Trauma‐informed primary care for medical residents

Abstract

Summary Background Psychological trauma can have a significant impact on mental and physical health, and interpersonal relationships. Many physicians report discomfort addressing psychological trauma in the context of health care visits, and few training opportunities exist for health care trainees to learn about the relationship between trauma and health. The aim of this project was to develop and implement an educational curriculum to teach medical and nursing trainees about trauma‐informed primary care. Methods We expanded upon pilot data from a brief interdisciplinary intervention to train medical residents in trauma‐informed primary care at a Veterans Affairs hospital. We generated a trauma‐informed care curriculum involving five 1‐hour didactic sessions, 10‐minute group reflection regarding patient interactions prior to each didactic session, and optional patient care observation and feedback. The curriculum aligned with internal medicine (n = 16) and nurse practitioner (n = 5) interprofessional primary care education sessions during the 2017/18 academic year. Results The curriculum was feasible and associated with increased self‐reported knowledge, attitudes and practice around trauma‐informed care. Free text feedback indicated that residents found the topic important, appreciated a skills‐based approach and valued experiential educational activities. Conclusions Training residents in trauma‐informed care results in improved knowledge, attitudes and practices in caring for patients with psychological trauma. Residents appreciated both experiential and skills‐based exercises. Next steps include continued exploration of using direct observation and feedback, and examining effects of training on patient outcomes (e.g. satisfaction with care).

A Scoping Review of Trauma-Informed Curricula for Primary Care Providers

“…The resulting 19 articles, with two conference abstracts, 21,22 were examined in-depth to determine the participants, mode and length of training, topics, and evaluation methods and results. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] We identified 17 different curricula in the 19 articles included for final analysis. The two articles by Green et al discuss the same curriculum, but evaluate different outcomes.…”

“…Trainings were taught by a mixture of health professionals including TIC experts, clinical psychologists, social workers, physicians, and nurses. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] (Continued on next page)…”

“…[23][24][25][26][27][28][29][30][31] Two educational curricula were adapted from prior curricula, while the remainder were created from a variety of sources, including Substance Abuse and Mental Health Services Administration principles, 4 the American Academy of Pediatrics Trauma Toolbox for Primary Care, 40 guidelines from the American Psychological Association, 41 evidence-based literature, and expert feedback. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] Bursch et al adapted the "Families OverComing Under Stress" resiliency training program (a strength-based, trauma-informed training program for deployed military personnel) for use with medical residents. 25 Green et al adapted the Risking Connection curriculum (a strength-based training program for helping people who have been hurt in interpersonal relationships, previously used in mental health, congregate care, faith-based, and medical facilities) for use with primary care residents, advanced practice providers, and physicians.…”

“…25 Green et al adapted the Risking Connection curriculum (a strength-based training program for helping people who have been hurt in interpersonal relationships, previously used in mental health, congregate care, faith-based, and medical facilities) for use with primary care residents, advanced practice providers, and physicians. 23,24 Utilizing the TIC pyramid by Raja et al 2015 as a framework to extract TIC training topics from articles, 19 the majority of the curricula covered topics related to universal trauma precautions; 71% (12/17) covered topics related to patient-centered communication and care [22][23][24][25][26]28,[30][31][32][33][34][35]38,39 and 94% (16/17) covered topics related to understanding the health effects of trauma. [21][22][23][24][25][27][28][29][30][31][32][33][34][35][36][37][38] The only curriculum that did not cover topics related to understanding the health effects of trauma was Shamaskin-Garroway et al, which focused on patient-centered communication skills.…”

Addressing Trauma and Building Resilience in Children and Families: Standardized Patient Cases for Pediatric Residents

“…Though several curricula have been designed to address ACEs and TIC, most have been limited in format and trainee demographic. Educators have developed brief didactic sessions on ACEs, [12][13][14] case-based discussions, 15,16 games, 17 practice sessions or role-plays, 18 and simulation. 19 These curricula have generally been well received and have shown promising outcomes.…”