By Aneesah McClinton & Cato T Laurencin, Journal of Racial and Ethnic Health Disparities, October 1, 2020
Abstract
Numerous organizations implement a trauma-informed approach. This model assists institutions in providing care and education that delivers support to members who have undergone traumatic experiences, and many institutions apply the principles as a universal precaution. Student and trainee experiences in medical education reveal a hidden curriculum that may deliver conflicting messages about the values of an institution, in which equity is promoted, but biased and discriminatory practices are commonplace. Implicit racial bias has been identified in the patient-provider interaction and may also extend its impact on the learner experience. Bias and discrimination inflict trauma on its targets via emotional injury. Applying the principles of the trauma-informed approach, we advocate for trauma-informed medical education (TIME). TIME fosters awareness that students and trainees can experience trauma from a biased system and culture and advocates for the establishment of policies and practices that support learners to prevent further re-traumatization. TIME will serve as a means to deliver just and equitable education.
The clinical learning environment demands a trauma-informed culture. A trauma-informed approach is advocated in the fields of health care, education, social services, law enforcement, and many others as a way to understand and attend to individuals affected by traumatic experiences. A critical aspect of the model is to acknowledge that trauma shapes an individual’s experience, and organizations that deliver care and provide education must be attuned to these experiences to interact and collaborate in a way that is culturally sensitive, transparent, establishes rapport, and empowers its members. Trauma is defined as an event or a set of circumstances that are physically and emotionally harmful, can be life-threatening, and adversely affects how individuals function in society, ultimately affecting their mental, physical, social, emotional, and spiritual health.
At the institutional level, it is difficult to determine who has experienced trauma; therefore, trauma-informed principles are implemented as a universal precaution [7]. At the individual level, the approach does not require that others know the type of trauma endured. Instead, they operate on a set of principles to create a supportive environment, and an individual’s ability to provide and maintain a trauma-informed approach is contingent on their well-being. Four essential components serve as the foundation of the trauma-informed approach and implore organizations to (1) realize the extensive impact of trauma; (2) recognize the signs and symptoms of trauma; (3) respond by fully integrating knowledge about trauma into policies, procedures, and practices; and (4) resist re-traumatization.
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