RISE With Residents

Pediatric ALL Clinical Trial

— RISE Residents  

Official title:

Evaluating an Educational Intervention for Improving Residents' Recognition and Response to Child Maltreatment - A Mixed Method Acceptability and Feasibility Study With a Pilot Randomized Trial

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT05490121
• Other study ID #: HiREB #14381
• Status: Active, not recruiting
• Phase: N/A
• Start date: August 1, 2022
• Est. completion date: December 30, 2023

Study information

• Verified date: November 2023
• Source: McMaster University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Prevention of child maltreatment (CM) remains a public health priority in Canada; approximately one-third of Canadians report exposure to at least one form of CM. Physicians play an important role in recognizing and responding to CM and its associated sequelae. However, increasing evidence indicates that physicians receive insufficient training related to recognizing and responding to CM. CM education is especially pertinent during the pediatric and psychiatry residency period but it remains unclear what the optimal approach is for preparing Canadian physicians with the knowledge and skills to effectively recognize and respond to CM. Those educational interventions that have been evaluated in medical education contexts have comparatively little emphasis on the complex overlap between IPV, children's exposure to IPV, and other forms of CM. The Violence, Evidence, Guidance, Action Project (VEGA) is a novel educational intervention that has the potential to improve the preparation of physicians to be able to effectively recognize and respond to CM in their clinical encounters and takes into account this complex overlap. The purpose of this study is to assess the acceptability and feasibility of a future randomized-controlled trial comparing two approaches to administering the VEGA intervention, facilitator-led or self-directed VEGA and whether/how these approaches can support residents' education.

The investigators hypothesize that there will be significant increases in preparedness, knowledge and skills, and self-efficacy to recognize and respond to CM in both the experimental and AC arms from Time 1 (baseline) to Time 2 (immediately after the intervention) and Time 1 (baseline) to Time 3 (3 month follow-up). The investigators also predict that these improvements will be slightly attenuated in the experimental arm. Qualitative data pertaining to perceived value and impact will corroborate the quantitative findings.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 71
• Est. completion date: December 30, 2023
• Est. primary completion date: August 31, 2023
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 100 Years

Eligibility

Inclusion Criteria:

• Participant is a resident at a Canadian University.

• Participant is fluent in written and spoken English.

Exclusion Criteria:

• Participant has previously accessed VEGA intervention materials.

• Participant is currently enrolled in or plans to enroll in any other educational intervention focused on family violence within the study time period (approximately next 3 months).

Related Conditions & MeSH terms

• Child Maltreatment
• Domestic Violence
• Education, Medical, Graduate
• Pediatric ALL
• Psychiatry

Intervention

Other:
• Violence, Evidence, Guidance, Action Project (VEGA) Education Intervention
VEGA is a novel education intervention that has the potential to improve the preparation of healthcare and social service providers (HHSPs) to be able to effectively recognize and respond to intimate partner violence (IPV) and related forms of family violence, including child maltreatment (CM), in their clinical encounters. VEGA was developed based on systematic reviews and consultation with individuals belonging to 22 national healthcare and social service organizations, including the Royal College of Physicians and Surgeons of Canada. VEGA follows a competency-based framework and a participatory, encounter-based curriculum that includes four learning modules: (a) the epidemiology of IPV and CM; (b) strategies for safely recognizing and responding to (i) IPV and (ii) CM; and (c) principles for ensuring safe clinical encounters for IPV and CM discussions.

Locations

Country	Name	City	State
Canada	McMaster University	Hamilton	Ontario

Sponsors (2)

Lead Sponsor	Collaborator
McMaster University	Royal College of Physicians and Surgeons of Canada

Country where clinical trial is conducted

Canada, 

References & Publications (58)

Adams NE. Bloom's taxonomy of cognitive learning objectives. J Med Libr Assoc. 2015 Jul;103(3):152-3. doi: 10.3163/1536-5050.103.3.010. — View Citation

Afifi TO, MacMillan HL, Boyle M, Taillieu T, Cheung K, Sareen J. Child abuse and mental disorders in Canada. CMAJ. 2014 Jun 10;186(9):E324-32. doi: 10.1503/cmaj.131792. Epub 2014 Apr 22. — View Citation

Akl EA, Pretorius RW, Sackett K, Erdley WS, Bhoopathi PS, Alfarah Z, Schunemann HJ. The effect of educational games on medical students' learning outcomes: a systematic review: BEME Guide No 14. Med Teach. 2010 Jan;32(1):16-27. doi: 10.3109/01421590903473969. — View Citation

Alnasser Y, Albijadi A, Abdullah W, Aldabeeb D, Alomair A, Alsaddiqi S, Alsalloum Y. Child maltreatment between knowledge, attitude and beliefs among Saudi pediatricians, pediatric residency trainees and medical students. Ann Med Surg (Lond). 2017 Feb 21;16:7-13. doi: 10.1016/j.amsu.2017.02.008. eCollection 2017 Apr. — View Citation

Armson H, Elmslie T, Roder S, Wakefield J. Is the Cognitive Complexity of Commitment-to-Change Statements Associated With Change in Clinical Practice? An Application of Bloom's Taxonomy. J Contin Educ Health Prof. 2015 Summer;35(3):166-75. doi: 10.1002/chp.21303. — View Citation

Bair-Merritt MH, Blackstone M, Feudtner C. Physical health outcomes of childhood exposure to intimate partner violence: a systematic review. Pediatrics. 2006 Feb;117(2):e278-90. doi: 10.1542/peds.2005-1473. — View Citation

Beynon CE, Gutmanis IA, Tutty LM, Wathen CN, MacMillan HL. Why physicians and nurses ask (or don't) about partner violence: a qualitative analysis. BMC Public Health. 2012 Jun 21;12:473. doi: 10.1186/1471-2458-12-473. — View Citation

Brown DS, Fang X, Florence CS. Medical costs attributable to child maltreatment a systematic review of short- and long-term effects. Am J Prev Med. 2011 Dec;41(6):627-35. doi: 10.1016/j.amepre.2011.08.013. — View Citation

Caslini M, Bartoli F, Crocamo C, Dakanalis A, Clerici M, Carra G. Disentangling the Association Between Child Abuse and Eating Disorders: A Systematic Review and Meta-Analysis. Psychosom Med. 2016 Jan;78(1):79-90. doi: 10.1097/PSY.0000000000000233. — View Citation

Chen LP, Murad MH, Paras ML, Colbenson KM, Sattler AL, Goranson EN, Elamin MB, Seime RJ, Shinozaki G, Prokop LJ, Zirakzadeh A. Sexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis. Mayo Clin Proc. 2010 Jul;85(7):618-29. doi: 10.4065/mcp.2009.0583. Epub 2010 May 10. — View Citation

Connor PD, Nouer SS, Mackey ST, Tipton NG, Lloyd AK. Psychometric properties of an intimate partner violence tool for health care students. J Interpers Violence. 2011 Mar;26(5):1012-35. doi: 10.1177/0886260510365872. Epub 2010 Jun 28. — View Citation

Cook DA, Levinson AJ, Garside S, Dupras DM, Erwin PJ, Montori VM. Internet-based learning in the health professions: a meta-analysis. JAMA. 2008 Sep 10;300(10):1181-96. doi: 10.1001/jama.300.10.1181. — View Citation

Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M; Medical Research Council Guidance. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008 Sep 29;337:a1655. doi: 10.1136/bmj.a1655. — View Citation

Crowe M, Inder M, Porter R. Conducting qualitative research in mental health: Thematic and content analyses. Aust N Z J Psychiatry. 2015 Jul;49(7):616-23. doi: 10.1177/0004867415582053. Epub 2015 Apr 21. — View Citation

Danese A, Tan M. Childhood maltreatment and obesity: systematic review and meta-analysis. Mol Psychiatry. 2014 May;19(5):544-54. doi: 10.1038/mp.2013.54. Epub 2013 May 21. — View Citation

Daniels L, Daniels V. Internal medicine residents' achievement goals and efficacy, emotions, and assessments. Can Med Educ J. 2018 Nov 12;9(4):e59-e68. eCollection 2018 Nov. — View Citation

Divakar U, Nazeha N, Posadzki P, Jarbrink K, Bajpai R, Ho AHY, Campbell J, Feder G, Car J. Digital Education of Health Professionals on the Management of Domestic Violence: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration. J Med Internet Res. 2019 May 23;21(5):e13868. doi: 10.2196/13868. — View Citation

Eldridge SM, Lancaster GA, Campbell MJ, Thabane L, Hopewell S, Coleman CL, Bond CM. Defining Feasibility and Pilot Studies in Preparation for Randomised Controlled Trials: Development of a Conceptual Framework. PLoS One. 2016 Mar 15;11(3):e0150205. doi: 10.1371/journal.pone.0150205. eCollection 2016. — View Citation

Ericsson KA. Deliberate practice and acquisition of expert performance: a general overview. Acad Emerg Med. 2008 Nov;15(11):988-94. doi: 10.1111/j.1553-2712.2008.00227.x. Epub 2008 Sep 5. — View Citation

Flaherty EG, Sege R, Binns HJ, Mattson CL, Christoffel KK. Health care providers' experience reporting child abuse in the primary care setting. Pediatric Practice Research Group. Arch Pediatr Adolesc Med. 2000 May;154(5):489-93. doi: 10.1001/archpedi.154.5.489. — View Citation

Flaherty EG, Sege R, Mattson CL, Binns HJ. Assessment of suspicion of abuse in the primary care setting. Ambul Pediatr. 2002 Mar-Apr;2(2):120-6. doi: 10.1367/1539-4409(2002)0022.0.co;2. — View Citation

Flaherty EG, Sege R, Price LL, Christoffel KK, Norton DP, O'Connor KG. Pediatrician characteristics associated with child abuse identification and reporting: results from a national survey of pediatricians. Child Maltreat. 2006 Nov;11(4):361-9. doi: 10.1177/1077559506292287. — View Citation

Flaherty EG, Sege R. Barriers to physician identification and reporting of child abuse. Pediatr Ann. 2005 May;34(5):349-56. doi: 10.3928/0090-4481-20050501-08. — View Citation

Guetterman TC, Fetters MD, Creswell JW. Integrating Quantitative and Qualitative Results in Health Science Mixed Methods Research Through Joint Displays. Ann Fam Med. 2015 Nov;13(6):554-61. doi: 10.1370/afm.1865. — View Citation

Hamberger LK. Preparing the next generation of physicians: medical school and residency-based intimate partner violence curriculum and evaluation. Trauma Violence Abuse. 2007 Apr;8(2):214-25. doi: 10.1177/1524838007301163. — View Citation

Inanici SY, Celik E, Hidiroglu S, Ozdemir M, Inanici MA. Factors associated with physicians' assessment and management of child abuse and neglect: A mixed method study. J Forensic Leg Med. 2020 Jul;73:101972. doi: 10.1016/j.jflm.2020.101972. Epub 2020 May 30. — View Citation

Jordan J, Jalali A, Clarke S, Dyne P, Spector T, Coates W. Asynchronous vs didactic education: it's too early to throw in the towel on tradition. BMC Med Educ. 2013 Aug 8;13:105. doi: 10.1186/1472-6920-13-105. — View Citation

Kimber M, McTavish JR, Couturier J, Boven A, Gill S, Dimitropoulos G, MacMillan HL. Consequences of child emotional abuse, emotional neglect and exposure to intimate partner violence for eating disorders: a systematic critical review. BMC Psychol. 2017 Sep 22;5(1):33. doi: 10.1186/s40359-017-0202-3. — View Citation

Kimber M, McTavish JR, Couturier J, Le Grange D, Lock J, MacMillan HL. Identifying and responding to child maltreatment when delivering family-based treatment-A qualitative study. Int J Eat Disord. 2019 Mar;52(3):292-298. doi: 10.1002/eat.23036. Epub 2019 Feb 6. — View Citation

Kimber M, McTavish JR, Luo C, Couturier J, Dimitropoulos G, MacMillan H. Mandatory reporting of child maltreatment when delivering family-based treatment for eating disorders: A framework analysis of practitioner experiences. Child Abuse Negl. 2019 Feb;88:118-128. doi: 10.1016/j.chiabu.2018.11.010. Epub 2018 Nov 23. — View Citation

Kuruppu J, McKibbin G, Humphreys C, Hegarty K. Tipping the Scales: Factors Influencing the Decision to Report Child Maltreatment in Primary Care. Trauma Violence Abuse. 2020 Jul;21(3):427-438. doi: 10.1177/1524838020915581. Epub 2020 Apr 7. — View Citation

Larsen DP, Butler AC, Roediger HL 3rd. Test-enhanced learning in medical education. Med Educ. 2008 Oct;42(10):959-66. doi: 10.1111/j.1365-2923.2008.03124.x. — View Citation

Lewis NV, Feder GS, Howarth E, Szilassy E, McTavish JR, MacMillan HL, Wathen N. Identification and initial response to children's exposure to intimate partner violence: a qualitative synthesis of the perspectives of children, mothers and professionals. BMJ Open. 2018 Apr 28;8(4):e019761. doi: 10.1136/bmjopen-2017-019761. — View Citation

Lindert J, von Ehrenstein OS, Grashow R, Gal G, Braehler E, Weisskopf MG. Sexual and physical abuse in childhood is associated with depression and anxiety over the life course: systematic review and meta-analysis. Int J Public Health. 2014 Apr;59(2):359-72. doi: 10.1007/s00038-013-0519-5. — View Citation

MacMillan HL, Kimber M, Stewart DE. Intimate Partner Violence: Recognizing and Responding Safely. JAMA. 2020 Sep 22;324(12):1201-1202. doi: 10.1001/jama.2020.11322. No abstract available. — View Citation

Mathews B, Kenny MC. Mandatory reporting legislation in the United States, Canada, and Australia: a cross-jurisdictional review of key features, differences, and issues. Child Maltreat. 2008 Feb;13(1):50-63. doi: 10.1177/1077559507310613. — View Citation

McLean SF. Case-Based Learning and its Application in Medical and Health-Care Fields: A Review of Worldwide Literature. J Med Educ Curric Dev. 2016 Apr 27;3:JMECD.S20377. doi: 10.4137/JMECD.S20377. eCollection 2016 Jan-Dec. — View Citation

McTavish JR, Kimber M, Devries K, Colombini M, MacGregor JCD, Wathen CN, Agarwal A, MacMillan HL. Mandated reporters' experiences with reporting child maltreatment: a meta-synthesis of qualitative studies. BMJ Open. 2017 Oct 16;7(10):e013942. doi: 10.1136/bmjopen-2016-013942. — View Citation

McTavish JR, Kimber M, Devries K, Colombini M, MacGregor JCD, Wathen N, MacMillan HL. Children's and caregivers' perspectives about mandatory reporting of child maltreatment: a meta-synthesis of qualitative studies. BMJ Open. 2019 Apr 4;9(4):e025741. doi: 10.1136/bmjopen-2018-025741. — View Citation

Murad MH, Coto-Yglesias F, Varkey P, Prokop LJ, Murad AL. The effectiveness of self-directed learning in health professions education: a systematic review. Med Educ. 2010 Nov;44(11):1057-68. doi: 10.1111/j.1365-2923.2010.03750.x. — View Citation

Norman G. RCT = results confounded and trivial: the perils of grand educational experiments. Med Educ. 2003 Jul;37(7):582-4. doi: 10.1046/j.1365-2923.2003.01586.x. No abstract available. — View Citation

Norman G. The end of educational science? Adv Health Sci Educ Theory Pract. 2008 Nov;13(4):385-9. doi: 10.1007/s10459-008-9139-x. Epub 2008 Oct 21. No abstract available. — View Citation

Norman GR, Sloan JA, Wyrwich KW. The truly remarkable universality of half a standard deviation: confirmation through another look. Expert Rev Pharmacoecon Outcomes Res. 2004 Oct;4(5):581-5. doi: 10.1586/14737167.4.5.581. — View Citation

Norman RE, Byambaa M, De R, Butchart A, Scott J, Vos T. The long-term health consequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis. PLoS Med. 2012;9(11):e1001349. doi: 10.1371/journal.pmed.1001349. Epub 2012 Nov 27. — View Citation

Pelletier HL, Knox M. Incorporating Child Maltreatment Training into Medical School Curricula. J Child Adolesc Trauma. 2017;10(3):267-274. doi: 10.1007/s40653-016-0096-x. Epub 2016 May 12. — View Citation

Pignatelli AM, Wampers M, Loriedo C, Biondi M, Vanderlinden J. Childhood neglect in eating disorders: A systematic review and meta-analysis. J Trauma Dissociation. 2017 Jan-Feb;18(1):100-115. doi: 10.1080/15299732.2016.1198951. Epub 2016 Jun 9. — View Citation

Regnaut O, Jeu-Steenhouwer M, Manaouil C, Gignon M. Risk factors for child abuse: levels of knowledge and difficulties in family medicine. A mixed method study. BMC Res Notes. 2015 Oct 30;8:620. doi: 10.1186/s13104-015-1607-9. — View Citation

Sawyer S, Coles J, Williams A, Williams B. A systematic review of intimate partner violence educational interventions delivered to allied health care practitioners. Med Educ. 2016 Nov;50(11):1107-1121. doi: 10.1111/medu.13108. — View Citation

Shannon S. Educational objectives for CME programmes. Lancet. 2003 Apr 12;361(9365):1308. doi: 10.1016/S0140-6736(03)13020-6. No abstract available. — View Citation

Short LM, Alpert E, Harris JM Jr, Surprenant ZJ. A tool for measuring physician readiness to manage intimate partner violence. Am J Prev Med. 2006 Feb;30(2):173-180. doi: 10.1016/j.amepre.2005.10.009. — View Citation

Stewart DE, MacMillan H, Kimber M. Recognizing and Responding to Intimate Partner Violence: An Update. Can J Psychiatry. 2021 Jan;66(1):71-106. doi: 10.1177/0706743720939676. Epub 2020 Aug 10. No abstract available. — View Citation

Su WM, Osisek PJ. The Revised Bloom's Taxonomy: implications for educating nurses. J Contin Educ Nurs. 2011 Jul;42(7):321-7. doi: 10.3928/00220124-20110621-05. — View Citation

Suglia SF, Sapra KJ, Koenen KC. Violence and cardiovascular health: a systematic review. Am J Prev Med. 2015 Feb;48(2):205-212. doi: 10.1016/j.amepre.2014.09.013. — View Citation

Sullivan GM. Getting off the "gold standard": randomized controlled trials and education research. J Grad Med Educ. 2011 Sep;3(3):285-9. doi: 10.4300/JGME-D-11-00147.1. No abstract available. — View Citation

Thabane L, Ma J, Chu R, Cheng J, Ismaila A, Rios LP, Robson R, Thabane M, Giangregorio L, Goldsmith CH. A tutorial on pilot studies: the what, why and how. BMC Med Res Methodol. 2010 Jan 6;10:1. doi: 10.1186/1471-2288-10-1. Erratum In: BMC Med Res Methodol. 2023 Mar 11;23(1):59. — View Citation

Turner W, Hester M, Broad J, Szilassy E, Feder G, Drinkwater J, Firth A, Stanley N. Interventions to Improve the Response of Professionals to Children Exposed to Domestic Violence and Abuse: A Systematic Review. Child Abuse Rev. 2017 Jan-Feb;26(1):19-39. doi: 10.1002/car.2385. Epub 2015 Jun 29. — View Citation

Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs Health Sci. 2013 Sep;15(3):398-405. doi: 10.1111/nhs.12048. Epub 2013 Mar 11. — View Citation

Zaher E, Keogh K, Ratnapalan S. Effect of domestic violence training: systematic review of randomized controlled trials. Can Fam Physician. 2014 Jul;60(7):618-24, e340-7. — View Citation

* Note: There are 58 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Demographics	Sociodemographic characteristics will be collected for all participants who are screened for the study, whether they are ineligible or eligible. These will include their age, their program (psychiatry or pediatrics), their sex at birth and their self-identified gender.	Pre-Intervention
Other	Previous Training in Child Maltreatment	Participants will be asked questions to gauge their previous education or training in various areas of CM. Participants will be given a definition of CM and asked in what areas they have received education or training related to CM, in what environment(s) they have learned about CM, and in which of these environments they have learned the most.	Time 1 (one week before intervention)
Other	Thoughts and Beliefs about Recognizing and Responding to CM in Professional Roles	Participants will be asked to rate their agreement with two statements about how much they believe (1) recognizing and (2) responding to CM is a part of their professional role. In qualitative interviews we will ask participants how often they believe they will encounter family violence in their future practice (how relevant it is to their future professional role as a psychiatrist or pediatrician), the purpose of these questions is to gauge this in our entire sample.	Time 1 (one week before intervention)
Other	Satisfaction with VEGA Training	Participants will complete a series of multiple choice and short-answer questions asking what they thought about the VEGA training. These questions will apply to all participants whether they completed self-directed or facilitator-led VEGA. Questions will include whether they believe the intended learning outcomes were achieved, what they thought of the instructional materials and educational scenarios, and how they would rate the usefulness of VEGA.	Time 2 (immediately after the intervention)
Primary	Number of Residents Who Meet Eligibility Criteria	The RC will track the number of residents who meet eligibility criteria, our aims are that we will recruit a total of 80 participants within 8 weeks, an average of 10 residents per week.	Through study completion, an average of 4 months
Primary	Number of Residents who Consent	The RC will track the number of residents who consent to the study and agree to be randomized to either self-directed or facilitator-led VEGA education approaches, both overall and per week of recruitment. Our aim is that the proportion of residents who contact the research team about participation and who consent to randomization will be 75% or greater.	Through study completion, an average of 4 months
Primary	Number of Residents who Complete Assigned Intervention	The RC will track the proportion of residents who are randomized and complete each arm, with completion consisting of reviewing all module content and the animated simulations in the case of self-directed VEGA and full attendance of the virtual workshop in the case of facilitator-led VEGA. Our goal is that the proportion of residents who are randomized and complete the assigned intervention will be 75% or greater for each arm. The acceptability of the facilitator-led and self-directed educational approaches as well as their value and impact will be determined via the coding of qualitative interview data from a sub-sample of participants.	Through study completion, an average of 4 months
Primary	Number of Residents who Complete Assessments	The RC will track the feasibility of collecting trial outcome data (survey assessments) at Time 1, Time 2, and Time 3. Our goal is that the proportion of missing data for each time point will be less than 20%. Qualitative description will be used to expand and extend what we learn about acceptability and feasibility of implementing the associated research activities, we anticipate participants will not identify any fatal flaws related to the conduct of an RCT.	Through study completion, an average of 4 months
Secondary	Child Maltreatment Vignette Scale	Child Maltreatment Vignette scale (Pelletier et al., 2014; Pelletier & Knox, 2017) is a psychometrically validated measure of knowledge and skill accuracy related to recognizing and responding to child maltreatment. Respondents will be prompted to review 14 distinct analog vignettes that depict a range of signs and symptoms of possible CM exposure and asked if they suspect child maltreatment and if they would report to Child Welfare Services. Changes to the question wording and small changes to the wording of the scenarios were made to align the measure with the Canadian context. A mean "knowledge and skill accuracy" score will be produced for analysis, with higher scores indicative of greater knowledge and skill accuracy related to CM. In a future RCT, this would be one of the primary outcomes of interest since this is a robust measure of knowledge and skills related to CM.	Time 1 (one week before intervention), Time 2 (immediately after the intervention), Time 3 (3 month follow-up)
Secondary	Child Maltreatment Knowledge and Skills Questions (Developed by VEGA Team)	Participants will be asked a series of questions about their knowledge and skills related to recognizing and responding to child maltreatment. These were developed by the VEGA training research team to capture specific aspects of child maltreatment knowledge directly addressed in the VEGA intervention and which are outside the scope of the child maltreatment vignette scale. The questions ask about the following topics (and more not mentioned here): parental/family risk factors for family violence, what future outcomes are associated with child maltreatment, other possible signs of child abuse, and principles for good documentation and providing ongoing care to children experiencing maltreatment. Including this measure in our study will allow us to make cross sample comparisons.	Time 1 (one week before intervention), Time 2 (immediately after the intervention), Time 3 (3 month follow-up)
Secondary	The Physician Readiness to Manage Intimate Partner Violence Survey: Preparedness Subscale	The Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) is a 67-item self-report tool that was developed to assess physician management of intimate partner violence across 10 subscales (Short et al.,2006; Connor et al., 2011). The preparedness subscale of PREMIS asks respondents to indicate the extent to which they feel prepared to address various aspects of IPV recognition and response when working with their clients across 10 items, including asking appropriate questions about IPV and responding to IPV disclosures. Response options are on a 7-item Likert type scale ranging from "Not prepared" (1) to "Quite Well Prepared" (7) and items are averaged to generate a mean score for practitioner preparedness, with higher scores indicative of greater perceived preparedness to recognize and respond to IPV. All items will be changed to be related to child maltreatment instead of IPV, several items were dropped as they are not relevant in the case of CM.	Time 1 (one week before intervention), Time 3 (3 month follow-up)
Secondary	Mandatory Reporting Self-Efficacy Scale (MRSES)	The MRSES is a 7-item self-report measure that asks respondents to indicate the extent to which they perceive their ability to implement a series of behaviours related to mandatory reporting of CM (Ayling, 2019). Informed by Bandura's self-efficacy theory and recommendations for self-efficacy scales (Bandura, 2006), response options are anchored on a scale from 0 to 100 with: "cannot do at all (0)"; moderately can do (50)"; and "highly certain can do (100)." A total score is generated by summing items across the scale for each participant, with higher scores indicative of greater self-efficacy related to recognizing and reporting suspected CM. We anticipate that this measure will be a key mediator of interest in a future definitive RCT given that across provincial and territorial jurisdictions in Canada (including Ontario), a suspicion of CM meets the threshold for a report to child protection authorities (Dubowitz, 2014; Mathews and Kenny, 2008).	Time 1 (one week before intervention), Time 2 (immediately after the intervention), Time 3 (3 month follow-up)
Secondary	Brief Individual Readiness for Change Scale (BIRCS)	The BIRCS scale is a 5-item readiness for change tool (Goldman, 2009). The scale's purpose is to screen for practitioners' readiness for change, in other words their receptivity to learning and applying new evidence-based research practices. For the purpose of this study, the items were adapted to assess provider's readiness to recognize and respond to all forms of child maltreatment (CM) in their clinical encounters. Response options range from '0' Strongly Disagree to '4' Strongly Agree. Two items were added, "I believe recognizing and responding to child maltreatment in my practice improves outcomes for my clients," and "I am motivated to learn about child maltreatment" to capture other aspects of residents' readiness to learn about CM and their belief's about how this will impact their practice.	Time 1 (one week before intervention)
Secondary	Achievement Goals for Work Domain (AGWD)	The Achievement Goals for Work Domain (AGWD) scale is a 23-item, psychometrically validated measure of work-related achievement goals that map onto the four goal orientations described by Achievement Goal Theory (Daniels & Daniels, 2018; Baranik et al., 2007). Respondents are asked to indicate their agreement with 23 statements, response options range from '1' strongly disagree to '7' strongly agree and responses are summed to generate a total score for each subscale corresponding to each type of goal orientation; higher scores are more indicative of the respondent's affinity to that goal orientation. In this study, they will be asked about their achievement goals for residency.	Time 1 (one week before intervention)

External Links

•   This is the VEGA Project website, where the public can access VEGA Family Violence Education Resources. More information can be found here about the development of VEGA.