Millham Lucia R I, Potter Jennifer, Hirsh David A, Trinh Nhi-Ha, Royce Celeste S, Levy-Carrick Nomi C, Rittenberg Eve
Acad Med. 2025 Mar 1;100(3):290-294. doi: 10.1097/ACM.0000000000005824. Epub 2024 Jul 23.
Trauma-informed care (TIC) provides a medical framework for addressing and mitigating the negative consequences of trauma. In response to student and faculty advocacy, medical schools are developing trauma-informed curricular content. However, medical education literature does not present a comprehensive assessment rubric to evaluate medical students' acquisition of trauma-informed clinical skills.
A committee of medical students, trainees, and faculty developed a longitudinal TIC curricular theme at Harvard Medical School (HMS). Guided by the National Collaborative on Trauma-Informed Health Care Education and Research competencies, the committee created a set of medical student TIC competencies from July to December 2019. From November 2021 to November 2022, 3 committee subgroups generated new TIC descriptors for each HMS entrustable professional activity (EPA), then circulated these to other subgroups, external experts, and stakeholders for review and feedback. From April to June 2023, the committee iteratively reviewed the materials until reaching consensus for content and pedagogy. The committee integrated TIC content into HMS's existing EPAs expected of students, provided anchoring descriptions of each level, and achieved consensus using a process of iterative review with TIC content experts.
The committee identified 10 TIC competencies and revised all 13 general HMS EPAs to include specific items based on these competencies. The committee incorporated at least 1 trauma-informed competency into each HMS EPA.
This novel set of HMS EPAs provides a framework for assessment of TIC clinical skills. Faculty will be trained to correctly and reliably incorporate TIC competencies into patient care and to use the TIC-inclusive EPAs for student assessment, ensuring that TIC is standard medical practice at HMS. This work may facilitate the adoption of trauma-inclusive EPAs by other institutions to educate the next generation of physicians to practice TIC and thus promote a more accessible, safe, and equitable health care system.
创伤知情护理（TIC）为应对和减轻创伤的负面影响提供了一个医学框架。为响应学生和教师的倡导，医学院校正在开发创伤知情课程内容。然而，医学教育文献并未提供一个全面的评估标准来评价医学生对创伤知情临床技能的掌握情况。
一个由医学生、实习生和教师组成的委员会在哈佛医学院（HMS）制定了一个纵向的TIC课程主题。在国家创伤知情医疗保健教育与研究协作组织能力的指导下，该委员会于2019年7月至12月创建了一套医学生TIC能力标准。从2021年11月到2022年11月，3个委员会小组为HMS的每个可托付专业活动（EPA）生成了新的TIC描述符，然后将其分发给其他小组、外部专家和利益相关者以征求意见和反馈。从2023年4月到6月，委员会反复审查这些材料，直到在内容和教学法上达成共识。该委员会将TIC内容整合到HMS对学生期望的现有EPA中，提供每个水平的锚定描述，并通过与TIC内容专家的反复审查过程达成共识。
该委员会确定了10项TIC能力标准，并修订了所有13项HMS通用EPA，以纳入基于这些能力标准的具体项目。该委员会在每个HMS EPA中至少纳入了一项创伤知情能力标准。
这套全新的HMS EPA为评估TIC临床技能提供了一个框架。教师将接受培训，以便正确且可靠地将TIC能力标准纳入患者护理，并使用包含TIC的EPA对学生进行评估，确保TIC在HMS成为标准医疗实践。这项工作可能会促进其他机构采用包含创伤内容的EPA，以教育下一代医生践行TIC，从而推动建立一个更易获得、更安全且更公平的医疗保健系统。
