A Trauma-Informed Approach to the Medical History: Teaching Trauma-Informed Communication Skills to First-Year Medical and Dental Students

Abstract

Introduction: Trauma is ubiquitous and associated with negative effects on physical and mental health. Trauma-informed care (TIC) is a framework for mitigating these health effects and improving patients' engagement with medical care. Despite these clinical benefits, TIC is not routinely taught in undergraduate medical education. Methods: We designed a session for first-year medical and dental students to introduce TIC principles and their application in patient care. The session focused on screening for and inquiring about trauma and responding to disclosures of trauma. Using live patient interviews, small-group discussions, and case-based role-plays, the session offered expert instruction and hands-on practice. Students completed pre-and postsession surveys and a 5-month follow-up survey. Students reported their comfort with screening for trauma and responding to disclosures of trauma before and after the session and at 5 months following the session. Results: Of the 164 student participants, 76% completed surveys during the session, and 50% completed the follow-up survey. More than one-third (34%) of respondents reported having received at least one disclosure of trauma from a patient within the first 5 months of medical school. Students' comfort with screening for trauma increased from 30% to 56%, and their comfort with responding to disclosure of trauma increased from 35% to 55%. These improvements persisted on reevaluation at 5 months. Discussion: We present a model for teaching trauma-informed communication skills to first-year medical and dental students. The intervention significantly increased students' comfort level and self-reported clinical skills, and benefits persisted at 5 months.

Trauma-Informed Care Curricula for the Health Professions: A Scoping Review of Best Practices for Design, Implementation, and Evaluation

“…Fifty-one of the 55 studies included assessments of curricula, and all 51 studies implemented a survey immediately after the educational intervention. Nine studies (17.6%) evaluated long-term outcomes; 1 (2.0%) had a 1-month follow-up survey, 75 3 (5.9%) had a 3-month follow-up survey, 52,79,92 1 (2.0%) had a 5-month follow-up survey, 55 1 (2.0%) had a 6-month follow-up survey, 104 and 3 (5.9%) had a 12-month follow-up survey. 78,87,102 Three studies stated that they used the Kirkpatrick model of evaluation when designing their survey instrument.…”

“…Medical educators should include these core components in their curricula. Our review identified several areas for Understand the impact of trauma on health 33 (60.0) [53][54][55][56][57][58][59][60][61][62][63][64][65][66][69][70][71][72][73][74][75][76][77][78][79]81,84,86,89,93,94,97,100 Define and apply traumainformed care 27 (49.1) [53][54][55]58,[60][61][62][68][69][70][71][72]74,75,77,81,82,85,87,89,93,…”

“…Confidence in trauma-informed care skills 38 (74.5) [52][53][54][55][57][58][59][60][61][62][64][65][66][67][68][70][71][72][74][75][76][77]81,83,84,87,88,90,[92][93][94]96,97,[99][100][101]103,105 Training content knowledge assessment 25 (49.0) 53,55,58,[60][61][62][63][64][65]71,75,78,80,83,85,86,…”

Roadmap for Trauma-Informed Medical Education: Introducing an Essential Competency Set

“…The Center for Collaborative Study of Trauma, Health Equity, and Neurobiology hosts a website of succinct text and video lessons exploring the foundational science of trauma and healing and its application; the connection between TIC and health equity; and a proposal for a new model of care. 49 Faculty can find detailed guidance for conventional and simulation laboratory–based teaching 50 of trauma-informed history gathering 51,52 and physical examination, 53 including faculty–student conversation guides, sample presentations, 54,55 tip sheets, assessment materials, and sample cases. MedEdPORTAL offers comprehensive curricular modules addressing childhood adversity, trauma, TIC, and resilience for in-person and virtual instruction for UME and graduate medical education across multiple specialties.…”

“…Personal and professional development 49 Faculty can find detailed guidance for conventional and simulation laboratory-based teaching 50 of trauma-informed history gathering 51,52 and physical examination, 53 including faculty-student conversation guides, sample presentations, 54,55 tip sheets, assessment materials, and sample cases. MedEdPORTAL offers comprehensive curricular modules addressing childhood adversity, trauma, TIC, and resilience for in-person and virtual instruction for UME and graduate medical education across multiple specialties.…”