Trauma-Informed Medical Education
As an incoming medical student, I’m interested in understanding the ways in which medical schools are starting to incorporate trauma-informed practices into their training and instruction. Trauma-informed medical education (TIME) is a relatively recent educational approach that can have significant impacts on how practitioners approach patients who have suffered from adverse experiences (McClinton & Laurencin, 2020). Regardless of their medical speciality, a provider who uses trauma-informed approaches can recognize how trauma impacts their patient’s health and behavior. Instead of making assumptions that can violate safety and trust, the provider can work alongside the patient to prevent triggers and the potential for future traumatization (SAMHSA, 2014). Given that at least 50% of the U.S. population has experienced a traumatic event, it’s important that national medical guidelines and educational initiatives encourage trauma-sensitive approaches to providing medical care as a universal precautionary approach (Kuehn, 2020). Implementing these practices can allow for more patient-centered care, improve patient health outcomes, and buffer the long-term negative physical and mental health impacts of traumatic exposures (Goldstein et al., 2018).
Trauma-informed models are guided by five core principles: safety, choice, collaboration, trustworthiness and empowerment (Wolf et al., 2014). In a short patient interaction, it can be difficult for doctors to deliver on all five of these principles if they never received training that utilizes this framework. Trauma-informed care is all about prioritizing the patient’s wellbeing rather than figuring out what’s wrong with the patient. In reality however, the vast majority of medical training is focused on helping students develop the ability to do the latter. Trauma-informed medical education can shift this focus through small changes that can have tremendous impacts. When medical students learn how to do physical examinations, they can be instructed to use certain language and techniques that avoid violating the patient’s safety and trust. Physical exams that involve certain regions of the body can be triggering for patients, however medical students can learn how to ask for permission and preface certain procedures in a transparent manner. Not only does this clearly define the purpose of a given procedure, but it also establishes trust between the patient and provider. In addition to guidance on general physical exams, trauma-informed medical education draws special attention to approaches that should be implemented during discussions and examinations of the genital regions. Sexual abuse is not always apparent during a patient encounter and patients aren’t always willing to disclose this information during a social history. Thus, doctors should not assume that their patients won’t feel vulnerable or unsafe during a genital examination. Medical schools are starting to teach their students specific techniques for these exams so that they’re able to complete it without violating the patient’s safety or re-traumatizing them.
Nonetheless, there are still barriers to implementing trauma-informed approaches in medical school curricula and continued education for current doctors. The process of changing existing curriculum is time intensive and the impact of trauma-sensitive approaches are not routinely addressed. Lots of physicians feel uncomfortable talking about these topics and open spaces to bring these obstacles to the forefront are somewhat new to the medical field. Lack of consistent care is another issue with trauma-informed approaches because not all providers will treat their patients with the same caution and sensitivity. Inherent biases are also routinely discussed in the medical field and this can cause doctors to inflict trauma on patients despite having trauma-sensitive training. Nonetheless, these obstacles can be addressed over time by slowly building trauma-informed approaches into medical education. The benefits of trauma-sensitive care are well-researched and should definitely be discussed more openly amongst educators in medicine.
References
Goldstein, E., Murray-García, J., Sciolla, A. F., & Topitzes, J. (2018). Medical students’ perspectives on trauma-informed care training. The Permanente Journal, 22.
Green, B. L., Saunders, P. A., Power, E., Dass-Brailsford, P., Schelbert, K. B., Giller, E., … & Mete, M. (2015). Trauma-informed medical care: A CME communication training for primary care providers. Family medicine, 47(1), 7.
Kuehn, B. M. (2020). Trauma-informed care may ease patient fear, Clinician Burnout. JAMA, 323(7), 595-597.
McClinton, A., & Laurencin, C. T. (2020). Just in TIME: Trauma-Informed Medical Education. Journal of racial and ethnic health disparities, 7(6), 1046–1052. https://doi.org/10.1007/s40615-020-00881-w
SAMHSA. (2014). Mental Health Services Administration. SAMHSA’s concept of trauma and guidance for a trauma-informed approach. Rockville, MD: Office of Policy, Planning and Innovation. Substance Abuse and Mental Health Services Administration, HHS.
Wolf, M. R., Green, S. A., Nochajski, T. H., Mendel, W. E., & Kusmaul, N. S. (2014). ‘We’re civil servants’: The status of trauma-informed care in the community. Journal of Social Service Research, 40(1), 111-120.