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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.

SafeMD: Training the next generation of MDs to care for survivors of sexual violence

Content warning: This post will contain discussions of sexual violence and misconduct. We recognize that readers of this post may have experienced sexual violence firsthand and/or have loved ones that are survivors. Supportive listening, help, and resources can be found at RAINN

Our names are Anna, Courtney, and Stephanie, and we are the M1 leads for SafeMD, an organization founded in 2015 to promote an environment in which sexual assault is illuminated, understood, actively combated, and not tolerated. The three of us were deeply involved in sexual assault prevention and awareness prior to medical school and were eager to continue this work during our medical training.

SafeMD members presenting a poster at Health Professions Education day in 2018.

Anna spent her undergraduate years working with the Sexual Assault Prevention and Awareness Center at the University of Michigan and spent her gap year doing research on trauma-informed care. Courtney has an extensive history of engagement with activism to support survivors of sexual violence and spent her gap year working at a domestic violence shelter in rural Michigan. Stephanie has been involved with Title IX advocacy and survivor support and is currently studying applications of trauma-informed care. 

Specifically, we are working to promote an environment in which survivors of sexual violence have access to and are aware of supportive resources in the medical community. We hope to provide future medical professionals with the necessary education to become proficient in caring for patients who have experienced trauma with nuance, skill, and empathy. To accomplish these goals, the founders of SafeMD in 2015 developed the initial projects of the organization: Allyhood Training and the Launch (M1 orientation) presentation. 

SafeMD founder Seth Klapman presenting at the AAMC conference in 2016.

Since 2015, the role of SafeMD has evolved and expanded to fill identified gaps in the curriculum. For example, during this year’s M1 sequence on reproductive sciences, SafeMD invited a sexual health educator at the University of Michigan’s University Health Service (Laura McAndrew, MPH, PMP) to present on the origins and implications of sexually transmitted infection stigma, its impact on sexuality, and how to provide affirming care that increases treatment engagement and reduces inequities.

During February, Teen Dating Violence Awareness Month, SafeMD held a virtual journal club to raise awareness about the causes and consequences of adolescent dating violence. Additionally, because the M1 didactic session on intimate partner violence (IPV) in healthcare settings was asynchronous this year due to COVID-19, SafeMD hosted a live, interactive virtual session with the intimate partner violence (IPV) Doctoring content lead (Dr. Vijay Singh) to provide information on how healthcare providers can identify and respond to IPV. 

SafeMD executive board members hosted a virtual journal club in February 2021 for Teen Dating Violence Awareness Month.

SafeMD has also developed a trauma-informed care workshop for medical students. Trauma-informed care in the healthcare field is an approach that assumes that a patient is more likely than not to have a history of trauma, and advocates for the promotion of a safe, transparent, and empowering patient-provider relationship. This interactive workshop, designed by current SafeMD executive board member Isabel Lott and former member Petrina LaFaire, was designed to provide medical students with an understanding of the principles of trauma-informed care and the importance of IPV screening, as well as give students a chance to gain confidence in effectively treating and communicating with a patient who has a history of IPV.

SafeMD Allyhood Training in 2017.

As SafeMD continually strives to maximize our impact on the Medical School community, we have incorporated self-analysis of training efficacy into the workshop by deploying a pre-post retrospective questionnaire to elicit feedback on the strengths and weaknesses of the intervention. We were able to analyze our data from Allyhood Training and present a poster at Health Professions Education Day. Furthermore, SafeMD also works with the Medical School’s Student Diversity Council to ensure that the curriculum is reflective of the fact that physicians across all fields of medicine will care for survivors of sexual violence during their careers.

April is Sexual Assault Awareness Month, and the SafeMD team has been busy! At the beginning of the month, we hosted a lunch talk from Dr. Tim Johnson, who discussed his work on the National Academies of Sciences, Engineering, and Medicine committee studying sexual harassment within academia. We also participated in Ann Arbor’s virtual Take Back the Night rally, and are providing free copies of Jennifer Hirsch and Shamus Khan’s book, Sexual Citizens, to medical students who would like to participate in a book club. Additionally, we are collecting messages of support for survivors of sexual violence throughout the month and will be organizing these into an art piece to be displayed long-term in Von Voigtlander Women’s Hospital.

If you’re interested in SafeMD, be sure to follow us on Twitter @UMichSafeMD and visit our website!