May Shum completed a bachelor’s in linguistics at Brown University before embarking on her medical training at the Yale School of Medicine, where she is currently a third-year medical student.
When she entered medical school in 2018, May had her heart set on pursuing a career in pediatrics. However, like most medical students finding their path, she had little to no formal experiences in pediatrics prior to starting medical school and wanted to learn more about the field. As she approached the summer following her first year, during which many students choose to engage in research, she reached out to faculty in the Department of Pediatrics at Yale.
It was through this search she was fortuitously introduced to Dr. Andrea Asnes, an Associate Professor of Pediatrics at the Yale School of Medicine and a board certified child abuse pediatrician who directs the Yale Programs for Safety, Advocacy and Healing. Although May had not heard of the field of child abuse pediatrics before meeting Dr. Asnes, she was drawn to Dr. Asnes’ strong commitment to mentorship for trainees and practitioners at all levels. Under her mentorship, May met with other Child abuse pediatricians and Pediatric Emergency Medicine physicians at Yale, including Dr. Gunjan Tiyyagura, a Pediatric Emergency Medicine physician at Yale who focuses on improving recognition and reporting of child abuse and neglect in acute care settings and developing family-centered interventions for household violence. Dr. Tiyyagura soon became May’s research mentor and the primary investigator for May’s current research.
May’s work centers on improving early intervention in cases of suspected abuse. In particular, her team aims to increase frontline provider recognition of child physical abuse. Children often present to emergency departments (ED) with physical injuries and it can be difficult to differentiate accident from abuse. However, if ED providers identify an abusive injury, they can greatly change the course of a child’s care. It is with this goal in mind that May and her team have been studying how a guideline that connects ED clinicians with child abuse specialists can impact care.
The guideline recommends the ED provider consult by phone with the regional child protection team if infants younger than 12 months of age present to the ED with one of several high-risk injuries associated with abuse. They found that these measures increased consultations to a child protection team in both community and pediatric ED settings.
In order to evaluate the appropriateness of these increases, May’s team then had child abuse experts review cases from community EDs and provide recommendations for diagnostic testing and reporting. They compared the experts’ recommendations with the real-time decision-making by ED physicians and found that the increases in testing and reporting by community EDs were in line with the experts’ recommendations. Through this work, May’s team built an acronym based on specific information the experts would have asked about in real-time:
MORE.
Mechanism: details about history and injury mechanism
Others present: witnesses to injury and history corroboration
“It is possible that any physician may care for a child or former survivor of child abuse; therefore, an understanding of and sensitivity towards those who have experienced child abuse can be of benefit to any physician’s training.
May Shum, MS3
Review of development: developmental ability
Exam details: disrobed exam for superficial trauma and additional physical exam details
May hopes that this acronym will be useful for remembering additional questions to ask when evaluating for abuse. Her study, The use of experts to evaluate a child abuse guideline in community emergency departments (citation below), has just been published in Academic Pediatrics. This is quite a feat for an initial venture into the pediatric scholarship.
Although being recently published was an exciting ending to this research project, May isn’t done. May now plans to continue studying the impact of this guideline on the care of children presenting to Emergency Departments. For her next project, she plans to assess differences in diagnostic testing and reporting for infants with abuse-associated injuries between pediatric and community EDs and whether her team’s guideline can help mitigate variations in care between these settings. In May’s words, “Ultimately, I hope that our work will benefit children in all ED settings by extending knowledge and resources beyond tertiary care centers to community hospitals as well.”
Child abuse pediatricians depend on other professionals – including ED physicians, primary care physicians, school nurses, and teachers – to recognize red flags for abuse and involve the appropriate providers. May reminds us that trainees at any level and with any level of experience can have a contribution to the field of child abuse and neglect if they are willing to have the perseverance to seek out mentorship. Trainees often struggle with finding ways to positively impact the lives of their patients. May’s story is an example of just how impactful trainees can be and hopefully encourage other trainees to find their own path to improving patients’ lives and wellness.
REFERENCES: Shum M, Asnes A, Leventhal JM, Bechtel K, Gaither JR, Tiyyagura G. The Use of Experts to Evaluate a Child Abuse Guideline in Community Emergency Departments. Acad Pediatr. 2020 Nov 5:S1876-2859(20)30575-1. doi: 10.1016/j.acap.2020.11.001. Epub ahead of print. PMID: 33160081
This article was written by Rebecca Leff, MS4, Ben Gurion University, Israel, and originally published in the March 2021 AAP Newsletter of the Council on Child Abuse & Neglect (COCAN) and has been republished with permission.