Assessing the Need for Trauma-Informed Education: How Prepared are Medical Students?

Case 1: During my early clinical experience, I accompanied my preceptor into an exam room to meet a young female patient scheduled for her annual physical, including her first pap smear for cervical cancer screening. Despite feeling adequately prepared to complete the pap smear, it was my first time performing this procedure and I wasn’t sure what to expect. After obtaining the patient’s consent, I conducted the examination, providing step-by-step guidance; however, the patient reacted with crying, screaming, and trembling. I immediately stopped the exam. Then, the patient disclosed that she was a survivor of sexual trauma. This unforeseen disclosure left me unsure of how to effectively address her distress. My lack of specific training in handling sensitive exams for trauma survivors led to this patient’s retraumatization and I now feel ill-equipped to provide appropriate support in this situation.
Audience consideration (AC): How might medical education evolve to incorporate comprehensive training on trauma-informed care, ensuring future physicians are equipped to navigate sensitive examinations and provide appropriate support for survivors?
Case 2: I arrived at the urology clinic eager to engage with patients and provide care in my chosen field. I entered my first patient’s room to see that he was visibly anxious. Upon inquiring his reason for coming to the urologist, he shared that he was having difficulties maintaining erections during intercourse, yet endorsed morning erections, suggestive of psychogenic erectile dysfunction. Subsequently, the patient disclosed that his nervousness stemmed from being a survivor of sexual trauma, and he shared he was nervous about undergoing a penile examination. Acknowledging his concerns, I opted to defer the examination, recognizing the appropriateness of having a chaperone in my capacity as a female student. I also wanted to wait to do the exam with my preceptor to avoid doing the exam twice; however, when I told my preceptor about the patient’s circumstances, there arose a misunderstanding regarding my decision to defer the exam, resulting in disappointment and questioning of my initiative as a student. Truthfully, as a student I did not feel prepared to navigate a penile exam alone in a patient who was a survivor of sexual assault, in fear of causing retraumatization.
AC: How can medical education integrate trauma-informed principles to enhance empathy and self-efficacy, addressing the needs of survivors of sexual trauma, while promoting collaboration with preceptors to ensure compassionate and comprehensive care?
More than half of women and more than one third of men have been victims of sexual violence in their lifetime.1 Sexual trauma often leads to various adverse psychological effects, notably post-traumatic stress disorder, triggered by cues like physical touch, which can heighten both emotional and physical reactions. During sensitive patient examinations, these triggers can lead to re-traumatization.2,3 While the standard medical education curriculum addresses the implications of sexual trauma on patient care, clinical examination skills, including male and female genitalia exams, are taught separately. Despite their coexistence in real clinical settings, the integration of these topics is overlooked.
AC: In light of the significant prevalence of sexual violence and its enduring effects on survivors, how can medical education better address the holistic needs of patients by integrating trauma-informed care into clinical examination training?
Through our research, we aim to ignite discussion regarding evidence-based training in trauma-informed physical examination skills for medical students. Using a survey-based cross sectional design, we are assessing medical student attitudes, self-efficacy, empathy, and compassion in performing sensitive genitalia examinations on patients with and without a history of sexual trauma. Students will also be asked whether they believe there is a need for further trauma-informed care integrated into the curriculum. If a gap is identified, these outcomes can ignite change in existing medical education curriculums.
AC: What are the consequences faced by survivors of sexual trauma when receiving care from students and physicians who are insufficiently equipped to handle trauma-informed care?
Establishing a cohort of well-trained, empathetic professionals is paramount for fostering patient trust and mitigating the risk of retraumatization. Failure to address these concerns may result in avoidance of essential examinations, ultimately compromising patient trust and adherence to treatment protocols. We aim to assess students' attitudes and competencies in conducting sensitive examinations, particularly with patients who have a history of sexual trauma. This data will enable us to identify potential gaps in trauma-informed physical examination skills and evaluate the necessity for additional training.