Amanda Labora

Background: The digital anorectal examination (DRE) is a valuable clinical tool but is often underutilized due to provider discomfort, lack of confidence, and concerns about patient experience. Trauma-informed care (TIC) frameworks have improved education for other sensitive examinations, but their application to DRE instruction remains limited. Objective: To evaluate whether a TIC-focused educational intervention improved resident physician comfort, confidence, and knowledge related to the DRE. Methods: From October 2024 to February 2025, a prospective study was conducted among family medicine, internal medicine, and surgery residents at a large academic medical center. Residents attended a 30-minute TIC-focused DRE didactic session. Surveys were administered at baseline, immediately after the session, and at 6 weeks. Outcomes included confidence using TIC principles and identifying pathology, changes in comfort performing the DRE, and frequency of deferring examinations. Results: A total of 136 residents participated; 99 (73%) had paired post-session responses, and 45 (33%) completed all 3 surveys. Six weeks after the session, participants reported higher average confidence employing TIC (5.09 to 6.79, scale 1-10), greater comfort performing the DRE (4.63 to 6.36), and improved confidence identifying anal (4.07 to 6.00) and rectal pathology (3.65 to 5.47), with all comparisons P <.001. At baseline, 88 of 130 residents (68%) reported deferring clinically indicated examinations at least sometimes, and, among these residents, only one resident (5%) reported doing so during the follow-up period. Conclusions: A brief, low-resource educational session incorporating TIC principles significantly improved resident confidence and comfort employing TIC and performing the DRE.

Supplementary Fig. 1 STING agonist diABZI synergizes with MAPK inhibition in PDAC by enhancing apoptosis.

Supplementary Fig. 4 Immunoblot analysis demonstrating the effect of ± 100 U/ml exogenous IFN on CFPAC-1 and SUIT2 parental cells compared to their respective IFNAR-deficient isogenic cell lines. (B) Immunoblot analysis of CFPAC-1 parental and IFNAR1-KO cells exposed to ± 1 µM diABZI ± 100 nM trametinib for 24 h (C)Immunoblot analysis of the effects of ± 100 U/ml exogenous IFN ± 1 µM diABZI for 24 h.

Supplementary Fig. 2 Tumor growth is inhibited by STING agonism and MEK inhibition in vivo.

Supplementary Fig. 3 MEK inhibition amplifies STING-induced transcription of IFNB1, IL-6, and TNFA in multiple PDAC cell lines.

Supplementary Fig. 5 IL6 is not responsible for the synergistic effects of STING agonism and MEK inhibition.

Supplementary Resources and Table

Supplementary Fig. 3 MEK inhibition amplifies STING-induced transcription of IFNB1, IL-6, and TNFA in multiple PDAC cell lines.

Supplementary Fig. 5 IL6 is not responsible for the synergistic effects of STING agonism and MEK inhibition.