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Guest H, Miller CL. Trauma-Informed Care in Nursing Curricula: Development of a Simulation-Based Educational Framework to Guide Health Professions. Nurs Educ Perspect 2024; 45:271-275. [PMID: 39159250 DOI: 10.1097/01.nep.0000000000001313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Abstract
AIM This research aimed to uncover elements of a comprehensive, trauma-informed (TI) multidisciplinary health professions simulation framework to improve the delivery of care to traumatized patients. BACKGROUND Trauma is a pervasive public health problem requiring a TI approach. Simulation is an evidence-based teaching strategy that advances knowledge and clinical reasoning. There is a lack of scientifically based simulation education models addressing the delivery of TI care for the health professions. METHOD A Delphi study utilizing a panel of experts was conducted to identify the most critical elements of a simulation framework. RESULTS Phase one identified 10 content areas and 111 subcontent areas. Phase two analysis revealed 99 percent of the 111 subcontent areas achieved expert consensus. CONCLUSION This Delphi study provides the first scientifically based framework to guide the development of a comprehensive, TI, multidisciplinary simulation framework to recognize trauma survivors and subsequently display concern and respect.
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Affiliation(s)
- Heather Guest
- About the Authors Heather Guest, PhD, RN, CNE, CHSE, is an assistant professor, Texas Tech University Health Sciences Center, Lubbock, Texas. Cathy L. Miller, PhD, RN, is a professor, College of Nursing and Health Science, University of Texas at Tyler, Tyler, Texas. This research was supported by a 2022 NLN Research in Nursing Education Mary Anne Rizzolo Doctoral Research Award. For more information, contact Dr. Guest at
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McBain SA, Cordova MJ. Clinical Education: Addressing Prior Trauma and Its Impacts in Medical Settings. J Clin Psychol Med Settings 2024; 31:501-512. [PMID: 39095585 DOI: 10.1007/s10880-024-10029-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 08/04/2024]
Abstract
Prior trauma exposure significantly increases the risk of developing PTSD following medical stressors and may contribute to the development of medically induced PTSD. However, healthcare systems often overlook the interaction between prior trauma and current medical stressors, contributing to negative psychosocial and health-related outcomes for patients. Integration of both trauma-informed and trauma-focused practices into psychosocial programming in medical settings may be key to effectively addressing the needs of trauma-exposed patients. Yet, there is a lack of practical guidance on how clinical psychologists in medical settings can respond to trauma's effects in routine clinical practice. This paper aims to provide an overview of trauma-focused theory, assessment, and treatment considerations within medical settings, emphasizing the importance of incorporating trauma-focused intervention into integrated psychosocial programming to address prior trauma and its impacts on care in order to improve patient outcomes.
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Affiliation(s)
- Sacha A McBain
- Departments of Psychiatry and Surgery, College of Medicine, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR, 72205, USA.
| | - Matthew J Cordova
- Department of Psychology, Palo Alto University, 1791 Arastradero Rd, Palo Alto, CA, 94304, USA
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Neff K, McKean E, Miller M, Fitzgerald JT, Owens L, Morgan HK. How medical students' trauma histories affect their clinical clerkship experiences. CLINICAL TEACHER 2024; 21:e13734. [PMID: 38247167 DOI: 10.1111/tct.13734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/29/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND As the gender demographics of medical students have evolved over the past decades, it is important to understand potential stressors and challenges that may affect clinical learning experiences. This study investigated the prevalence of prior sexual assault (SA) and interpersonal violence (IPV) in medical students and how these affect their clinical clerkship experiences. METHODS A survey was distributed to third- and fourth-year medical students at a single institution in August 2022 querying respondents on demographics and prior experiences with SA/IPV at any point in their lives. Respondents who indicated they had previously experienced SA/IPV were directed to questions about how these experiences affected clerkships. FINDINGS Of 419 students, 125 responded to the survey (30.8% response rate). Forty (31.1%) reported a history of SA/IPV-32 (80.0%) women, five (12.5%) men, and three (7.5%) who did not report gender or identified as non-binary. Of the 40 respondents with a history of SA/IPV, 20 (50.0%) reported that their prior history affected their overall clinical experience, and nine (22.5%) felt that it affected their performance. Only seven (17.5%) reported using any resources, such as counselling, during their clerkships. Narrative responses discussed significant effects on performing physical exams, taking a history, interacting with team members, and engaging during clerkships. DISCUSSION This work demonstrates the high number of students affected by SA/IPV and how these prior experiences affected core components of their clerkship experiences. CONCLUSIONS Institutions must be proactive to create better supports for learners with histories of trauma, including SA/IPV.
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Affiliation(s)
- Katherine Neff
- Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Erin McKean
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Madison Miller
- Department of Obstetrics and Gynecology, Henry Ford Health, Detroit, Michigan, USA
| | - James T Fitzgerald
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Lauren Owens
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
| | - Helen K Morgan
- Department of Obstetrics and Gynecology, Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
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Brown T, Fialkowski A, Elisseou S, Grossman S, Sager Z, Potter J, Trinh NH. Trauma-informed precepting: A novel curriculum for faculty development. MEDICAL TEACHER 2024:1-6. [PMID: 39066897 DOI: 10.1080/0142159x.2024.2382858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 07/17/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE Traumatic experiences are ubiquitous and associated with negative impacts on health and wellbeing in patients, students, and clinicians. Trauma-informed care (TIC) is a harm reduction framework that aims to minimize re-traumatization and the negative health impacts of trauma. TIC is increasingly being incorporated into undergraduate medical education (UME) curricula; however, to date, there is no standardized curriculum to support faculty in precepting TIC clinical skills. METHODS We created a series of five educational modules in an asynchronous online format to support faculty in the instruction and precepting of TIC clinical skills in UME. The modules instruct on trauma epidemiology, trauma-informed clinical skills, trauma-informed precepting, and trauma-informed self-care (TISC). The modules are interactive and utilize multimedia content. RESULTS Fifty-three faculty members of the primary care clerkship participated in the modules. After the modules, faculty demonstrated increased knowledge of TIC, though their comfort in applying principles with patients and students was unchanged. DISCUSSION We present a novel, standardized curriculum to support faculty in the practice and precepting of TIC clinical skills. The intervention is shown to promote knowledge surrounding TIC. In the future, pairing these asynchronous modules with in-person training may be necessary to improve comfort with the application of these skills.
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Affiliation(s)
- Taylor Brown
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Sadie Elisseou
- Harvard Medical School, Physician, Department of Internal Medicine, Veteran Affairs Boston Healthcare System, Boston, MA, USA
| | - Samara Grossman
- Department of Psychiatry, Brigham and Women's Hospital, Social Worker, Boston, MA, USA
| | - Zachary Sager
- Harvard Medical School, Physician, Department of Psychiatry, Veteran Affairs Boston Healthcare System, Boston, MA, USA
| | - Jennifer Potter
- Department of Medicine, Harvard Medical School, Veteran Affairs Boston Healthcare System, Boston, MA, USA
- Department of General Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Nhi-Ha Trinh
- Office of Student Affairs, Harvard Medical School, Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
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Nolan HA, Roberts L. Twelve tips for implementing trigger or content warnings in healthcare professions education. MEDICAL TEACHER 2024; 46:903-910. [PMID: 38104560 DOI: 10.1080/0142159x.2023.2290995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Abstract
Trigger warnings are statements offering prior notification of sensitive content, allowing recipients to prepare for and avoid ensuing distress. Students are increasingly reporting expectations for warnings in classrooms and learning contexts. Discussions regarding use of warnings have clear relevance to healthcare education, which regularly explores sensitive content. Their use has been positioned as a measure for inclusive education and as a means to enhance trauma awareness and empathy. Expectations for warnings need to be considered in the context of preparedness for professional practice. This Twelve Tips paper explores the evidence in relation to warnings and its applicability to social learning contexts. These tips highlight considerations and strategies for the use of warnings in the context of healthcare education, balancing issues of inclusivity, learner and educator wellbeing, and professional preparedness. These discussions are situated within the context of current classroom-based healthcare education.
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Affiliation(s)
| | - Lesley Roberts
- Warwick Medical School, University of Warwick, Coventry, UK
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Whitaker RC, Payne GB, O’Neill MA, Brennan MM, Herman AN, Dearth-Wesley T, Weil HF. Trauma-Informed Undergraduate Medical Education: A Pathway to Flourishing with Adversity by Enhancing Psychological Safety. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:324-331. [PMID: 38863986 PMCID: PMC11166023 DOI: 10.5334/pme.1173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/14/2024] [Indexed: 06/13/2024]
Abstract
We describe the Life Experiences Curriculum (LEC), which attempts to integrate medical student well-being with trauma-informed medical education. The long-term goal of LEC is to help medical students flourish with adversity and trauma, where flourishing refers to having a sense of purpose that arises from awareness of one's strengths and limitations, shaped by life experiences. The short-term goal of LEC is to develop students' relational capacities, such as acceptance and awareness of self and others, while building and maintaining students' psychological safety. We describe the conceptual rationale for these goals and the curriculum's development, implementation, evaluation, and limitations. The curriculum extends over four years and involves a preclinical seminar and students' individual and group reflection sessions with LEC faculty. The seminar addresses the coexistence of trauma and flourishing across life experiences, as well as how safety in relationships is impaired by traumatic experiences and must be restored for healing and growth. The physician faculty have no role in student evaluation and co-lead all LEC activities. LEC is intended to provide students with new language for understanding the process of trauma and flourishing in both individuals and systems and to build and sustain students' relational capacities. There are ongoing efforts to re-imagine self-care as communal-care in which care and support are given and received in a community of students and faculty. Such a model may help build the relational capacities needed to deliver trauma-informed care and also promote flourishing with adversity in healers and in those seeking to be healed.
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Affiliation(s)
- Robert C. Whitaker
- Professor of Clinical Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, US
- Director of Research and Research Education in the Columbia-Bassett Program, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, US
- Bassett Medical Center and Bassett Research Institute, Cooperstown, NY, US
| | - Georgia B. Payne
- Second year medical student in the Columbia-Bassett Program, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, US
| | - Maeve A. O’Neill
- Assistant Professor of Clinical Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, US
| | - Megan M. Brennan
- Assistant Clinical Professor of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, US
| | - Allison N. Herman
- Bassett Medical Center and Bassett Research Institute, Cooperstown, NY, US
- Research Associate in the Columbia-Bassett Program, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, US
| | - Tracy Dearth-Wesley
- Bassett Medical Center and Bassett Research Institute, Cooperstown, NY, US
- Senior Research Associate in the Columbia-Bassett Program, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, US
| | - Henry F.C. Weil
- Professor of Clinical Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, US
- Senior Associate Dean for the Columbia-Bassett Program, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, US and Bassett Medical Center and Bassett Research Institute, Cooperstown, NY, US
- Chief Operating Officer of Bassett Medical Center, Cooperstown, NY, US
- Chief Clinical Officer and Chief Academic Officer of Bassett Healthcare Network, Cooperstown, NY, US
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Shrivastava SR, Shrivastava PS, Joshi A. Integrating Psychological Care Training in Trauma Care for Medical Students: the Need and the Strategies. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:447-450. [PMID: 38826692 PMCID: PMC11141583 DOI: 10.2147/amep.s449903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/28/2024] [Indexed: 06/04/2024]
Abstract
Trauma, whether arising from accidents, violence, or medical emergencies, generally has a substantial impact on the lives of victims, their family members, the society, and the healthcare delivery system. The purpose of the article is to justify the need to train medical students in trauma-related psychological care, explore the significance of simulation-based training, and identify coping strategies to augment the resilience of medical students. As healthcare professionals are the ones who are executing trauma care-related interventions, it is essential that medical students are trained to offer psychological care to the victims and family members of trauma to enable healing of both the body and the mind. If medical students learn about psychological care pertaining to trauma, they will be well equipped to handle sudden traumatic events by being more adaptable and resilient. Medical students can be trained in multiple ways to improve their psychological preparedness while delivering trauma care. As a part of the psychological training related to the management of trauma victims, medical students must be trained in developing coping strategies and resilience. In conclusion, facilitating learning among medical students in the psychological aspects of trauma care is a crucial domain for developing competent healthcare professionals. It is a priority to integrate into medical education a comprehensive learning about psychological care that will empower medical students to respond effectively to the complexities of trauma with empathy, resilience, and effective communication.
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Affiliation(s)
- Saurabh RamBihariLal Shrivastava
- Department of Community Medicine, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, MH, India
| | | | - Abhishek Joshi
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, MH, India
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Villamagna AH, Bonura EM. COVID-19 curriculum highlighting the importance of trauma-informed pedagogy. MEDICAL EDUCATION 2024; 58:619-620. [PMID: 38362604 DOI: 10.1111/medu.15348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/23/2024] [Indexed: 02/17/2024]
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Roze des Ordons AL, Ellaway RH. Storylines of Trauma in Health Professions Education: A Critical Metanarrative Review. TEACHING AND LEARNING IN MEDICINE 2024:1-13. [PMID: 38635478 DOI: 10.1080/10401334.2024.2342443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/29/2024] [Indexed: 04/20/2024]
Abstract
PHENOMENON Learners in medical education are often exposed to content and situations that might be experienced as traumatic, which in turn has both professional and personal implications. The purpose of this study was to synthesize the literature on how trauma has been conceptualized and approached within medical education, and the implications thereof. APPROACH A metanarrative approach was adopted following the RAMESES guidelines. Searches of 7 databases conducted in January 2022 with no date limitations yielded 7,280 articles, of which 50 were identified for inclusion through purposive and theoretical sampling. An additional 5 articles were added from manual searches of reference lists. Iterative readings, interpretive and reflexive analysis, and research team discussions were performed to identify and refine metanarratives. FINDINGS Five metanarratives were identified, including the concept of trauma, the trauma event, the person with trauma, the impact of trauma, and addressing trauma, with each metanarrative encompassing multiple dimensions. A biomedical concept of trauma predominated, with lack of conceptual clarity. Theory was not integrated or developed in the majority of articles reviewed, and context was often ambiguous. Trauma was described in myriad ways among studies. Why certain events were experienced as trauma and the context in which they took place were not well characterized. The impact of trauma was largely concentrated on harmful effects, and manifestations beyond symptoms of post-traumatic stress were often not considered. Furthermore, the dominant focus was on the individual, yet often in a circumscribed way that did not seek to understand the individual experience. In addressing trauma, recommendations were often generic, and earlier research emphasized individually-focused interventions while more recent studies have considered systemic issues. INSIGHTS Multiple dimensions of trauma have been discussed in the medical education literature and from many conceptual standpoints, with biomedical, epidemiologic, and individualized perspectives predominating. Greater precision and clarity in defining and understanding trauma is needed to advance research and theory around trauma in medical education and the associated implications for practice. Exploring trauma from intersectional and collective experiences and impacts of trauma and adapting responses to individual needs offers ways to deepen our understanding of how to better support learners impacted by trauma.
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Affiliation(s)
- Amanda L Roze des Ordons
- Department of Critical Care Medicine, Division of Palliative Medicine, Department of Oncology, Department of Anesthesiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rachel H Ellaway
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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West HM, Flain L, Davies RM, Shelley B, Edginton OT. Medical student wellbeing during COVID-19: a qualitative study of challenges, coping strategies, and sources of support. BMC Psychol 2024; 12:179. [PMID: 38549145 PMCID: PMC10979564 DOI: 10.1186/s40359-024-01618-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/22/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Medical students face challenges to their mental wellbeing and have a high prevalence of mental health problems. During training, they are expected to develop strategies for dealing with stress. This study investigated factors medical students perceived as draining and replenishing during COVID-19, using the 'coping reservoir' model of wellbeing. METHODS In synchronous interactive pre-recorded webinars, 78 fourth-year medical students in the UK responded to reflective prompts. Participants wrote open-text comments on a Padlet site. Responses were analysed using reflexive thematic analysis. RESULTS Analysis identified five themes. COVID-19 exacerbated academic pressures, while reducing the strategies available to cope with stress. Relational connections with family and friends were affected by the pandemic, leading to isolation and reliance on housemates for informal support. Relationships with patients were adversely affected by masks and telephone consultations, however attending placement was protective for some students' wellbeing. Experiences of formal support were generally positive, but some students experienced attitudinal and practical barriers. CONCLUSIONS This study used a novel methodology to elicit medical students' reflections on their mental wellbeing during COVID-19. Our findings reinforce and extend the 'coping reservoir' model, increasing our understanding of factors that contribute to resilience or burnout. Many stressors that medical students typically face were exacerbated during COVID-19, and their access to coping strategies and support were restricted. The changes to relationships with family, friends, patients, and staff resulted in reduced support and isolation. Recognising the importance of relational connections upon medical students' mental wellbeing can inform future support.
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Affiliation(s)
- Helen M West
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.
| | - Luke Flain
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Rowan M Davies
- School of Medicine, University of Liverpool, Liverpool, UK
- Salford Royal NHS Foundation Trust, Manchester, UK
| | - Benjamin Shelley
- School of Medicine, University of Liverpool, Liverpool, UK
- Calderdale and Huddersfield NHS Foundation Trust, West Yorkshire, UK
| | - Oscar T Edginton
- School of Medicine, University of Liverpool, Liverpool, UK
- Leeds Teaching Hospitals NHS Foundation Trust, Leeds, UK
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Nolan HA, Roberts L. Trigger warnings as tools for learning-theorising an evolving cultural concept. MEDICAL EDUCATION 2024; 58:185-195. [PMID: 37528527 DOI: 10.1111/medu.15172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND While definitions of trigger warnings vary, it is generally accepted that they caution about potential reactions arising from exposure to distressing material. Controversy surrounds use of warnings in education, with concerns noted regarding impacts on academic freedom, "coddling", thereby undermining resilience, reinforcement of traumatised identity and enablement of avoidance. Proponents of warnings position them as accommodations for those affected by trauma, enhancing inclusion, and suggest warnings empower choice and enable informed engagement in learning. A recent meta-analysis of warnings' efficacy demonstrated no effect on affective responses or comprehension. Findings regarding avoidance suggested warnings may increase engagement with material. Synthesis of heterogeneous results relating to context of warning application necessitates cautious interpretation of findings. Furthermore, controlled experimental designs do not reflect complex ecologies of social learning environments. METHODS Evidence relating to warnings in healthcare professions education remains limited. We undertake a narrative review and synthesis of evidence regarding the role and functions of trigger warnings from a range of disciplines, to inform healthcare education practice. We apply this evidence in considering how warnings may act within a range of theoretical frameworks for healthcare professionals educations including andragogy, self-directed learning and, ultimately, transformative learning. Tensions between exposure to emotionally stimulating learning episodes and the necessity of emotion for learning while simultaneously attending to learners' needs and fulfilling educators' responsibilities are explored. We probe gaps and contentions in existing theoretical frameworks for learning, and consider implications of recognised limitations with reference to warnings. We summarise by proposing a conceptual model for the role of warnings that considers wider salient factors for fostering effective learning. DISCUSSION AND CONCLUSIONS Difficulties associated with deriving contextually-relevant evidence and conclusions relating to warnings as an evolving cultural concept are highlighted. We propose warnings as tools to enable critical reflection and emotional literacy, to curate effective learning environments and support humanistic healthcare professional identity formation, within wider trauma-informed pedagogies and educator practice.
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Neil JM, Barton C, Hegarty K. Should we be concerned? A qualitative study of educators' perceptions of medical student wellbeing in domestic violence training. MEDICAL TEACHER 2024; 46:245-251. [PMID: 37579323 DOI: 10.1080/0142159x.2023.2244664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Domestic violence (DV) is common in the Australian community so it is likely that there will be medical students who are affected personally by DV. Some of these students may find DV training confronting or even re-traumatising. A trauma-informed medical education (TIME) framework utilising trauma-informed care principles may minimise this risk to students. We aimed to explore educators' perceptions of student well-being in Australian medical school DV training. METHOD This descriptive qualitative study interviewed 13 educators with experience teaching DV in Australian medical schools using an interpretivist methodology and a TIME framework. Interview data was thematically analysed to identify themes. RESULTS Four key themes included (1) educators thrown in at the deep end; (2) keeping students emotionally safe; (3) a trauma-informed learning environment and; (4) challenges of student DV disclosures. Few of the participants had received training in DV. Educators used methods such as trigger warnings and ground rules to improve student's emotional safety. Experienced educators dealt with disclosures of DV by students which led to role confusion. DISCUSSION There is a need for increased training of medical educators that includes awareness and implementation of TIME principles when training medical students in DV as well as increased supports and resources for educators.
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Affiliation(s)
- Jennifer Margaret Neil
- Department of Medical Education, The University of Melbourne, Melbourne, Australia
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Christopher Barton
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Kelsey Hegarty
- Department of General Practice, The University of Melbourne and The Royal Women's Hospital, Melbourne, Australia
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Rodriguez N, Gonzales-Pacheco DM, Byham-Gray LD, Rothpletz-Puglia P. Trauma-Informed Care Training for Dietetic Interns Improves Attitudes Toward Women Who Have Experienced Trauma. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:869-876. [PMID: 37921798 DOI: 10.1016/j.jneb.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE To assess change in attitudes toward women who have experienced trauma and to describe interns' reflections regarding the provision of universal trauma precautions and the training sessions. METHODS Dietetic interns participated in 3 2-hour trauma-informed care (TIC) training sessions. A multiple-methods design was used, incorporating a presurvey and postsurvey to assess change in attitudes and thematic analysis to assess self-reflections. RESULTS The attitudes of the interns improved across all statements. Two components measuring attitudes about sympathetic feelings toward mothers with underlying trauma and substance use disorder during pregnancy and retaining custody of their children reached statistical significance (P < 0.05). Four themes were identified in the self-reflections: TIC training was informative, valuable, and warranted, and interns felt comfortable discussing TIC. CONCLUSIONS AND IMPLICATIONS Students positively assessed the TIC training and changed their attitudes. Trauma-informed care can be effectively incorporated within dietetics education to support students in developing therapeutic relationships in their future nutrition care standards.
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Affiliation(s)
- Nancy Rodriguez
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, Newark, NJ
| | - Diana M Gonzales-Pacheco
- Department of Individual, Family, and Community Education, College of Education and Human Sciences, University of New Mexico, Albuquerque, NM
| | - Laura D Byham-Gray
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, Newark, NJ
| | - Pamela Rothpletz-Puglia
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, Newark, NJ.
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Stern EM. Art is Patient: A Museum-Based Experience to Teach Trauma-Sensitive Engagement in Health Care. THE JOURNAL OF MEDICAL HUMANITIES 2023; 44:481-501. [PMID: 37505360 DOI: 10.1007/s10912-023-09810-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/29/2023]
Abstract
Psychological trauma is ubiquitous, an often hidden yet influential factor in care across clinical specialties. Interdisciplinary health professions education is mobilizing to address the importance of trauma-sensitive care. Given their attention to complex human realities, the health humanities are well-poised to shape healthcare learners' responses to trauma. Indeed, many such arts and humanities curricula propose narrative exercises to strengthen empathy, self-reflection, and sensitive communication. Trauma, however, is often unwordable, fragmentary, and physically encoded, incompatible with storying methods. This article presents a recent innovation, the Art is Patient seminar series, which focuses on aesthetic exercises to help learners access and share non-verbal, embodied, and relational responses to art. Based in an art museum context, it provides successive experiences of approaching, witnessing, and engaging with visual art as an analogue to developing trauma-sensitive relationships. Reflections on the process locate the seminar vis-à-vis health humanities practices, aesthetics, and trauma-informed approaches.
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Affiliation(s)
- Eva-Marie Stern
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Frizell CA. The Importance of Acknowledging the Experiences of Racial/Ethnic Minoritized Physician Assistants/Associates. J Physician Assist Educ 2023; 34:269-270. [PMID: 37656810 DOI: 10.1097/jpa.0000000000000537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Affiliation(s)
- Carl A Frizell
- Carl A. Frizell, DMSc, MSPAS, PA-C, is an assistant professor and academic education director, Department of Physician Assistant Studies, School of Graduate Studies, Meharry Medical College, Nashville, Tennessee
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Truscott A, Hayes D, Bardsley T, Choksi D, Edbrooke-Childs J. Defining young people's mental health self-care: a systematic review and co-development approach. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02320-7. [PMID: 37947894 DOI: 10.1007/s00787-023-02320-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
Self-care is among the emerging types of mental health support which operate outside traditional services, although the meaning and practice of self-care for young people with mental health difficulties are currently unclear. This systematic review was pre-registered with PROSPERO (CRD42021282510) and investigated conceptualizations of self-care in academic publications which investigated or discussed self-care for young people's mental health or wellbeing. A Patient and Public Involvement (PPI) workshop facilitated young people with experience of mental health difficulties to respond to the identified concepts and co-develop a definition of self-care. Searches in PsycINFO, MEDLINE, Embase, CINAHL Plus, Scopus, Cochrane Library of Systematic Reviews, and gray literature sources resulted in 90 included publications. Content analysis indicated little conceptual consistency, with health and wellness promotion most commonly used to define self-care. The PPI workshop co-developed a definition of mental health self-care, which attendees felt should emphasize an individual process of self-awareness, self-compassion, and specific strategies to work toward emotional balance. This study highlights the gap between current academic understandings of young people's mental health self-care and young people's experience. The presented definition will enable future research to begin from an understanding of self-care which is relevant to young people with experience of mental health difficulties.
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Affiliation(s)
- Alex Truscott
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, 4-8 Rodney St, London, N1 9JH, UK.
| | - Daniel Hayes
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, 4-8 Rodney St, London, N1 9JH, UK
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Tom Bardsley
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, 4-8 Rodney St, London, N1 9JH, UK
| | - Disha Choksi
- Anna Freud National Centre for Children and Families, 4-8 Rodney St, London, N1 9JH, UK
| | - Julian Edbrooke-Childs
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, 4-8 Rodney St, London, N1 9JH, UK
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McClintock AH, Fainstad T, Blau K, Jauregui J. Psychological safety in medical education: A scoping review and synthesis of the literature. MEDICAL TEACHER 2023; 45:1290-1299. [PMID: 37266963 DOI: 10.1080/0142159x.2023.2216863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Psychological safety (PS) is the belief that the environment is safe for risk taking. Available data point to a lack of PS in medical education. Based on literature in other fields, PS in clinical learning environments (CLEs) could support trainee well-being, belonging, and learning. However, the literature on PS in medical education has not been broadly assessed. MATERIALS AND METHODS In 2020, authors searched PubMed, Web of Science, CINAHL, Scopus, ERIC, PsycInfo, and JSTOR for articles published prior to January 2020. Authors screened all search results for eligibility using specific criteria. Data were extracted and thematic analysis performed. RESULTS Fifty-two articles met criteria. The majority focused on graduate medical education (45%), and 42% of studies took place within a CLE. Articles addressed organizational and team level constructs (58%), with fewer descriptions of specific behaviors of team members that promote or hinder safety. The impacts of safe environments for trainees and patients are areas in need of more exploration. DISCUSSION Future research should focus on defining specific organizational and interpersonal leader behaviors that promote PS, seek to understand how PS is determined by individual trainees, and measure the impact of PS on learners, learning, and patient care outcomes.
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Affiliation(s)
- Adelaide H McClintock
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Tyra Fainstad
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kevin Blau
- Department of Medicine, University of Washington School of Medicine, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Joshua Jauregui
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Latessa RA, Galvin SL, Swendiman RA, Onyango J, Ostrach B, Edmondson AC, Davis SA, Hirsh DA. Psychological safety and accountability in longitudinal integrated clerkships: a dual institution qualitative study. BMC MEDICAL EDUCATION 2023; 23:760. [PMID: 37828469 PMCID: PMC10571297 DOI: 10.1186/s12909-023-04622-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/28/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Psychological safety and accountability are frameworks to describe relationships in the workplace. Psychological safety is a shared belief by members of a team that it is safe to take interpersonal risks. Accountability refers to being challenged and expected to meet expectations and goals. Psychological safety and accountability are supported by relational trust. Relational continuity is the educational construct underpinning longitudinal integrated clerkships. The workplace constructs of psychological safety and accountability may offer lenses to understand students' educational experiences in longitudinal integrated clerkships. METHODS We performed a qualitative study of 9 years of longitudinal integrated clerkship graduates from two regionally diverse programs-at Harvard Medical School and the University of North Carolina School of Medicine. We used deductive content analysis to characterize psychological safety and accountability from semi-structured interviews of longitudinal integrated clerkship graduates. RESULTS Analysis of 20 graduates' interview transcripts reached saturation. We identified 109 discrete excerpts describing psychological safety, accountability, or both. Excerpts with high psychological safety described trusting relationships and safe learning spaces. Low psychological safety included fear and frustration and perceptions of stressful learning environments. Excerpts characterizing high accountability involved increased learning and responsibility toward patients. Low accountability included students not feeling challenged. Graduates' descriptions with both high psychological safety and high accountability characterized optimized learning and performance. CONCLUSIONS This study used the workplace-based frameworks of psychological safety and accountability to explore qualitatively longitudinal integrated clerkship graduates' experiences as students. Graduates described high and low psychological safety and accountability. Graduates' descriptions of high psychological safety and accountability involved positive learning experiences and responsibility toward patients. The relational lenses of psychological safety and accountability may inform faculty development and future educational research in clinical medical education.
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Affiliation(s)
- Robyn A Latessa
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- University of North Carolina Health Sciences at Mountain Area Health Education Center, Asheville, NC, USA
| | - Shelley L Galvin
- Department of Obstetrics and Gynecology, Mountain Area Health Education Center, Asheville, NC, USA
| | - Robert A Swendiman
- Department of Pediatric General Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Joshua Onyango
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Bayla Ostrach
- University of North Carolina Health Sciences at Mountain Area Health Education Center, Asheville, NC, USA
- Departments of Family Medicine and Medical Anthropology, Boston University School of Medicine, Boston, MA, USA
| | | | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Asheville, NC, USA
| | - David A Hirsh
- Harvard Medical School, Boston, MA, USA.
- Department of Medicine, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA, 02139, USA.
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Pandit K, Chu DL, Russell R, Wright M, Titone L, Diaz T, Truong J, Murano T, Egan DJ. The utility of an online discussion board for reflective writing in an emergency medicine rotation. AEM EDUCATION AND TRAINING 2023; 7:e10899. [PMID: 37529174 PMCID: PMC10387829 DOI: 10.1002/aet2.10899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/05/2023] [Accepted: 07/08/2023] [Indexed: 08/03/2023]
Abstract
Background Narrative analysis and reflection have been found to support professional identity formation (PIF) and resilience among medical students. In the emergency department, students have used reflective practice to process challenging clinical experiences, such as ethical dilemmas or moral distress. An online discussion board, however, has not been described as a curricular component of emergency medicine (EM) rotations. The objective of this educational innovation was to support medical students in an EM clinical rotation via an online discussion board for reflecting on and debriefing clinical experiences with faculty and peers. Methods Fifty-two medical students enrolled in the pass/fail EM elective between May 13, 2019, and October 30, 2020. Each cohort of six students took part in a cohort-specific discussion using the Canvas learning management system. Students were encouraged to post about any observations, reflections, or emotions after their shifts. Faculty course directors responded to each post using concepts of debriefing, coaching, and trauma-informed teaching. Results Over 18 months, 49 of 52 (94%) students participated in the discussion board. Of 346 total posts, half were by students, and the other half were faculty responses. Students posted 3.27 times each, on average. Students rarely raised questions about scientific knowledge content, fact-based aspects of patient care, or specific skills. Rather, they often posted about intensely affective reactions to experiences that left them with complex emotions. Upon review of posts by the course directors, the majority (54%) of students' posts contained a range of affective responses. Students appreciated faculty responses and supported each other in their written responses to peers. Conclusions An online discussion board can be used successfully for asynchronous reflective practice to debrief clinical experiences during an EM rotation, if designed incorporating faculty and peer support using trauma-informed teaching principles to bolster well-being and PIF.
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Affiliation(s)
- Kiran Pandit
- Department of Emergency MedicineAlbert Einstein College of MedicineBronxNew YorkUSA
| | - David L. Chu
- New York‐Presbyterian Hospital CenterNew YorkNew YorkUSA
| | - Roxanne Russell
- Mailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
| | - Melissa Wright
- Center for Engaged PedagogyBarnard CollegeNew YorkNew YorkUSA
| | - Lauren Titone
- Department of Emergency MedicineColumbia University Vagelos College of Physicians & SurgeonsNew YorkNew YorkUSA
| | - Tomas Diaz
- Department of Emergency MedicineColumbia University Vagelos College of Physicians & SurgeonsNew YorkNew YorkUSA
| | - Jimmy Truong
- Department of Emergency MedicineColumbia University Vagelos College of Physicians & SurgeonsNew YorkNew YorkUSA
| | - Tiffany Murano
- Department of Emergency MedicineColumbia University Vagelos College of Physicians & SurgeonsNew YorkNew YorkUSA
| | - Daniel J. Egan
- Department of Emergency MedicineMassachusetts General Hospital and Brigham and Women's HospitalBostonMassachusettsUSA
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20
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Lee CH, Santos CD, Brown T, Ashworth H, Lewis JJ. Trauma-Informed Care for Acute Care Settings: A Novel Simulation Training for Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11327. [PMID: 37520013 PMCID: PMC10376910 DOI: 10.15766/mep_2374-8265.11327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 04/11/2023] [Indexed: 08/01/2023]
Abstract
Introduction Physicians often care for patients who have experienced traumatic events including abuse, discrimination, and violence. Trauma-informed care (TIC) is a framework that recognizes the prevalence of trauma, promotes patient empowerment, and minimizes retraumatization. There are limited education curricula on how to apply TIC to acute care settings, with simulation-based training presenting a novel educational tool for this aim. Methods Students participated in a didactic on TIC principles and its applications in acute care settings. Learners participated in three simulation cases where they performed physical exams and gathered history on patients with urgent medical needs related to intimate partner violence, transgender health, and health care discrimination. Debriefing followed each simulation. Results Seventeen medical students participated across four sessions. The sessions were evaluated with pre- and postparticipation surveys, including Likert scales and free-response questions. After participation, individuals' self-assessed confidence improved across multiple domains, including identifying situations for trauma screenings, inquiring about trauma, and responding as a bystander. Learners also felt more familiar with TIC-specific history taking and physical exam skills. Finally, simulation was perceived as a beneficial educational tool. All findings were statistically significant (p ≤ .01). Discussion Our simulation-based training enabled students to practice conversations and interventions related to trauma. This novel training represents a feasible and effective means for teaching TIC for acute care settings, including in the emergency department and in-patient settings. Development and evaluation were supported by the Society for Academic Emergency Medicine.
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Affiliation(s)
| | | | - Taylor Brown
- Second-Year Resident, Department of Emergency Medicine, Beth Israel Deaconess Medical Center
| | - Henry Ashworth
- First-Year Resident, Department of Emergency Medicine, Highland Hospital, Alameda Health System
| | - Jason J. Lewis
- Assistant Professor, Department of Emergency Medicine, Beth Israel Deaconess Medical Center
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21
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Chisholm-Burns M, Spivey C. Integration of Trauma-informed Care Into the Doctor of Pharmacy Curriculum. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100038. [PMID: 37380268 DOI: 10.1016/j.ajpe.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/12/2022] [Accepted: 12/15/2022] [Indexed: 06/30/2023]
Abstract
Trauma-informed care (TIC) is a framework based on understanding and responding to individuals' experiences of psychological trauma (defined as harmful circumstances that have a lasting impact on emotional well-being), as well as fostering their sense of safety and empowerment. Health profession degree programs are increasingly integrating TIC training into their curricula. Although literature is scarce regarding TIC education in academic pharmacy, student pharmacists will likely encounter patients, co-workers, and peers who have experienced psychological trauma. Students may also have experienced psychological trauma themselves. Therefore, student pharmacists would benefit from TIC learning, and pharmacy educators should consider implementing trauma-informed education. This commentary defines the TIC framework, explores its benefits, and considers an approach to implementing the TIC framework in pharmacy education with little disruption to existing curricula.
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22
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Wang E. Domestic Violence and Abuse Is Our Issue. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1757-1758. [PMID: 37295858 DOI: 10.1016/j.jaip.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Eileen Wang
- Division of Allergy and Immunology, Department of Medicine, National Jewish Health, Denver, Colo; Divison of Allergy and Immunology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colo.
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23
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Ashworth H, Lewis-O'Connor A, Grossman S, Brown T, Elisseou S, Stoklosa H. Trauma-informed care (TIC) best practices for improving patient care in the emergency department. Int J Emerg Med 2023; 16:38. [PMID: 37208640 DOI: 10.1186/s12245-023-00509-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/03/2023] [Indexed: 05/21/2023] Open
Abstract
A patient's current or previous experience of trauma may have an impact on their health and affect their ability to engage in health care. Every year, millions of patients who have experienced physically or emotionally traumatic experiences present to emergency departments (ED) for care. Often, the experience of being in the ED itself can exacerbate patient distress and invoke physiological dysregulation. The physiological reactions that lead to fight, flight, or freeze responses can make providing care to these patients complex and can even lead to harmful encounters for providers. There is a need to improve the care provided to the vast number of patients in the ED and create a safer environment for patients and healthcare workers. One solution to this complex challenge is understanding and integrating trauma-informed care (TIC) into emergency services. The federal Substance Abuse and Mental Health Service Administration's (SAMHSA) six guiding principles of TIC offer a universal precaution framework that ensures quality care for all patients, providers, and staff in EDs. While there is growing evidence that TIC quantitatively and qualitatively improves ED care, there is a lack of practical, emergency medicine-specific guidance on how to best operationalize TIC. In this article, using a case example, we outline how emergency medicine providers can integrate TIC into their practice.
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Affiliation(s)
- Henry Ashworth
- Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA, USA.
| | | | - Samara Grossman
- Department of Psychiatry, Boston Public Health Commission, Boston, MA, USA
| | - Taylor Brown
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sadie Elisseou
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Hanni Stoklosa
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- HEAL Trafficking, Los Angeles, CA, USA
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24
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Ferro HP, Williams K, Holbrook DS, O'Conor KJ. Disproportionate impact of abortion restriction: Implications for emergency department clinicians. Am J Emerg Med 2023; 69:160-166. [PMID: 37121065 DOI: 10.1016/j.ajem.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/11/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023] Open
Abstract
Individuals experiencing intimate partner violence (IPV) and/or human trafficking (HT) are at increased risk of severe health consequences as a result of legislation criminalizing and/or restricting abortion, which is expected to increase as a result of the Supreme Court decision Dobbs v. Jackson. These risks are further stratified by race, socioeconomics, and other marginalizing demographic attributes. IPV and HT introduce barriers to maintaining physical and mental health, due to control of access to transportation and funds by the abuser, fear of retribution for seeking healthcare, and other barriers. Individuals experiencing IPV or HT often lack reproductive autonomy, as a result of facing reproductive coercion at the hands of their abusers. Following the Dobbs decision, these vulnerable patient populations will face further limitations on their reproductive autonomy and increased obstacles to obtaining an abortion if they medically need or desire one. This will likely result in more patients presenting to the emergency department due to complications from unsafe or unsupervised self-managed abortions, as well as patients being reluctant to report having obtained an unlawful abortion due to fear of legal consequences. This is particularly relevant to individuals experiencing IPV and HT, as they may be more likely to use these methods for obtaining an abortion due to numerous barriers. Emergency medicine clinicians are vital in providing care to these patients, as they frequently present to emergency departments. A multi-pronged approach to better support these patients is essential, involving an increased index of suspicion for IPV, HT or the complications of unsupervised abortion, improved organizational structures, specialized training for staff, improved screening methods, reflection on implicit bias, and recommendations for mindful documentation and legal considerations.
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Affiliation(s)
- Haleigh P Ferro
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21287, United States.
| | - Kelly Williams
- Johns Hopkins Medicine, 1800 Orleans St, Baltimore, MD 21287, United States.
| | - Debra S Holbrook
- Mercy Medical Center, 345 St. Paul Pl, Baltimore, MD 21202, United States.
| | - Katie J O'Conor
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21287, United States.
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25
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Nolan H, Roberts L. Response to: Response triggered: Trigger warnings, a necessity or nuisance. MEDICAL EDUCATION 2023; 57:379. [PMID: 36201197 DOI: 10.1111/medu.14945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Helen Nolan
- Warwick Medical School Gibbet Hill, Coventry, UK
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26
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Burns CJ, Borah L, Terrell SM, James LN, Erkkinen E, Owens L. Trauma-Informed Care Curricula for the Health Professions: A Scoping Review of Best Practices for Design, Implementation, and Evaluation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:401-409. [PMID: 36538661 DOI: 10.1097/acm.0000000000005046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Trauma-exposed persons often experience difficulties accessing medical care, remaining engaged in treatment plans, and feeling psychologically safe when receiving care. Trauma-informed care (TIC) is an established framework for health care professionals, but best practices for TIC education remain unclear. To remedy this, the authors conducted a multidisciplinary scoping literature review to discern best practices for the design, implementation, and evaluation of TIC curricula for health care professionals. METHOD The research team searched Ovid MEDLINE, Cochrane Library, Elsevier's Scopus, Elsevier's Embase, Web of Science, and the PTSDpubs database from the database inception date until May 14, 2021. Worldwide English language studies on previously implemented TIC curricula for trainees or professionals in health care were included in this review. RESULTS Fifty-five studies met the inclusion criteria, with medicine being the most common discipline represented. The most prevalent learning objectives were cultivating skills in screening for trauma and responding to subsequent disclosures (41 studies [74.5%]), defining trauma (34 studies [61.8%]), and understanding trauma's impact on health (33 studies [60.0%]). Fifty-one of the studies included curricular evaluations, with the most common survey items being confidence in TIC skills (38 studies [74.5%]), training content knowledge assessment (25 studies [49.0%]), participant demographic characteristics (21 studies [41.2%]), and attitudes regarding the importance of TIC (19 studies [37.3%]). CONCLUSIONS Future curricula should be rooted in cultural humility and an understanding of the impacts of marginalization and oppression on individual and collective experiences of trauma. Moreover, curricula are needed for clinicians in more diverse specialties and across different cadres of care teams. Additional considerations include mandated reporting, medical record documentation, and vicarious trauma experienced by health care professionals.
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Affiliation(s)
- Courtney Julia Burns
- C.J. Burns is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-3216-5921
| | - Luca Borah
- L. Borah is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-8975-1051
| | - Stephanie M Terrell
- S.M. Terrell is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-7776-4621
| | - LaTeesa N James
- L.N. James is a health sciences informationist, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-5955-2876
| | - Elizabeth Erkkinen
- E. Erkkinen is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-3522-7286
| | - Lauren Owens
- L. Owens is assistant professor, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington; ORCID https://orcid.org/0000-0002-8277-2826
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Bazargan-Hejazi S, Negrete Manriquez JA, McDermoth-Grimes M, Parra EA, Prothrow-Stith D. Underrepresented in medicine students' perspectives on impactful medical education. BMC MEDICAL EDUCATION 2022; 22:904. [PMID: 36585706 PMCID: PMC9805279 DOI: 10.1186/s12909-022-03983-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 10/13/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Exploring the perceptions of underrepresented in medicine (URiM) students about the medical education curriculum and learning environment could optimize their education outcomes. The current study delineated perceptions of URiM medical students about the unique elements and characteristics of an impactful medical education program that create a positive, supportive learning environment culture. METHODS We conducted in-depth interviews with 15 URiM students between January 2018 and April 2018. Interviewees were recruited from an accredited medical education program in Historically Black Colleges and Universities (HBCUs). The University is also a member of the Hispanic Association of Colleges and Universities in the U.S. The main question that guided the study was, "What do URiM students at a Historically Black Colleges and Universities (HBCU) medical school believe would make a medical education program (MEP) impactful?" We used the grounded theory analytical approach and performed content analysis via qualitative thematic evaluation. RESULTS Of 112 enrolled medical students (MS), 15 verbally consented to participation. We identified four general themes and several subthemes. The themes include 1) Grounding learning in the community; 2) Progressive system-based practice competency; 3) Social justice competency and 4) Trauma-informed medical education delivery. Theme 1 included the following subthemes (a) community engagement, and (b) student-run clinic, mobile clinic, and homeless clinic rotations. Theme 2 includes (a) interprofessional learning and (b) multidisciplinary medicine for cultivating a 'just' healthcare system. Theme 3 includes (a) longitudinal social justice curriculum, (b) advocacy, and (c) health disparity research. Theme 4 had the following subdomains (a) early and ongoing mentoring and (b) provision of supportive policies, services and practices to maximize learning and mental health. CONCLUSION Our learners found that social justice, trauma-informed, community-based curricula are impactful for URiM learners. These findings highlight the need for further research to assess the impact of permeating the championship culture, community cultural wealth, and transformational education in all aspects of the MEP in providing a supporting and positive learning environment for URiM students.
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Affiliation(s)
- Shahrzad Bazargan-Hejazi
- College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA 90059 USA
- David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095 USA
| | - Jose A. Negrete Manriquez
- College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA 90059 USA
- David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095 USA
| | - Monique McDermoth-Grimes
- College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA 90059 USA
- College of Medicine, Howard University, Washington, DC, USA
| | - Elisabeth Alexandra Parra
- College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA 90059 USA
- David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095 USA
| | - Deborah Prothrow-Stith
- College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA 90059 USA
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Roze des Ordons AL, Ellaway RH, Eppich W. The many spaces of psychological safety in health professions education. MEDICAL EDUCATION 2022; 56:1060-1063. [PMID: 35981976 DOI: 10.1111/medu.14919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Amanda L Roze des Ordons
- Department of Critical Care Medicine; Division of Palliative Medicine, Department of Oncology; Department of Anesthesiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rachel H Ellaway
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Demers LA, Wright NM, Kopstick AJ, Niehaus CE, Hall TA, Williams CN, Riley AR. Is Pediatric Intensive Care Trauma-Informed? A Review of Principles and Evidence. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101575. [PMID: 36291511 PMCID: PMC9600460 DOI: 10.3390/children9101575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 11/23/2022]
Abstract
Pediatric critical illness and injury, along with the experience of recovering from critical illness are among the most potentially traumatic experiences for children and their families. Additionally, children often come to the Pediatric Intensive Care Unit (PICU) with pre-existing trauma that may sensitize them to PICU-related distress. Trauma-informed care (TIC) in the PICU, while under-examined, has the potential to enhance quality of care, mitigate trauma-related symptoms, encourage positive coping, and provide anticipatory guidance for the recovery process. This narrative review paper first describes the need for TIC in the PICU and then introduces the principles of TIC as outlined by the American Academy of Pediatrics: awareness, readiness, detection and assessment, management, and integration. Current clinical practices within PICU settings are reviewed according to each TIC principle. Discussion about opportunities for further development of TIC programs to improve patient care and advance knowledge is also included.
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Affiliation(s)
- Lauren A. Demers
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
| | - Naomi M. Wright
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Psychology, University of Denver, Denver, CO 80208, USA
| | - Avi J. Kopstick
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Texas Tech University Health Science Center El Paso, El Paso, TX 97705, USA
| | - Claire E. Niehaus
- Division of Psychology and Psychiatry, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Trevor A. Hall
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
- Correspondence: ; Tel.: +1-503-418-2134
| | - Cydni N. Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
| | - Andrew R. Riley
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
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Sager Z, Nathan S, Doherty K, Kaiser AP, King KD, Topor DR, Morrison NR, Moye J. Traumatic disclosures in the life stories of older Vietnam era veterans. J Am Geriatr Soc 2022; 70:2967-2972. [PMID: 35730430 PMCID: PMC10314788 DOI: 10.1111/jgs.17918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/12/2022] [Accepted: 05/19/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Eliciting life stories is an important component of person-centered care that may aid in understanding how an individual's unique background and narrative impacts their health. Such life stories, especially when gathered from older military Veterans, may include traumatic events, raising the urgency that clinicians be prepared to provide care that is trauma-informed and ensure Veteran's experiences are acknowledged and treated effectively. METHODS We examined the prevalence and type of potentially traumatic and/or adverse life events spontaneously shared by 231 older Veterans participating in a life story intervention while receiving care within the U.S. Veterans Health Administration system. Veteran life stories were extracted from the electronic medical record and deductive qualitative content analysis was used to code potentially traumatic or adverse life experiences based on a codebook adapted from the Brief Trauma Questionnaire and Adverse Childhood Experience questionnaire. RESULTS A majority (71.0%) of Veterans described at least one traumatic disclosure in their life story. Among narratives with a disclosure of any type, more than half (53.0%) included descriptions of combat trauma, 21.5% noted a history of life-threatening illness, and 9.5% reported having been in a serious accident. Fewer noted adverse childhood experiences (19.5%). CONCLUSIONS Elicitation of life stories among older Veterans may advance person-centered care and life stories frequently include disclosure of potentially traumatic and/or adverse life events. These findings underscore the normative experience of traumatic events among older Veterans and highlight the importance of developing age-sensitive trauma-informed care competencies.
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Affiliation(s)
- Zachary Sager
- New England Geriatric Resarch Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Susan Nathan
- New England Geriatric Resarch Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Kelly Doherty
- New England Geriatric Resarch Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Anica Pless Kaiser
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Katherine D. King
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Clinical Psychology, William James College, Newton, Massachusetts, USA
| | - David R. Topor
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Nicholas R. Morrison
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychology, Westfield State University, Westfield, Massachusetts, USA
| | - Jennifer Moye
- New England Geriatric Resarch Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
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Kherani IZ, Sharma M. Toward Trauma-Informed Pedagogy: An Intersectional Analysis of Pimping in Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1295-1298. [PMID: 35507457 DOI: 10.1097/acm.0000000000004724] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Increased awareness of the role of power and privilege in medical education demands reevaluation and critical reflection on the role of pimping, both in name and practice. The authors use an intersectional approach to explore the ways in which the term pimping is rooted in sexist, racist, and classist stereotypes. In using this term to describe a pedagogical approach rooted in hierarchical power and stark knowledge differentials, the medical community intentionally or unintentionally reinforces racist stereotypes, acts of carceral violence, gender-based violence, and harmful ways of referring to sex work. The authors suggest drawing on principles of trauma-informed care, often considered solely in the context of clinical care, as a means of engaging in transformative pedagogy. Embracing such a trauma-informed, transformative pedagogical approach can help dismantle entrenched hierarchies and create a liberatory learning environment grounded in knowledge cocreation and reimagination of teacher-learner binaries. Decentralization of power in teaching relationships can further empower trainees to become active knowledge partners alongside educators, encouraging shared responsibility, trust, and empathy in learning spaces.
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Affiliation(s)
- Imaan Zera Kherani
- I.Z. Kherani was a second-year medical student, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada, at the time this was written
| | - Malika Sharma
- M. Sharma is an infectious disease physician, St. Michael's Hospital, and assistant professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Carlson GC, Than CT, Rose D, Brunner J, Chanfreau-Coffinier C, Canelo IA, Klap R, Bean-Mayberry B, Agrawal A, Hamilton AB, Gerber MR, Yano EM. What Drives Women Veterans' Trust in VA Healthcare Providers? Womens Health Issues 2022; 32:499-508. [PMID: 35367107 PMCID: PMC9522916 DOI: 10.1016/j.whi.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 02/01/2022] [Accepted: 02/10/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Little is known about women veterans' trust in Veterans Affairs (VA) health care and what factors promote trust in VA providers. We examined provider behaviors and characteristics of women veterans associated with trust in their VA providers. METHODS We used a 2015 survey of women veterans who were routine users of primary care at 12 VA medical centers (n = 1,395). Patient trust in their VA provider was measured on a seven-item scale. We used multiple logistic regression to examine associations of patient-provider communication and gender appropriateness with complete trust in VA provider (100 [complete trust] vs. <100 [less than complete trust]), controlling for patient characteristics. RESULTS On average, 39.7% of women veterans reported complete trust in their VA providers. Those with complete trust reported greater patient-provider communication and gender appropriateness of VA services than those with less-than-complete trust (all ps ≤ .001). In multiple logistic regression models, higher ratings of provider communication (adjusted odds ratio, 2.37), gender-appropriate care (adjusted odds ratio, 1.93), and trauma-sensitive communication (adjusted odds ratios, 1.79-6.08) were associated with a higher likelihood of reporting complete trust in their VA provider. CONCLUSIONS Women veterans reported high levels of trust in their VA providers. Provider communication, gender-appropriate care, and trauma-sensitive communication were associated with greater patient trust. Although it is important to highlight the steps already taken by VA to increase the quality of care for women veterans, current findings suggest that women veterans' trust may be further increased by interventions to improve trauma-informed care by VA providers.
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Affiliation(s)
- Gwendolyn C Carlson
- Department of Mental Health, VA Greater Los Angeles Healthcare System, North Hills, California; VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California; Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, California.
| | - Claire T Than
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California
| | - Danielle Rose
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California
| | - Julian Brunner
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California
| | - Catherine Chanfreau-Coffinier
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California; VA Informatics and Computing Infrastructure (VINCI), Salt Lake City VA Healthcare System, Salt Lake City, Utah
| | - Ismelda A Canelo
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California
| | - Ruth Klap
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California; Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, California
| | - Bevanne Bean-Mayberry
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California; Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, California
| | - Alpna Agrawal
- Department of Mental Health, VA Greater Los Angeles Healthcare System, North Hills, California; VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California; Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, California
| | - Alison B Hamilton
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California; Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, California
| | - Megan R Gerber
- Albany Medical College, Albany Stratton VA Medical Center, Albany, New York
| | - Elizabeth M Yano
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California; Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, California; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
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Using a Limerick Writing Contest to Address Residency and Career Stress and Foster Connection Among Pediatric Residents Approaching Graduation. Acad Pediatr 2022; 22:1081-1084. [PMID: 34995823 DOI: 10.1016/j.acap.2021.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 12/22/2021] [Accepted: 12/28/2021] [Indexed: 11/22/2022]
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Nolan HA, Roberts L. Medical students' views on the value of trigger warnings in education: A qualitative study. MEDICAL EDUCATION 2022; 56:834-846. [PMID: 35352384 PMCID: PMC9544229 DOI: 10.1111/medu.14803] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Trigger warnings-advance notification of content so recipients may prepare for ensuing distress-feature in discussions in higher education. Students' expectations for warnings in some circumstances are recognised, and some educators and institutions have adopted use. Medical education necessitates engagement with potentially distressing topics. Little is known about medical students' expectations regarding warnings in education. METHODS All students from a 4-year graduate-entry UK medical degree programme were contacted via digital message outlining study details and were openly sampled. Qualitative methodology was chosen to explore participant expectations, experiences and meanings derived from experiences. Students participated in semi-structured interviews exploring perspectives on functions, benefits and drawbacks of trigger warnings in classroom-based medical education. We analysed interview transcripts using thematic analysis. RESULTS Thirteen semi-structured, qualitative interviews were undertaken. Themes in the following areas were identified: (1) students' experiences influence understanding of trauma and trigger warnings, (2) warnings as mediators of learning experiences, (3) professional responsibilities in learning, (4) exposure to content, (5) professional ethos in medical education and (6) how to issue trigger warnings. Students recognised the term 'trigger warning', and that warnings are an accommodation for those affected by trauma. Students' conceptualisation of warnings was influenced by personal experiences and peer interactions both within and outside education. Students expressed both support and concerns about use of warnings and their ability to influence learning, assuming of responsibility and professional development. DISCUSSION Diverse student opinions regarding warnings were identified. Most students suggested that warnings be used prior to topics concerning recognised traumas. Incremental exposure to distressing content was recommended. Students should be supported in managing own vulnerabilities and needs, while also experiencing sufficient formative exposure to develop resilience. Greater understanding of trauma prevalence and impacts and underpinnings of warnings amongst students and educators are recommended to optimise education environments and professional development.
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Parker S, Johnson-Lawrence V. Addressing Trauma-Informed Principles in Public Health through Training and Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148437. [PMID: 35886289 PMCID: PMC9319668 DOI: 10.3390/ijerph19148437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/06/2022] [Indexed: 01/27/2023]
Abstract
The increasing prevalence of traumatic events requires our public health workforce to be knowledgeable about ways trauma influences population and individual health. There is a gap in student training about the various ways that traumatic events affect their capacity to perform public health work and the communities they serve. While other human services disciplines explicitly use trauma-informed terminology and concepts in student training, references to trauma-informed approaches are more implicit in public health curricula. This study examined trauma-informed principles and related terminology for use in public health coursework in the context of a community-wide water contamination public health crisis in Flint, Michigan, USA. We addressed the principles of trauma-informed approaches across key competency areas common to USA public health accredited programs, including discussion to support student understanding of the principle in action. Using trauma-informed language (1) enhances our capacity to name and respond empathetically in traumatized communities, (2) provides guiding principles for less community-engaged efforts, and (3) fosters stronger relationships for more community-engaged initiatives by providing areas of accountability for unintended consequences throughout the program’s development and implementation processes. Rising public health professionals equipped with knowledge of trauma-informed approaches can more intentionally minimize unintended negative consequences of public health initiatives.
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Affiliation(s)
- Shan Parker
- Department of Public Health and Health Sciences, University of Michigan-Flint, Flint, MI 48502, USA
- Correspondence:
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Stout J, Martin AI. Trauma-Informed Care in the Classroom: Our Experience with a Content Warning in a Medical School Course. MEDICAL SCIENCE EDUCATOR 2022; 32:711-718. [PMID: 35818610 PMCID: PMC9270545 DOI: 10.1007/s40670-022-01559-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 06/03/2023]
Abstract
Trauma is now recognized as a common human experience that has consequences, including adverse effects on learning outcomes. Principles of trauma-informed care include awareness of the impact of trauma and use of strategies to prevent retraumatization. While well-described in medical and mental health care, these principles have been inconsistently applied in the medical education classroom. Content warnings can be part of a trauma-informed classroom approach that notifies learners about potentially distressing topics, allows individuals to employ self-care, and seeks to resist retraumatization. This article describes our experience integrating a content warning about reproductive topics in a second-year medical school course. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-022-01559-0.
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Affiliation(s)
- Julianne Stout
- Veterinary Administration Department, Indiana University School of Medicine-West Lafayette, Purdue University, 715 Clinic Drive Suite 2069, West Lafayette, IN 47907 USA
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Sukhera J, Knaak S, Ungar T, Rehman M. Dismantling Structural Stigma Related to Mental Health and Substance Use: An Educational Framework. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:175-181. [PMID: 34647920 DOI: 10.1097/acm.0000000000004451] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Stigma related to mental health and substance use (MHSU) is a well-established construct that describes how inequitable health outcomes can result from prejudice, discrimination, and marginalization. Although there is a body of literature on educational approaches to reduce stigma, antistigma education for MHSU has primarily focused on stigma at the social, interpersonal/public, and personal (self-stigma) levels, with little attention to the problem of structural stigma. Structural stigma refers to how inequity is manifested through rules, policies, and procedures embedded within organizations and society at large. Structural stigma is also prominent within clinical learning environments and can be transmitted through role modeling, resulting in inequitable treatment of vulnerable patient populations. Addressing structural stigma through education, therefore, has the potential to improve equity and enhance care. A promising educational approach for addressing structural stigma is structural competency, which aims to enhance health professionals' ability to recognize and respond to social and structural determinants that produce or maintain health disparities. In this article, the authors propose a framework for addressing structural MHSU stigma in health professions education that has 4 key components and is rooted in structural humility: recognizing structural forms of stigma; reflecting critically on one's own assumptions, values, and biases; reframing language away from stereotyping toward empathic terms; and responding with actions that actively dismantle structural MHSU stigma. The authors propose evidence-informed and practical suggestions on how structural competency may be applied within clinical learning environments to dismantle structural MHSU stigma in organizations and society at large.
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Affiliation(s)
- Javeed Sukhera
- J. Sukhera is chair of psychiatry, Institute of Living, and chief of psychiatry, Hartford Hospital, Hartford, Connecticut; ORCID: https://orcid.org/0000-0001-8146-4947
| | - Stephanie Knaak
- S. Knaak is research consultant, Mental Health Commission of Canada, and assistant professor, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; ORCID: https://orcid.org/0000-0001-7663-3451
| | - Thomas Ungar
- T. Ungar is psychiatrist in chief, St. Michael's Hospital, Unity Health Toronto, and associate professor, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0002-9627-0421
| | - Maham Rehman
- M. Rehman is research associate, Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Darling A, Ullman E, Novak V, Doyle M, Dubosh NM. Design and Evaluation of a Curriculum on Intimate Partner Violence for Medical Students in an Emergency Medicine Clerkship. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:1279-1285. [PMID: 36262384 PMCID: PMC9575587 DOI: 10.2147/amep.s365450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/22/2022] [Indexed: 05/16/2023]
Abstract
PURPOSE Intimate partner violence (IPV) is a widespread public health issue that is relevant to all areas of medicine. Patients who suffer from IPV often contact the health care system via the emergency department, making this a particularly important but too often overlooked issue in this setting. Education on IPV varies in medical schools and emergency medicine (EM) educational programs, and evidence suggests that a barrier to assessing for IPV is a lack of adequate training of clinicians. In this study, we sought to design, implement and evaluate the efficacy of a curriculum on IPV geared towards medical students on an EM clerkship. METHODS We assembled a multi-disciplinary team of EM education faculty, a resident content expert on IPV, and social workers to design a two-part curriculum that was administered to medical students on an EM clerkship. The curriculum involved a 20-minute narrated slide presentation viewed asynchronously, followed by a 1-hour case-based discussion session. The curriculum was evaluated using a 13-item self-assessment survey on knowledge, comfort level and skill in managing victims of IPV, administered electronically before and after the curriculum. Survey results were compared pre- and post-curriculum using Wilcoxon signed-rank test. RESULTS Thirty-four students completed the curriculum and 26 completed both the pre and post self-assessment surveys. A statistically significant improvement in knowledge, comfort level and skills was observed in 11 of the 13 survey elements. CONCLUSION Based on the self-assessment survey results, this curriculum was well received and successfully increased participants' comfort, knowledge and skill level regarding assessment of patients for IPV. This is a focused and feasible curriculum that can be easily incorporated into an EM clerkship to provide effective education on a relevant but often overlooked topic.
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Affiliation(s)
- Alanna Darling
- Department of Emergency Medicine, UMass Chan Medical School – Baystate Medical Center, Springfield, MA, USA
- Correspondence: Alanna Darling, UMass Chan Medical School - Baystate Medical Center, Department of Emergency Medicine, 759 Chestnut St., Springfield 5, S5426, Springfield, MA, 01199, USA, Tel +1 508-414-4492, Email ;
| | - Edward Ullman
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Victor Novak
- Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Melissa Doyle
- Center for Violence Prevention and Recovery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Nicole M Dubosh
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
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Bynum WE, W Teunissen P, Varpio L. In the "Shadow of Shame": A Phenomenological Exploration of the Nature of Shame Experiences in Medical Students. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S23-S30. [PMID: 34348391 DOI: 10.1097/acm.0000000000004261] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Shame occurs when an individual blames a globally flawed self for a negative outcome. Much of the focus on shame in medical education has been directed toward graduate medical education with less recognition paid to shame occurring in medical school. In particular, while research has explored the triggers of medical students' shame, little is known about what shame feels like, what it makes an individual want to do, and what perceived effects it causes. Thus, this study asks: After shame has been triggered in medical students, how is it experienced? METHOD The authors selected hermeneutic phenomenology to provide a rich description of the structures and meaning of medical students' lived experiences of shame. Sixteen medical students from a private medical school in the United States were recruited for the study. Data were collected using one-on-one semistructured interviews and analyzed in accordance with Ajjawi and Higgs' 6 steps of hermeneutic analysis. RESULTS Data analysis yielded component parts of participants' shame experiences, including affective feelings, physical manifestations, cognitive processes, action tendencies, and effects. Analysis of the relationships among these component parts yielded specific phenomenological structures, including patterns of shame (e.g., chronic shame, flashbacks), self-evaluative processes (e.g., battling voices, skewed frames of reference), and perceived effects of shame (e.g., isolation, psychological distress). An overarching theme of shame as a destabilizing emotion emerged across the dataset. CONCLUSIONS Shame is a complex emotion in medical students that, through its destabilizing effects, can lead to withdrawal, isolation, psychological distress, altered professional identity formation, and identity dissonance. The authors highlight the possibility that shame may be occurring as a response to educational trauma, present a metaphor of dominoes to conceptualize the destabilizing nature of shame, and outline the implications for individuals and institutions in medical education.
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Affiliation(s)
- William E Bynum
- W.E. Bynum IV is associate professor, Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina; ORCID: https://orcid.org/0000-0003-3796-9301
| | - Pim W Teunissen
- P.W. Teunissen is professor of workplace learning, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0002-0930-0048
| | - Lara Varpio
- L. Varpio is professor, Department of Medicine, Uniformed Services University, Bethesda, Maryland; ORCID: https://orcid.org/0000-0002-1412-4341
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Nolan HA, Roberts L. Medical educators' views and experiences of trigger warnings in teaching sensitive content. MEDICAL EDUCATION 2021; 55:1273-1283. [PMID: 34060096 DOI: 10.1111/medu.14576] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Trigger warnings-prior notification of topics so recipients may prepare for ensuing distress-are encountered widely in contemporary culture. Students at some universities have expressed expectations for trigger warnings. Medical education routinely exposes students to numerous potentially distressing topics. However, this topic remains understudied in medical education. Little is understood about educators' views or practice relating to warnings in the context of medical education. METHODS Twenty medical educators from a medical degree programme in the UK participated in a semi-structured qualitative interview study, exploring medical educators' views and experiences of managing distressing situations and, specifically, their use of warnings. We analysed interview transcripts by thematic coding and identified themes. RESULTS Analysis identified themes relating to educators' conceptualisation of trigger warnings and rationale for use, concerns about the use of warnings and the critical purpose of medical school in ensuring preparedness for clinical practice. Participants shared that warnings were given to empower students in approaching distressing topics and to enable engagement with learning. Warnings acknowledged that some experiences would be distressing and normalised and signalled acceptability of emotional responses. Decisions to use warnings were influenced by the nature of content and, reactively, in response to experiences of student distress. Terminology regarding trigger warnings was interpreted varyingly by participants. A broad variety of topics were identified as potentially sensitive. A number of concerns were noted regarding the use of warnings. DISCUSSION Warnings alone did not fulfil educators' responsibility in supporting students' professional development, but may be a useful adjunct, signalling that self-care is valued and should be prioritised. Despite frequent use of warnings, individual educator practice was shaped by varying rationale. A framework that addresses competing tensions of preventing distress and supporting professional development is needed as part of a trauma-informed approach to medical education.
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Affiliation(s)
| | - Lesley Roberts
- Warwick Medical School, University of Warwick, Coventry, UK
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Anani U, Lanphier E, Feltman D. Trading Cultural Competency for Trauma Informed Care. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:13-16. [PMID: 34399668 DOI: 10.1080/15265161.2021.1952348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
| | - Elizabeth Lanphier
- Cincinnati Children's Hospital Medical Center
- University of Cincinnati College of Medicine
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Hildebrandt S. Books, bones and bodies: The relevance of the history of anatomy in Nazi Germany for medical education today. Anat Rec (Hoboken) 2021; 305:886-901. [PMID: 34118137 DOI: 10.1002/ar.24691] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/20/2021] [Accepted: 05/06/2021] [Indexed: 01/13/2023]
Abstract
The history of anatomy in Nazi Germany highlights the consequences to humanity when the destructive potentials immanent to all science and medicine are enabled by an anti-democratic, totalitarian regime. Anatomy presents an example of ethical transgressions by scientists and health care professionals that were amplified in the criminal political climate of the Nazi regime. This can happen anywhere, as science is never apolitical. This article gives a short account of anatomy in Nazi Germany, which is followed by an outline of the tangible and intangible legacies from this history, to then discuss implications for anatomy education today. While Jewish and politically dissident anatomists were forced out of their positions and country by the Nazi regime, the majority of the remaining anatomists joined the Nazi party and used bodies of Nazi victims for education and research. Some anatomists even performed deadly human experiments. Patterns and legacies that emerge from this history can be traced into the present and concern research ethics in general and anatomical body procurement specifically. They shed light on current practices and controversies in the anatomical sciences, including anthropology. It will be argued here that the history of anatomy in Nazi Germany can inform current anatomy education in a concept of anatomy as the first "clinical discipline." By integrating insights from the history of anatomy into the learning process, anatomy education can model an approach to medicine that includes a full appreciation of the shared humanity of medical practitioners and patients.
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Affiliation(s)
- Sabine Hildebrandt
- Division of General Pediatrics, Department of Pediatrics, Boston Children' Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Brown T, Mehta PK, Berman S, McDaniel K, Radford C, Lewis-O'Connor A, Grossman S, Potter J, Hirsh DA, Woo B, Krieger D. A Trauma-Informed Approach to the Medical History: Teaching Trauma-Informed Communication Skills to First-Year Medical and Dental Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11160. [PMID: 34150993 PMCID: PMC8180538 DOI: 10.15766/mep_2374-8265.11160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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.
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Affiliation(s)
- Taylor Brown
- Fourth-Year Medical Student, Harvard Medical School
- Corresponding author:
| | - Pooja K. Mehta
- Second-Year Resident, Department of Medicine, Brigham and Women's Hospital
| | - Sarah Berman
- First-Year Resident, Department of Psychiatry, Cambridge Health Alliance
| | | | | | - Annie Lewis-O'Connor
- Nurse Practitioner, Department of Medicine, Division of Women's Health, Brigham and Women's Hospital; Instructor, Harvard Medical School
| | - Samara Grossman
- Social Worker, Department of Psychiatry, Brigham and Women's Hospital
| | - Jennifer Potter
- Professor, Department of Medicine, Harvard Medical School; Physician, Department of General Internal Medicine, Beth Israel Deaconess Medical Center
| | - David A. Hirsh
- The George E. Thibault Academy Associate Professor, Harvard Medical School; Physician, Department of Internal Medicine, Cambridge Health Alliance
| | - Beverly Woo
- Associate Professor of Medicine, Harvard Medical School; Senior Physician, Department of Medicine, Brigham and Women's Hospital
| | - David Krieger
- Clinical Instructor in Medicine, Harvard Medical School; Physician, Atrius Health
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Bynum WE, Sukhera J. Perfectionism, Power, and Process: What We Must Address to Dismantle Mental Health Stigma in Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:621-623. [PMID: 33885411 DOI: 10.1097/acm.0000000000004008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In this commentary, the authors draw on 2 personal accounts of mental illness published by Kirk J. Brower, MD, and Darrell G. Kirch, MD, in this issue to consider how and why mental health stigma is maintained in medical education. In particular, they explore how perfectionism, power differentials, and structural forces drive mental illness stigma in medical education. They argue that mental health stigma in medical education, while deeply embedded in the physician archetype and medical culture, is not inevitable and that dismantling it will require individual courage, interpersonal acceptance, and institutional action.
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Affiliation(s)
- William E Bynum
- W.E. Bynum IV is associate professor, Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina
| | - Javeed Sukhera
- J. Sukhera is associate professor, Departments of Psychiatry and Paediatrics and scientist, Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Osman NY, Hirsh DA. The organizational growth mindset: Animating improvement and innovation in medical education. MEDICAL EDUCATION 2021; 55:416-418. [PMID: 33377544 DOI: 10.1111/medu.14446] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Nora Y Osman
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - David A Hirsh
- Harvard Medical School, Boston, MA, USA
- Cambridge Health Alliance, Cambridge, MA, USA
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McDaniel KG, Brown T, Radford CC, McDermott CH, van Houten T, Katz ME, Stearns DA, Hildebrandt S. Anatomy as a Model Environment for Acquiring Professional Competencies in Medicine: Experiences at Harvard Medical School. ANATOMICAL SCIENCES EDUCATION 2021; 14:241-251. [PMID: 32657538 DOI: 10.1002/ase.2000] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 06/03/2020] [Accepted: 06/27/2020] [Indexed: 06/11/2023]
Abstract
Anatomy education provides students with opportunities to learn structure and function of the human body, to acquire professional competencies such as teamwork, interpersonal skills, self-awareness, and to reflect on and practice medical ethics. The fulfillment of this wide potential can present challenges in courses that are part of an integrated curriculum and shorter than traditional courses. This new reality, together with students' increasing concern about the stresses within medical education, led to efforts at Harvard Medical School to implement practical steps toward an optimal learning environment in anatomy. These were based on core elements of ethical anatomy education and principles of trauma-informed care. Anatomy is conceptualized here as the "first clinical discipline," with relational interactions between anatomical educators, medical students, and body donors/patients. Essential prerequisites for the implementation of this work were support by the medical school leadership, open partnership between engaged students and faculty, faculty coordination, and peer-teaching. Specific interventions included pre-course faculty development on course philosophy and invitations to students to share their thoughts on anatomy. Student responses were integrated in course introductions, combined with a pre-dissection laboratory visit, an introductory guide, and a module on the history and ethics of anatomy. During the course, team-building activities were scheduled, and self-reflection encouraged, for example, through written exercises, and elective life-body drawing. Students' responses to the interventions were overall positive, but need further evaluation. This first attempt of a systematic implementation of an optimal learning environment in anatomy led to the identification of areas in need of adjustment.
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Affiliation(s)
| | - Taylor Brown
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | - Cynthia H McDermott
- Department of Cell Biology, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Trudy van Houten
- Program in Medical Education at Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Brigham's and Women's Hospital, Boston, Massachusetts
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | - Martha E Katz
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Dana A Stearns
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Sabine Hildebrandt
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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