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Trauma-Informed Care for Doctors

March 13, 2024
Trauma definition written in a dictionary.

This may sound like a surprising title for a blog… why might we need trauma-informed care for doctors? Isn’t that something that doctors do for their patients?

Trauma is silently becoming an epidemic in the world as we become increasingly aware of the fact that trauma isn’t what happens to you, but what happens inside you when those things happen to you.

Dr Emily Amos

Thankfully, medicine has come to realise the importance of our patients stories and journeys in shaping their future paths, both in life and in health. At Whole Hearted Medicine, we have long believed however that the role of trauma in medical training is often overlooked when it comes to the journeys of doctors themselves. That there are many parallels between the typical model of trauma-informed care that serve very well when working with doctors in the way that we do through out our educational retreats & coaching. Furthermore, that this model of care is very important in how we continue to support doctors and medical students and hopefully stem the tide of burnout that we are seeing amongst our profession.

There is a lot about the path into and through medical training that can be quite traumatic for those who walk it. From the intense competition to get in to training, often resulting in significant life sacrifices in order to do so, to the frequent moving from training post to training post and the large time and energetic commitment to exams and study required by speciality colleges. This can come at the detriment to building connections in life, both family & friends, but also with ourselves. These connections are the all important support networks that tend to buffer difficult life experiences. In a systematic review of protective factors against burnout in police officers, a profession that bears many similarities to medicine, Alves et al (2023)1 found that social support proved to be the most significant protective factor against burnout. However, these social relationships need to be nurtured in order to provide that sort of support when needed. If you ask any trainee preparing to sit specialty exams what is the biggest area of their lives that has suffered through this process, many will cite their social and intimate relationships.

Although the ‘see one, do one, teach one’ days of medicine training are thankfully fading, there are still many of us in medicine who have experienced this ‘sink or swim’ method of teaching. It’s often stated that medical students enter their tertiary education with higher than average score in mental health, however these patterns show an obvious down turn in the first two years of medical education2. From the ever present fear of making a mistake to the immense workload demands on junior doctors and trainees that often call for them to forsake their own basic physiological needs in favour of continuing to work- doctors perform their roles under huge stress. The Yerkes-Dodson Stress-Performance Curve shows that while a certain amount of stress is important for peak function, beyond that point, performance tends to suffer. Likewise, Morava et al (2024)3 demonstrated that acute stress in university students (as measured via objective markers such as raised HR & BP and salivary cortisol) resulted in greater mind wandering and lower lecture comprehension scores. Although this era of medical training does seem to be making way for a more collaborative and supportive pedagogy for trainees, junior doctors and medical students, that doesn’t negate the potential impact this sort of teaching may have had on those doctors who experienced it.

To reflect back on the definition that “trauma isn’t what happens to you, but what happens inside you when something happens to you”, it is also important to explore the broader medical culture and what role this may have in driving traumatic experiences in doctors and medical students. According to the most recent large scale study into the mental health of doctors and medical students4 “doctors reported substantially higher rates of psychological distress and suicidal thoughts compared to both the Australian population and other Australian professionals”, with younger doctors and female doctors much more susceptible to these effects. One contributing factor to these figures is cited as being the fear of stigmatising attitudes towards mental ill health. From micro aggressions in professional environments and training pathways to structural biases and bullying, in an environment where fear of reprisal or career impact prevents doctors and trainees from feeling safe enough to reach out for and access supportive care; the likelihood that these experiences result in ongoing traumatic distress amongst doctors and medical students is increased.

One of the core components of the practice of self compassion is the understanding that suffering and distress are a common human experience, common humanity vs isolation is the way that Dr Kristin Neff5 frames this important concept. Time and time again on our retreats, as we work with doctors across a variety of life stages and professional positions, we see this common humanity come into play. As we connect and share, we see right in front of us that the distress each of us may be feeling is not ours alone to battle on with, but rather a shared human experience. No longer a room full of doctors who must be “in control” or “holding it all together in order to serve others”, but humans who each deserve support and care.

“I thought the retreat was really useful. I could see that nearly all the attendees were struggling. Some were extremely distressed and that was hard to watch but everyone was very respectful and supportive within the group. The atmosphere was one of support for each other as human beings.”

Retreat Participant

Principles of Trauma-Informed Care in our retreats:

  • Safety
    • Ensuring physical and emotional safety for participants eg. assuring confidentiality, modelling compassion and fostering an atmosphere of curiosity rather than judgement.
  • Choice
    • Ensuring participant autonomy and providing clear pathways of communication for alternative models of care or education if needed.
  • Collaboration
    • Creating learning spaces that value discussion and exploration of sometimes ethically difficult concepts, providing opportunities in teaching sessions for group work and sharing.
  • Trustworthiness (self & others)
    • Addressing potential interpersonal factors including communication issues that may impact upon task clarity, placing & upholding clear boundaries and understanding the role that our own personal triggers may have in our interactions with others.
  • Empowerment
    • Co-creating content with learners to provide opportunities for them to voice their experiences of concepts explored and discussing these collaboratively to create a shared understanding.

Bringing a trauma-informed lens to the care & education of doctors and medical students isn’t about labelling all doctors and medical students as suffering from post traumatic distress. It is about integrating the sort of holistic bio-psycho-social care that means that the mental health of those who have or are experiencing post-traumatic distress is not made worse by accessing that care or education. As the basic principles of Trauma-Informed Care closely mirror those of adult learning principles– which place significant weight on the autonomy of learners, their readiness to learn and creating a co-collaborative environment between educators and learners; by providing care and education that is suitable for those who have or continue to experience trauma, all adult learners are likely to benefit.

“I feel like I have a better understanding of self-compassion and why I need it in my life. I also learnt that I am not alone in my feelings from others sharing their experience. I’ve learnt to be kinder to myself and more accepting of my flaws.”

Retreat Participant

Trauma Informed care in medical education is a protective and potentially hugely beneficial approach that not only prioritises agency in adult learners but also helps to identify those who would benefit from increased support and care. There is no down side to providing this sort of care and as an organisation Whole Hearted Medicine is committed to continuing to provide trauma-informed care and medical education to doctors and medical students, just as we have from the very beginning.

  1. Alves, L., Abreo, L., Petkari, E., & Pinto da Costa, M. (2023). Psychosocial risk and protective factors associated with burnout in police officers: A systematic review. Journal of affective disorders332, 283–298. https://doi.org/10.1016/j.jad.2023.03.081 ↩︎
  2. Voltmer, E., Köslich-Strumann, S., Voltmer, J. B., & Kötter, T. (2021). Stress and behavior patterns throughout medical education – a six year longitudinal study. BMC medical education21(1), 454. https://doi.org/10.1186/s12909-021-02862-x ↩︎
  3. Morava, A., Shirzad, A., Van Riesen, J., Elshawish, N., Ahn, J., & Prapavessis, H. (2024). Acute stress negatively impacts on-task behavior and lecture comprehension. PloS one19(2), e0297711. https://doi.org/10.1371/journal.pone.0297711 ↩︎
  4. Beyond Blue: National Mental Heath Survey of Doctors and Medical Students 2013, access 12th March, 2024: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://medicine.uq.edu.au/files/42088/Beyondblue%20Doctors%20Mental%20health.pdf ↩︎
  5. Neff K. D. (2023). Self-Compassion: Theory, Method, Research, and Intervention. Annual review of psychology74, 193–218. https://doi.org/10.1146/annurev-psych-032420-031047
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