Medical Schools Must Improve Trauma-Informed Care Education.

Last fall, I arrived at the hospital for a routine checkup. The provider I would be seeing was a new trainee, and they entered the room timidly as they verified my name and date of birth. We carried on a conversation about medical school, the rhythmic movements of their stethoscope during my exam proceeding without incident until they said, “Listening to the heart is easier for me with skin contact.” They quickly slipped their hand deeply down my shirt, their fingers and stethoscope suddenly touching my breast directly. Unprepared and clearly uncomfortable, I froze. Silently, I let them complete the exam. Leaving the hospital, I wondered why this provider did not ask for permission or provide a word of warning before touching a woman’s chest. In questioning how their medical education had failed them in this, I realized a hard truth—I too was being failed by my curriculum regarding its lack of trauma-informed care education. I was surprised I did not notice this gap in my medical training earlier. Before medical school, I worked at a shelter for survivors of domestic violence and sexual assault. Their experiences of trauma and lasting triggers were diverse, and certainly not isolated to gynecology, as some medical schools’ limited trauma-informed care curricula suggest. Particularly concerning to me was how past encounters with providers often colored patients’ perception and trust of medicine as a whole, discouraging them from accessing necessary treatment in the future. I remembered a resident of the shelter whose experience of forced IV drug use led to severe psychological distress each time their arms were touched. While they knew they would benefit from seeing a physician who subspecialized in addiction medicine, they did not seek care due to fear of potential continued contact to their arms during an appointment. They saw this fear often realized by other residents of the shelter, whose physicians generally lacked understanding of the triggers inherent in basic care plans. This was the case in one shelter resident who came to the shelter directly from the hospital, the cause of their inpatient hospital stay being abdominal stab wounds sustained from retaliation by their former partner. Their surgeon gave me instructions on how and when to change their surgical dressings, but was unable to provide guidance on how to complete this task without the shelter resident experiencing crying that sometimes persisted for hours. In those moments, I breathed gentleness and warmth, yet internally struggled with strong tides of frustration over the medical team’s lack of thought regarding the emotional impact of their plans. It is of the utmost importance to me that patients and their families do not remember me as the provider that made them feel discomfort or triggered their previous trauma. With continued reflection on my experience with the provider at my appointment, I am certain that medical schools must take action to bolster their trauma-informed care curricula. The onus cannot be on trainees like me to establish our own individual and substantive self-directed learning plans, yet we still must learn to show patients that we are worthy of their trust. Experiences of discomfort and unease, such as the one at my own appointment, are preventable with proactive trauma-informed medical education. I am grateful that my own institution has allowed me and other interested students and faculty to implement required training on this subject and that it was received by students with open arms. Other medical schools must rise to their responsibility to provide this content and cultivate learners with a strong ability to integrate knowledge of patients’ life experiences into care that feels safe and comfortable for all.