Chapter 11: Implementing a Trauma-Informed Care Curriculum in Undergraduate Medical Education

Was the example above an individual or collective retraumatization? Who was traumatized, the student, the instructor or both? What does traumainformed care have to teach us about this situation? These are the questions this chapter will explore, first by providing a definition of trauma and trauma informed care (TIC), and then by describing the Harvard Medical School (HMS) curriculum and practice of teaching which is the student initiative and faculty and institutional response taken to incorporate TIC content into the curriculum.

Trauma is extremely common, affecting populations across the nation and the world. In 2017, the World Health Organization published results from surveys in 24 countries (n = 68,894) which assessed 29 lifetime traumas and PTSD and found that across the world, 70.4% of respondents experienced lifetime traumas (Kessler et al., 2017). A large national study published in 2013 (n = 2,953) showed that 90% of respondents had at least one traumatic event exposure, with multiple traumatic event types as the norm (Kilpatrick et al., 2013). In addition, exposure to adverse childhood experiences (ACEs)—summarized as abuse (physical, emotional, or sexual), neglect (physical or emotional), and household dysfunction (exposure to divorce, a member of the household with mental illness, substance abuse, or who is incarcerated, or witnessing violence in the home)—was shown to affect two-thirds of study participants in an influential large national study (n = 17,000) in 1998 (Felitti et al., 1998). Merrick and colleagues (2019) found similar results in their analysis of 2015–2017 Behavioral Risk Factor Surveillance System data, which consisted of telephone surveys of 400,000 U.S. adults; by their estimate, one in six adults have four or more types of adverse childhood experiences (Merrick et al., 2019).