Tanya Jain, Nisha Uppuluri, Megha Shankar
Trauma informed care (TIC) is an approach to clinical care that centers on how trauma affects patients, particularly those in marginalized communities. TIC has been shown to improve psychobehavioral outcomes, decrease retraumatization, and increase trustworthiness and mutuality between patients and clinicians. Despite the evidence for TIC in promoting patient-centered care, there is a gap in teaching TIC within medical education. To address this gap, we sought to develop, implement, and evaluate a TIC elective course.
We developed a skills-focused 8-week TIC elective through literature review and collaboration with faculty and community experts. Topics included a framework for practicing trauma-informed care, sexual assault/trafficking, domestic violence, healthcare-induced trauma, state sanctioned violence, displacement trauma, and neighborhood violence. The elective was implemented through workshops led by faculty and community TIC experts to a cohort of 15 medical students. A nested mixed methods approach was used to evaluate the elective. Quantitative data included pre/post surveys with Likert-type questions on trauma-informed care knowledge, attitudes (Attitudes Related to Trauma-Informed Care, ARTIC), and empathy (Toronto Empathy Questionnaire, TEQ) and was analyzed using descriptive statistics and t-tests. Qualitative data was collected through a focus group nested at the end of the course to explore students' perspectives on the elective, using a note-based method and rapid qualitative analysis.
There was a significant increase of 29.0% in mean self-reported knowledge of TIC (p<0.001). There was a significant increase of 7.4% in ARTIC scores (p<0.05) and TEQ scores remained stable with a baseline score at 52.6 (out of 64). Four themes emerged from focus group analysis: (1) need for TIC teaching, practice, and assessment into primary medical education curricula, (2) importance of learning a TIC framework for understanding and responding to specific forms of trauma, (3) appreciation for an interactive case-based discussion format, and (4) balance of teaching from academic medical faculty and community experts.
An 8-week, skills-based, community-oriented medical student elective on TIC was successfully developed and implemented. Evaluation showed high baseline empathy and improvement in TIC knowledge and attitudes, with medical students emphasizing the need for TIC education as a required part of medical curricula. Incorporating TIC within medical education may be a way to teach medical students a key cornerstone of patient-centered care.
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