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Caring for the Climate, It’s Essential Medicine

If you haven’t heard it before, climate change is being described as the greatest public health threat of this century. It is the topic of large international meetings, like last year’s COP26, where country leaders discussed carbon goals and made numerous commitments for cameras and newsstands. The topic is increasingly featured in political debates and in media where national conversations about our priorities as a country are held. Locally, Ann Arbor is investing in the A2Zero campaign to achieve carbon neutrality in the city.

We are, however, doing an insufficient amount to address the threat adequately. Oil investments are still being made, carbon taxes are being stalled in legislation, and investment in sustainable energy and waste management is slow. The medical system itself is a major contributor to the problem with its massive energy costs and production of physical waste. For these reasons, individuals in the medical sphere have to push for practices that may help curb the inevitable changes in climate ahead of us.

Another reason it is important for medical professionals to care about climate change is that we have a lot to contribute by looking at the issue in the ways we contemplate issues in human health. The prevention framework from the world of public health, I believe, can be applied to climate change in an unfortunately tidy way; we’re past the point of primary prevention (preventing climate change entirely), we’re failing at methods of secondary prevention (making interventions to reduce the speed of climate change) and we’re not unified in how to perform tertiary prevention (managing climate change in the long-term and the harms it is already causing).

In primary care you work with patients on health concerns that rarely have a simple fix, where numerous small actions accumulate into poor outcomes, and where there is distance between the timing of the health insult and health outcome. These are the same kinds of barriers that get in the way of making meaningful changes in the way of climate change.

In the way that stopping smoking is a difficult but assured way to improve one’s future health, our emissions and waste production today make life easier even if the consequences in 20 years will be life altering (on a global scale). However, we don’t have to wait 20 more years to see effects, we’re already seeing the results of climate change here in Michigan in the ways of increased frequency of extreme weather events, threats to food security and the expansion of the geographic ranges of vector-borne diseases. 

A Wolverine Street Medicine run in Detroit.

Like many issues in global public health, the negative effects of climate change are disproportionately being felt by more vulnerable populations. When taking the Homeless Healthcare elective, which is organized by the Wolverine Street Medicine student group, I had the unfortunate privilege of seeing the effects of climate change firsthand. Heavy rains made it impossible for people with lower extremity wounds to keep their legs dry on the street. High rates of COPD and asthma, partly attributable to city air quality, meant that needs for medicated inhalers were common (devices that have their own cost on the environment). Most life-threatening was the unseasonably cold weather during my rotation that caught many unhoused folks, even those with years of experience on the street, unprepared with sufficient supplies for staying warm. For these patients, worrying about the environment never stops; now coming into the warmer months they have to start thinking about how to stay cool and hydrated in humid summers. It is terribly difficult to live unhoused, and what we’re doing to the climate is not making it easier.

That humans are accelerating climate change is a fact that we’ve understood well for decades, and it’s something that I’ve known about since I was a kid. I remember that it was talked about in my 6th grade earth science class as global warming. I’m glad now that we recognize more is happening as a result of human activity than polar bears being stranded on melting ice flows. But the subject wasn’t anything I cared much about until it became a major part of my undergraduate education by accident; I wanted to study nutrition, and all of the food systems courses at my school were run through the department of environment.

My academic understanding of the issue was brought to reality when working in the urban agriculture scene in Detroit, where food sovereignty for communities was discussed as an assurance that they could provide for themselves knowing that their already-limited access to good food would be the first to go in the event of national food insecurity from climate change. Then it continued to be a theme in my graduate studies in public health, as I looked into understanding the interplay between our agricultural system, our nutrition and our climate. But when I started medical school, there was suddenly no talk about climate change. It was not a feature in the pre-clinical curriculum in areas where it clearly felt applicable. I learned of some more senior students who were engaged in individual projects that related to climate change and they had formed a little group that they used to vent about eco-anxiety and get feedback on their ideas. 

On Earth Day 2022, we announced the results of our Planetary Health Report Card and celebrated the planet with a vegan ‘Make-Your-Own Dirt Cup’ station.

Because of those students I was brought into a community of climate activists and have been able to make this a staple of my work today. I am a DOW Sustainability Fellow, the Co-Chair for Plant-Based Health with the Medical Students for a Sustainable Future and co-director of the White Coats for Planetary Health (WCPH), the organization born out of that small group of students that now organizes advocacy efforts for the elevation of climate change themes in all areas of UMMS’s functioning. Last summer, I was part of a group of students who presented to the academic cabinet about the need for more investment in climate change topics at our school, pointing to the report from the President’s Commission on Carbon Neutrality that was coming out with carbon production reduction mandates for the university.

In that presentation we discussed the need to comprehensively understand the school’s relationship with climate change and proposed that the school facilitate students completing the Planetary Health Report Card (PHRC). This is a tool developed for students to use to audit their medical school and how it engages with climate change in five different domains: Curriculum, Research, Community Engagement, Student Support and Operations. To date, 74 medical schools around the globe have participated in the international initiative.

Because of faculty support and passionate students, the WCPH were able to complete the PHRC for the first time this past year; UMMS scored a C+ with large areas to improve upon in how the school engages in climate teaching its core curriculum and how it engages on the topic with the local community and global academic movements. U-M is used to being the ‘Leaders and Best,’ and while a C+ is hardly a score to brag about, we now clearly know areas where our school can improve, and I feel the motivation to act from folks in all corners of University of Michigan Medical School.

I am immensely proud of WCPH and everything that we have been able to accomplish this past year.

  • We’ve hosted events in the Global Health and Disparities Path to share local environmental issues and connect climate change to different areas of medical practice.
  • We also improved upon the Planetary Health elective that our members put on in January to bring climate experts from around the country to run workshops with our students and outline actionable ways to get involved in climate advocacy.
  • We spurred the creation of a committee of school administrators that makes decisions toward achieving carbon neutrality at the Medical School. That represents the first committee at an individual school at the University of Michigan to address the topic, and WCPH has guaranteed permanent representation on it.

I am most proud of my student peers and how dedicated they are to this mission. It is reassuring to see more people each year coming into UMMS wanting to be involved in this area and make it a focus of their work outside of patient care.

If you’re a student and interested in learning more about climate advocacy here at UMMS, please reach out to WCPH at wcph-leadership@umich.edu. We would love to get you involved, and if you have an idea for a project we would love to help in any way.

To learn more about virtual opportunities and movements around the country, please join MS4SF. And if you’re a professional, please use your influence in your department to do some introspection. Every field contributes to the climate change problem, which means every field can contribute to creating solutions.

Fostering Community Through my M-Home Experience

I’ve had the pleasure to be involved with M-Home since my first weeks at University of Michigan Medical School, and it has truly shaped so much of my medical school experience. In those first weeks, we had an opportunity to run for student council positions, and I was surprised to find myself elected to an M-Home representative role.

It was overwhelming at first because I had little idea about what the role entailed or what M-Home was, given that it was pretty new to our medical school. But I would soon find out that M-Home would provide me with a community that helped to sustain me through the highs and lows of my medical school journey.

What is M-Home?
M-Home is a longitudinal learning community established at University of Michigan Medical School in 2015 as a way to provide a “home” for students within our school. M-Home is based around four Houses now named after significant figures in UMMS history: Dr. Amanda Sanford, Dr. Jonas Salk, Dr. William Henry Fitzbutler, and Dr. Alice Hamilton. Within each House there is a designated counselor, as well as two House faculty who serve as faculty for our Doctoring course. As part of orientation to UMMS, each student is sorted (yes, it’s very Harry Potter-esque) into their House in which they will have their Doctoring group of 10-12 students from their House.

I remember sitting in a large lecture hall in Fall of 2018 waiting to crack my glowstick that had been passed out to me as part of my class’s “sorting ceremony.” The lecture hall filled with laughs, cheers and excitement as we all cracked our glowsticks to see which House we were about to join. When I saw the color blue and knew I was joining Sanford House, I felt like I had a group of people I was instantly connected to, even though I had met very few of my classmates or faculty at that point.

I felt so moved and comforted in that first week being welcomed by our Sanford House reps and by our amazing counselor Amy. I wanted to be involved in leading the community, which led me to add my name to the running for M1 Sanford House rep. When I got the role, I found an even deeper connection to the House reps above me. My relationships with my M2, M3 and M4 reps created invaluable opportunities to receive advice and support for me as an M1. Being able to connect with other House reps has continued to be one of my favorite aspects of M-Home for the past four years.

My fellow M-Home House reps

Introducing M-Pods
As M-Home president, I have been involved in conversations on how we can bring the deep inter-class community that we feel as M-Home reps to the rest of our Medical School classmates, especially in the very isolating times of the COVID-19 pandemic. In my last weeks as a UMMS student I am helping to launch our new M-Pods program, which I envision as a connection “safety-net” for all medical students. We will be creating small groups with students from every class with the goal of giving every incoming student a contact to reach out to if they find themselves needing support or a simple piece of advice that they don’t already have the connections for.

I personally know how hard it can be to make the first move to reach out for help, and I am hopeful that our M-Pods project will make it easier for any medical student who struggles to connect. As I pass along this project to the rest of our amazing M-Home team to continue after my graduation, I hope that my efforts will create a deeper and more connected community for all University of Michigan Medical School students in the years to come.

M-Home Olympics: A fun, annual event that creates some friendly competition among the four Houses. Go Sanford House!

 

The LEAGUES Fellowship: Inclusion in Surgery

What is The LEAGUES Fellowship?

The LEAGUES (Leadership Exposure for the Advancement of Gender and Underrepresented Minority Equity in Surgery) Fellowship is a summer program in the Michigan Medicine Department of Surgery that is offered to medical students across the country between their first and second years of school. Our goals are to give early exposure to procedural specialties, and to create a pipeline for students who are from underrepresented backgrounds and who share our values of increasing diversity in medicine and surgery.

Each summer, LEAGUES fellows attend a four-week program at Michigan Medicine that includes seminars about surgery, sessions teaching key surgical skills, and mentored research projects with Department of Surgery faculty, culminating in a presentation at the Center for Healthcare Outcomes and Policy. The LEAGUES Fellowship was created by Michigan Medicine’s all-star general surgery resident Dr. Valeria Valbuena, and the program piloted in 2020. Our leadership team is made up of several UMMS medical students and surgery residents, and the wonderful Dr. Gifty Kwakye serves as our faculty advisor.

Getting Involved in LEAGUES
Caroline
Coming into medical school, surgery was not on my radar as a possibility for myself. I was an anthropology major in college, and I did not believe that I fit into the stereotypical box that I had in my head at that time for a surgeon. The summer after my first year of medical school, I participated in a summer program for M1s at Michigan called Surgery Olympics. In this program, I did social sciences research with an incredible surgeon who also happens to be a minority, an immigrant, a Black woman, and a mother. If Surgery Olympics was the ignition, my M2 rotation on surgery was the spark, and I fell in love with surgery. I wanted to find a way to combine my excitement for the field with my desire to pay it forward by building a more diverse and inclusive surgical workforce and mentorship group. And, as sometimes happens at the University of Michigan Medical School, into my email inbox “walked” Dr. Valbuena with LEAGUES and an opportunity to get involved.

What Makes The LEAGUES Fellowship Special
Brandon
To me, what makes LEAGUES a special program is its mission to help students who have fewer resources. Not only do we aim to recruit students from underrepresented backgrounds, we also intentionally look for students who may have fewer research or mentorship opportunities at their school. Additionally, the faculty mentors that we pair with students are excellent. They work with the students to develop a practical research project that fits their interests, and they continue to invest in the students once they return to medical school. Previous LEAGUES fellows have published peer-reviewed manuscripts with their faculty and used their faculty to build more connections throughout academic medicine. The Michigan Medicine Department of Surgery is passionate about the LEAGUES program, and their efforts have led to an unparalleled opportunity for medical students.

Built by Trainees, for Trainees
Devon
LEAGUES is a program built by and built for trainees. The unique aspect of peer-to-peer mentorship within LEAGUES has provided me with the opportunity to be a mentor, even as a student, and to learn from peers across the country. The LEAGUES Fellowship not only allows you to be a leader at every stage in medical school, but also emphasizes this role. During the LEAGUES summer lecture series I shared my experiences in health policy and advocacy and was able to later speak at a LEAGUES fellow’s medical school to inspire their student group to start a similar advocacy project. I also had the opportunity to attend an academic conference with one of our LEAGUES fellows, and as we both edited our presentations together, attended talks and networked, I saw the joy of peer learning and mentorship. I learned a lot from her experiences as a social worker and osteopathic medical student and continue to learn from our fellows. The LEAGUES Fellowship successfully recruits diverse medical students who enrich any environment they enter.

The Best Part of LEAGUES
Caroline
My favorite part of LEAGUES has been getting to know the people involved, including the fellows, my co-med student leaders, the residents and the faculty. Our LEAGUES fellows have been complete rock stars, and it is amazing to learn about the ways they live out their passions during medical school. It is also exciting to meet future colleagues in surgery from other medical schools. It is inspiring to get to know the residents who started and grew the fellowship and to see their example of allyship and advocacy during surgical residency. Listening to the program’s faculty-led seminars and learning about these leaders’ journeys to surgery has also been incredibly inspiring and motivating. Mentorship is huge, and our LEAGUES sessions leave me feeling inspired by leadership at all levels and encouraged about the future of surgery.

Making an Impact at the University of Michigan’s Student Run Free Clinic

My first volunteer shift at the University of Michigan Student Run Free Clinic (UMSRFC) took place at the beginning of September. At that point I had only been in medical school for a couple months and had just begun learning basic clinical skills like how to take a patient history. While nervous at the thought of interviewing a real patient instead of an actor (we often have actors called Standardized Patients play the role of patients in class for practice), I was excited to try to apply what I’d learned in the Doctoring course to an actual patient experience.

I absolutely stumbled through my first couple patient encounters. I fumbled to find the right words, unsure of what follow-up and clarifying information to request when my medical knowledge was so limited. I performed a physical exam alongside a fourth-year medical student, who guided me through where to put my stethoscope and which parts of the patient’s chest I should listen to. When she asked me if I heard anything abnormal, I said no. Truthfully, though, I couldn’t hear anything. I only realized when I got home that I’d been using the wrong side of my stethoscope!

The U-M Student Run Free Clinic is located in Pinckney, MI and provides a variety of services including but not limited to basic primary and preventative care services, referrals to radiology or dermatology, and psychiatric and gynecologic services.

The UMSRFC is an organization that’s dedicated to providing quality health care at no charge to uninsured residents of Livingston, Washtenaw, and Oakland counties. It is run by a leadership team composed of students from the U-M Medical School, School of Nursing, School of Pharmacy, School of Social Work and School of Public Health. Throughout the pandemic, the clinic has been able to remain open and has continued servicing patients, with 635 total visits in 2021. [Learn more about supporting the UMSRFC at this link or below!]

Because of how insecure I felt about my own skills that first day at the clinic, I was really blown away by the other student volunteers. It seemed incredible to me that in three short years I would have the knowledge needed to ask the right questions, to confidently examine a patient and judge whether they needed further care. If anything, volunteering in the clinic really made me aware of how much I still didn’t know, and how much I would soon learn. That day I took my first patient history, I learned how to write up a patient visit, I presented an oral history to an attending physician for the first time, and I got just a brief insight into the incredible organization, dedication and effort that goes into running the clinic.

I also had the privilege of volunteering at the clinic on an “interprofessional education” day, so rather than just medical students volunteering, the clinic was also staffed by both nursing and social work students. Together, we were able to provide pretty complete services for patients who came in. Through phone translator services I could ask questions to a patient who only spoke Spanish, through the new dermatology e-consult service we were able to set up a patient for a specialist appointment to further examine an irregular mole, and, most surprising to me, we were even able to provide a diabetic patient with free insulin, which he could not afford himself.

Why the UMSRFC Matters to Me
I came into medical school knowing that I wanted to become involved with the UMSRFC. Throughout my entire admittance process, during interviews, Q&As with current students, and searches through existing organizations at the school, the UMSRFC constantly came up. Since you do not have to be a member of the leadership team to volunteer with the clinic, many students get involved with the SRFC to gain more practical pre-clinical experience taking histories and performing physical exams before starting rotations in the hospital during the second year of medical school. What’s nice about the clinic is that it provides a very low-stress environment in which students can practice the skills they’ve been learning. As nervous as I was during my first shift at the clinic, I was certain that the older students and the trained physicians volunteering would help guide me. No one made me feel dumb when I couldn’t remember what a medication did or didn’t know the correct “SOAP” format used when presenting to an attending; instead, they supported and guided me through the unfamiliar terminology.

Having the opportunity to participate in patient interactions so early on in medical school is certainly a compelling reason to join the clinic, but I was most drawn to the interpersonal aspect of work with the UMSRFC, the opportunity to become more involved in the greater Pinckney community that I would a part of for the next four years. This was driven by my personal interest in public health and desire to make connections within the community that could help inspire or influence any future pursuits in this area. And so, I applied for and was selected as the Community Outreach Coordinator for the UMSRFC.

As Community Outreach Coordinator, I’m primarily responsible for running social media pages, finding volunteer opportunities for medical students at community events where they can provide medical services and promote the clinic, and serving as a liaison between community organizations and the UMSRFC. I’ve met community members, organized events, and had the opportunity to learn to balance school and personal responsibilities with those of the clinic.

As students, we are also required to complete a Capstone project by the end of our fourth year. One way that many students choose to complete this requirement is by joining a Path of Excellence and completing their project under guided mentorship of physicians/professionals with similar interests. I recently joined the Ethics Path of Excellence and hope to draw from relationships and observations made through work with members of the greater community when developing my research project.

What’s really great about the clinic is that because it is student-run, there is a lot of space for creativity and the cultivation of new ideas. There is so much flexibility for people to begin personal projects aimed at improving the clinic and expanding access to care; the experience really becomes what you make of it. Because truly, the clinic could not run without the volunteer services of undergraduate students, graduate students, and various board-certified clinical providers. In 2021, the clinic was kept running by 3600+ volunteer hours in and out of the physical clinic space.

Support is Critical to the UMSRFC’s Success
While volunteers provide services in the clinic, we also really rely on institutional funding, grants and individual donations from generous supporters and donors to remain effective and to be able to continue improving our quality of care. Among other efforts, this year the social work team partnered with the Gleaners Community Food Bank to provide emergency food boxes to patients experiencing food insecurity, a dermatology e-consult service was started to increase access to highly critical specialized service, and we were able to increase the number of vaccines stored at and distributed at the clinic. The pandemic has also created new needs to keep both volunteers and patients safe, such as face masks, goggles, hand sanitizer and the expansion of our virtual services.

Giving BlueDay is a University-wide day of giving that encourages supporters to donate to the U-M programs that are meaningful to them, and donations collected during Giving Blue Day (and on any day of the year!) are crucial in allowing us to continue expanding our services. Last year, UMSRFC was fortunate enough to raise more than $20,000 to help expand our services and sustain the clinic mission.

I want to thank all past donors and invite individuals to share our Giving BlueDay page and keep the clinic in mind when considering what organizations to donate to this year!

Why I Love Space Medicine and How You Can Get Involved, Too

Contributing to the advancement of the space frontier has been my greatest childhood dream. Recently, I had the privilege and great fortune to make this dream come true – albeit just a little. Let me first give a little background:

Space medicine (a sub-specialty within Aerospace Medicine) concerns itself with the medical hazards of microgravity and prolonged spaceflight. There are two ways that one can really contribute to this field:

  1. Via an operational/clinical capacity where you are the one designing the medical protocols/recommendations for spaceflight; you are doing the pre-flight, in-flight and post-flight medical exams for astronauts; you are sitting at console in Mission Control monitoring the health of your astronauts; and etc. Last year, I had the opportunity to get very slightly exposed to this realm of space medicine while rotating with a commercial space company. Fortunately, we also have a UMMS alumna who does exactly this on a regular basis as a NASA Flight Surgeon!
  2. Via a research capacity where you are the one researching the effects of microgravity and prolonged spaceflight on physiology and health, investigating ways to mitigate the associated health risks, and developing countermeasures to the health hazards of the austere environment of outer space. Last year, I had the opportunity to get slight exposure to this realm of space medicine when I completed a rotation with NASA researching the microgravity-induced blood flow anomalies within the jugular veins.

Space Medicine Elective at Michigan

I genuinely believe that I was fortunate enough to be chosen for these experiences because of the work I previously did to create a Space Medicine Elective at the University of Michigan Medical School (UMMS). UMMS always strongly and proudly supports its students’ unique curiosities, and I will forever be grateful to the school for this! When I spoke about my interest in space medicine with my counselor, the administration and faculty mentors alike, I received so much support from everyone to bring my vision of a medical school Space Medicine Elective to reality. It took hard work and time, but last year the course was formalized as an official part of the course catalog (housed within the Anesthesiology Department), and it has since also launched at the University of Cincinnati’s medical school! I have so many people to thank for this – ranging from the student team that helped me build the curriculum, to the subject-matter experts who vetted the content, to Dr. Bagian for offering his expertise as course director, to mentors within the administration and Anesthesiology department who helped make the course come alive, and to my counselor who first sparked life into the idea.

I hope for everyone who reads this blog to enroll in the 2-week elective if you get a chance! The curriculum involves a series of readings, PowerPoints with integrated case studies, journal articles, online lectures/videos, podcasts, quizzes, assessments and peer student presentations. Through these, students gain insight into the field of space medicine, the effects of microgravity on human physiology, the health challenges associated with prolonged spaceflight and aviation, and current clinical applications to mitigate these risks. I know that with the support of the administration here, space medicine at UMMS will continue to grow and reach more students each year and expand nationwide! For those at other schools, we would love to work with you to help model something similar at your institution if you are interested, so do not hesitate to reach out!

Ultimately, my long-term career goal is to combine my medical training and passion for space by contributing to the advancement of commercialized spaceflight one day. Many folks ask me which of the two above ways I hope to contribute to space medicine, and my genuine answer to this is that I am not quite sure yet. What I do know with full certainty is that I am of no use to the space medicine community unless I am a competent physician first, so my first priority is to focus on my clinical training during residency. But eventually, as part of the next generation of physicians, I want to be ready for the responsibility to tackle the health challenges of this ultimate medical frontier, and I very much plan on making a niche in my future career for this work!

Overall, I can only thank UMMS from the bottom of my heart for allowing me to pursue my passion for space medicine, helping me set my career trajectory in motion, and helping me get closer to making my childhood dream a reality – and I want to help pay this forward to others. If you share this interest and/or are curious about the field but do not know how to get started, please reach out to me, and I would be more than happy to talk through it with you.

Advice for Gaining Exposure to Space Medicine

  • If you have the means, go to the annual Aerospace Medicine Association’s (AsMA) Conference. Everyone everywhere in the world who is doing anything space medicine-related meets at this conference, so seek out this opportunity to network and get your foot in the door. This is also THE place to learn more about the field and assess for yourself if it is something you are energized by and if you can envision a niche for it in your future career.
  • Become a dues-paying member of AsMA and AMSRO (which stands for Aerospace Medicine Student and Resident Organization – a constituent of AsMA). This gets you on their listserv, and thus gets you plugged into the community and opportunities within it.
  • Apply for the scholarships offered by AsMA and AMSRO. Many of these are targeted towards students who are just starting to gain exposure to the field, so it’s a great opportunity!
  • Take the initiative to educate yourself about the field at your own time! There are plenty of online lecture (like the Red Risk School Series and the Baylor Space Medicine Lecture Series). Take the Intro to Space Medicine elective as a Branches student to learn even more!
  • If you have a local AMSRO chapter, join it!
  • Take the initiative to reach out to and connect with students around the country who share this passion! It is a very niche field and a small community that is vastly spread out over the country. You may be the only one with an interest in space medicine in your immediate proximity, but I guarantee you that there are others who share this interest and who are probably doing work in it already too.

Many folks ask me which specialty they need to choose to get involved with space medicine in the future, and here I will share the advice I once received: it is likely that any number of days you spend being a “space doctor” is going to be less than the number of days you spend being a “doctor doctor”, so choose whichever specialty you genuinely enjoy and then find a way to make it relevant to space medicine. Throughout medical school, I was drawn to Anesthesiology and Ophthalmology – both fields that are not heavily represented in space medicine. In fact, the most heavily represented fields in the space medicine are Emergency Medicine, Internal Medicine and Family Medicine, but do I also know a Plastic Surgeon in space medicine? Yes. Do I know a Radiologist in space medicine? Yes. Do I know a Urologist and Orthopedic Surgeon in space medicine? Yes. You get the point.

With the advent of commercialized spaceflight upon us, the “typical” person now has the chance to go to space, and with that comes a whole set of new medical challenges that will need to draw upon the skills of various medical specialties – so my advice to others now is also to do what you love and make yourself relevant!

GO BLUE!

Michigan Trauma-Informed Medical Education (M-TIME): Using Evidence-Based Practices to Train the Next Generation of Physicians in Trauma-Informed Care

Before medical school, I worked as a crisis counselor at a domestic violence shelter in rural Michigan. I saw the lasting effects of trauma and its manifestations on health, and quickly realized my passion within medicine: trauma-informed care (TIC).

TIC is a framework of medical practice that promotes autonomy, safety, empowerment and healing, and that recognizes individuals are more likely than not to have experienced at least one traumatic event during their lifetime (to be exact, research shows 89% of U.S. adults have been exposed to trauma). TIC is essential for clinicians because trauma has been documented to have deleterious impacts on health; these events can lead to difficulty accessing medical care, remaining engaged in treatment plans, and feeling psychological safety when receiving care. 

At the Duderstadt Center on U-M’s engineering campus advocating for survivors of sexual violence.

Despite this, education on TIC in medical schools across the U.S. is largely absent, and upon starting my M1 year at UMMS, I quickly realized that our first-year clinical skills course did not include any instruction on TIC. However, a special characteristic about UMMS is how receptive the faculty and staff are to curricular improvement, especially regarding strengthening social justice and humanism as key pillars. The clinical skills course leadership immediately responded positively to my advocacy for inclusion of TIC in the curriculum, and asked me to use my prior work and research experience on trauma and TIC to design, implement and evaluate an evidence-based TIC workshop to be completed by all M1s in the fall of 2021. Excited to dive into this medical education project, I enrolled in the Scholarship of Learning and Teaching (SoLT) Path of Excellence program, which allowed me to engage in structured medical education training on a regular basis during my M1 year. 

The culture of mentorship at UMMS is second to none, and I had the pleasure of working on my project with the close mentorship of Dr. Lauren Owens, a faculty member in the Department of Obstetrics and Gynecology. In forming this team, known as Michigan Trauma-Informed Care Education (M-TIME), I also partnered with my incredible classmates Luca Borah, Stephanie Terrell and Elizabeth Erkkinen, each of whom has work experience in trauma-informed care as well. The foundation of our project involved working with LaTeesa James, a health sciences informationist at UMMS’s Taubman Health Sciences Library, to conduct a formal scoping review of the empirical literature on TIC curricula in the health professions. Sifting through more than 1800 articles, we identified the 51 articles meeting review inclusion criteria and quickly got to work synthesizing the strengths of these programs for use in the UMMS TIC workshop.

To support myself financially during the summer between M1 and M2 as I completed this project, I applied for and was awarded the $1,000 M1 Summer Impact Accelerator grant through the medical school. I also knew that part of my project would be designing a retrospective pre-post survey instrument to capture comprehensive data about the workshop’s efficacy and collect narrative feedback from the M1 students about areas for improvement. To maximize survey response rate, I was awarded a $2,000 Capstone for Impact grant through the medical school; this enabled me to provide a $10 gift card to a beloved local coffee shop, Sweetwaters Coffee and Tea, to every single M1 student who completed the survey after the TIC workshop. In implementing a participant survey, I also wrote and submitted an application to the university’s Institutional Review Board (IRB), the first of many IRB applications to come in my career. 

At the Nobel Peace Center in Oslo, Norway after giving a podium presentation at the European Conference on Domestic Violence.

The TIC workshop took place in October 2021 and was a huge success! The workshop components included: (1) a didactics portion emphasizing the link between trauma and health outcomes, best practices for trauma screening within patient encounters, and physician vicarious trauma; (2) a case-based session to practice TIC skills in small groups; and (3) a structured debrief. For statistical analysis of my survey instrument data, I partnered with a statistician at RISE (Research, Innovation, Education, Scholarship), a hub for medical education innovation at Michigan Medicine. I am so happy to share that 129 out of 170 M1 students completed the survey (75.9% response rate) and that our analysis illustrated statistically significant (p < 0.001) increases in students’ knowledge of TIC, intention to integrate TIC into their future clinical practice, and confidence in TIC skills. Moreover, narrative survey responses showed an overwhelming desire for increased curricular time devoted to TIC in the future. 

Now that the workshop has concluded, I have shifted my attention toward disseminating the results of this project and am beginning to conceptualize improvements to the TIC curriculum for next year’s entering class. With mentorship from Dr. Owens, I have written several first-author publications about this work, and have greatly enjoyed connecting with trainees and physicians around the country who also study TIC in medical education.

With my medical school partner in crime, classmate Jacqueline Lewy, who provided the most amazing support and sounding board as I completed my project.

The success of designing, implementing and evaluating an evidence-based curricular intervention for 170 first-year medical students relied upon the unique constellation of resources and support available to UMMS students, including: (1) the SoLT Path of Excellence and steady stream of individualized advice from enthusiastic Path advisors Drs. John Burkhardt, Dan Cronin, and Caren Stalburg; (2) LaTeesa James, a health sciences informationist at the Taubman Health Sciences Library; (3) the $1,000 provided by the M1 Summer Impact Accelerator and $2,000 provided by the Capstone for Impact grant; (4) the statisticians at RISE; (5) the mentorship by faculty member Dr. Owens; (6) the assistance of my classmates Luca Borah, Stephanie Terrell, and Elizabeth Erkkinen; and (7) the enthusiasm of the first-year clinical skills course staff for curricular innovation and improvement. 

All of this is to say that at the University of Michigan Medical School, if you can dream it, you can do it. The faculty and staff here at UMMS enthusiastically champion student projects — my TIC curricular intervention is a true testament to that.