By: Emma Siegel, PharmD Candidate 2022 at The Ohio State University
As a pharmacy student, I have observed how the life experiences of patients affect their care, and at times have felt unprepared to handle these situations. During an internship at an HIV specialty pharmacy, I came across many patients who struggled to take their life-sustaining medications daily, as the medications served as constant reminders of their HIV-positive status and the societal shame associated with that diagnosis. Pharmacy students would benefit from learning an approach to caring for patients dealing with traumatic events, known as trauma-informed care (TIC). Because TIC is a relatively new concept, students are not often taught how to provide this type of care, which may leave some feeling inadequately prepared to help patients who may be suffering from trauma.
What is trauma-informed care, and why should we be concerned about it?
TIC is a framework that acknowledges the healthcare team’s need to have a complete picture of a patient’s life situation, including their past trauma, in order to provide effective, healing treatment.1 Per the Substance Abuse and Mental Health Services Administration (SAMHSA), “individual trauma can result from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.” The Adverse Childhood Experiences (ACEs) test is often used to assess and quantify common traumatic experiences, and higher numbers of ACEs often correlate with poorer health outcomes.2
The core components of TIC include safety, trustworthiness and transparency, peer support, collaboration, empowerment, and humility and responsiveness.1 This approach has been shown to improve patient outcomes, as well as reduce burnout among healthcare staff by creating less chaotic healthcare environments, better provider-patient relationships, and more comprehensive patient care.1 The importance of incorporating TIC into the pharmacist’s patient care process and methods for learning about this issue have been described within pharmacy literature and news. By incorporating TIC into their practice, pharmacists at an HIV clinic in California have been able to create a calmer healthcare environment and increase patient and provider satisfaction.
While a trauma-informed medication education (TIME) framework has been proposed for introduction in undergraduate medical education, pharmacy-specific literature is limited.3 Faculty and students from Southern Illinois University Edwardsville School of Pharmacy received grant funding to develop a pilot program which offered TIC training, which has impacted how some faculty have started to incorporate TIC and anti-racism education within the curriculum.
So, the question arises: how do we introduce this topic into the pharmacy curricula without causing “curricular bloat?”
Proposed Strategies for Integrating TIC into Pharmacy Education:
- Patient testimonies, followed by student discussion, have been used within Ohio State University’s integrated lab curriculum to incorporate the practice of cultural humility, which can be extended to encompass TIC.4 Real patients are brought in to speak and answer questions on topics including LGBTQIA+ care and inclusion, the influence of culture on views towards medication, and other sensitive topics.
- Simulated patient interactions can be used to highlight difficult conversations students may have with patients. An example is a 4-hour program developed for training medical residents which utilized didactic videos and standardized patient encounters. The majority of residents that participated in the program agreed that it enhanced their understanding of ACEs (64.5%), reflected realistic encounters (68.8%), and helped them to apply concepts and principles in practice (65.6%).5
- Reflection activities could serve to reinforce the concepts of TIC. For example, students may be asked to view a lecture about TIC and then reflect on their own experiences in pharmacy school surrounding this topic. A 2017 study of health professional students found self-assessment of ACE Scores increased the likelihood of understanding the scientific and clinical findings of the ACE Study and TIC.2
Overall, many opportunities exist for incorporating this difficult, yet important, subject into pharmacy school curricula. Hopefully, more colleges of pharmacy will begin incorporating TIC and students will feel more confident in their ability to ensure excellent patient care. Pharmacy programs will face some challenges as they begin exploring this area, including lack of time for an additional topic and lack of resources such as faculty expertise, as well as the novelty of TIC in practice.
What are some other methods of incorporating TIC into pharmacy curricula? Has your institution had any success with a particular approach?
David Matthews, PharmD, BCACP, Assistant Professor at The Ohio State University College of Pharmacy
1. Center for Health Care Strategies. What Is Trauma-Informed Care? Trauma-Informed Care Implementation Resource Center. Updated 2021. Accessed October 27, 2021.
2. Strait J, Bolman T. Consideration of Personal Adverse Childhood Experiences during Implementation of Trauma-Informed Care Curriculum in Graduate Health Programs. Perm J. 2017;21:16-61. DOI: https://doi.org/10.7812/TPP/16-061.
3. Brown T, Berman S, McDaniel K, et al. Trauma-Informed Medical Education (TIME): Advancing Curricular Content and Educational Context. Acad Med. 2021;96:661-667. DOI: https://doi.org/10.1097/ACM.0000000000003587.
4. Nebergall S, Dula CA, King SA, et al. Educating Pharmacy Students About Underserved Populations Using Patient Speakers and Simulation Activities. Am J Pharm Educ. 2021;85(7):8461. DOI: https://doi.org/10.5688/ajpe8461.
5. Wen FK, Miller-Cribbs JE, Coon KA, Jelley MJ, Foulks-Rodriguez KA. A simulation and video-based training program to address adverse childhood experiences. The International Journal of Psychiatry in Medicine. 2017;52(3):255-264. DOI: http://doi.org/10.1177/0091217417730289.
Emma Siegel is a student in her final year at The Ohio State University College of Pharmacy. Educational scholarship interests include the practice of ambulatory and community pharmacy, especially within underserved patient populations. In her free time, Emma enjoys playing with her chihuahua named Pip and doing yoga.
Pulses is a scholarly blog supported by Currents in Pharmacy Teaching and Learning