Workshop Guide




Open Instructor

Challenging Patient Curriculum Instructor Guide^

PGY-2: Refugees and Immigrants

The Diagnosis and Treatment of Traumatized Refugees


The two overall goals of this session are:

  1. A PGY-2 resident will be able to diagnose and manage a refugee patient with post-traumatic stress disorder (PTSD).

Specific Objectives:

    1. Learn the criteria for diagnosing PTSD
    2. Identify the scales to measure symptoms to diagnose PTSD
    3. Learn the prevalence of PTSD
    4. Recognize the course of PTSD and how different patients respond differently to traumatic experiences
    5. Discuss the challenges in assessment and treatment of PTSD
    6. Learn treatment approaches to PTSD
    7. Identify local resources in caring for patients with PTSD
  1. A PGY-2 resident will be able to discuss the emotional challenges and possible personal reactions of caring for refugee patients who have been significantly traumatized.

 Specific Objectives:

    1. Discuss personal experiences with patients who have been traumatized
    2. Identify sources of support when dealing with emotionally challenging situations

ACGME core competencies:

Patient Care

  •  Demonstrate the ability to diagnose and treat patients with PTSD

Medical Knowledge

  • Learn the diagnostic criteria for PTSD
  • Learn the treatments used for PTSD

Practice-Based Learning and Improvement

  • Gain competence in working with social workers, psychiatric and other mental health professionals in caring for patients with PTSD

 Interpersonal and Communication Skills

  • Demonstrate the ability to communicate effectively with patients from different cultures with regard to diagnosis and treatment of PTSD


  • Be aware of his or her own personal attitudes, beliefs, biases and behaviors and how these may impact clinical care
  • Recognize the emotional toll that caring for patients who have been traumatized can cause and how to address this

Systems-Based Practice

  • Identify community resources to assist refugees who have been diagnosed with PTSD


Session Guide^


Time Needed:   2 hours – PowerPoint presentation, movie: The Diary of Immaculée, and discussion

Equipment Needed:

  • Computer
  • LCD projector
  • DVD player

Personnel Needed: Instructor

Suggested Readings (attached):

Eisenmann DP. Screening for mental health problems and history of torture.  In: Walker PF, Barnett ED (Eds). Immigrant Medicine. Philadelphia, PA: Saunders Elsevier; 2007: pages 633-651.

Instructor Script and Notes:

Part 1 – PowerPoint Presentation

  1. Introduce the case presentation as provided on the initial ppt slides.
  2. Review the objectives of the session as outlined in the ppt.
  3. Discuss each slide (self-explanatory).
  4. Slides 12-13 – Harvard Trauma Questionnaire: Review slides, but spend more time looking at actual questionnaire (will provide copies).
  5. Discuss slides 14-22 (self-explanatory).
  6. Discussion – slide 23. Hold this until after the movie. Then return to these discussion points:
    1. personal experiences in treating emotionally traumatized patients seen by the residents;
    2. how can we best support each other when caring for emotionally challenging patients, how do we avoid emotional distress.

Part 2 – Movie: The Diary of Immaculée (running time 38 minutes)

Show the entire film. It is a documentary about a brave young woman who survived the Rwanda genocide by being hidden in a small bathroom with other women. Almost her whole family was killed. She returns to Rwanda and visits her home and locations where family members were killed. She shows amazing resilience, courage, love and forgiveness. Discussion of movie to follow. Include questions to residents about their reactions to the film, the variable responses to trauma (Immaculée goes on with her life, forgives, loves, has a family, etc. while a friend of her slaughtered brother is unable to cope/get over the emotional trauma), and how does seeing this film help the resident better understand the experiences of his/her own patients.