Why is it Important to Teach Medical Students and Junior Doctors How to Ask Patients About Experiences of Abuse or Trauma?
Time to read: 2 minutes
This piece had its genesis in the questions posed to co-author Associate Professor Mike Salzberg (Consultation-liaison psychiatrist) when teaching medical students and junior doctors. The issue at hand was if they should ask about a history of trauma such as sexual abuse, and how should they appropriately handle often sensitive disclosures from patients.
At the time, I was undertaking a registrar term in Consultation-liaison psychiatry and teamed up with A/Prof Salzberg, and later two other experts in the medical education field to review the literature around this and think about how we might stimulate further discussion in this area.
TRAUMA IS PREVALENT AND ITS IMPACT FAR REACHING
Bessel van der Kolk writes in The Body Keeps the Score –
Trauma is not just an event that took place sometime in the past; it is also the imprint left by that experience on mind, brain and body. This imprint has ongoing consequences.
Almost three-quarters of Australians have been exposed to a traumatic event. Trauma can take many forms, for example, family violence, combat atrocities or physical assault. It has significant impacts on a person’s emotional and physical health as well as the way in which they may present to health professionals. Somatisation, as one example, is more common in people with a history of trauma.
RECOMMENDATIONS FOR TRAUMA INFORMED MEDICAL EDUCATION
We propose the concept of trauma-informed medical education. Here are the key points –
- Teaching about trauma and abuse should occur in a step-wise, incremental or ‘nautilus shell’-like fashion from pre-clinical years in medical degrees through to prevocational years and specialist training programs
- Separate trauma discourses exist, for example, there is a fair amount of literature on teaching about family violence. There are commonalities however between differing types of trauma
- Trauma-informed medical education is relevant to all clinical specialities
- We do not propose adding into already loaded medical school curricula, but integrating this teaching into core rotations and communication skills training
- Small group teaching, experiential and cross-discipline learning, as well as the medical humanities, are opportunities to expand knowledge in this area
- Eliciting a history of trauma and abuse can evoke a variety of psychological reactions, including vicarious traumatisation and/or be triggering for students or clinicians with their own history of trauma [ Read more on Complex PTSD where we have a slide on questions to evaluate Adverse Childhood experiences sensitively]
- Providing a means to debrief and cope with this should be intrinsic to the core business of medical education
This article was intended as the starting point for a more rigorous discussion and to prompt creative ideas about addressing this extremely important issue. I co-authored a Perspectives article on this pertinent in the Medical Journal of Australia. I welcome your thoughts.
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