. Pre-, post-, and 6-week post-session responses will be compared, with primary outcomes including resident comfort performing the DARE, comfort employing a trauma-informed approach, and confidence in identifying common anorectal pathologies. Preliminary survey data from one of seven planned educational sessions (N=13) demonstrated that all residents found the session to be useful. Residents were most concerned they may cause the patient pain during a DARE (46%), may not perform the exam well (46%), and may not gain useful information from the exam (46%). Immediately after the educational session, mean DARE comfort level scores improved significantly (6.38 to 8.31, p< 0.01), as well as comfort levels employing a trauma-informed approach (3.77 to 7.92, p< 0.001). All data collection, including 6-week follow-up surveys, will be complete in March of 2025.

Conclusion/Discussion: Given the time constraints within medical education and the sensitive nature of the DARE, we aim to demonstrate that trainee comfort and confidence in performing the DARE can be improved through a low-resource training session that emphasizes a trauma-informed approach. Empowering physicians across multiple specialties early on in their training to perform this sensitive exam may help to minimize delays in diagnostic workup for patients with common, benign or potentially malignant anorectal disease.