A qualitative exploration of medical educators’ familiarity and perspectives regarding trauma-informed approaches in medical education

INTRODUCTION: Evidence demonstrates profound impacts of trauma, on both physical and mental health across the lifespan, making trauma a significant public health issue. Current understanding of traumatic events acknowledges origins from social, structural, as well as interpersonal sources. Trauma-informed approaches (TIAs) provide a framework for interactions with those affected, and advocate for accommodation of trauma impacts throughout individual practice, and in organisations and systems to prevent retraumatisation. While TIAs are increasingly recommended in healthcare policy, evidence suggests these are not consistently incorporated in medical education. Educators are key stakeholders in embedding this practice, yet their perspectives have not been evaluated, representing a critical knowledge gap. METHODS: We applied Brown et al.'s proposed Trauma-Informed Medical Education (TIME) framework (2021) that integrates trauma-informed principles throughout educational content and context as a conceptual model in this qualitative exploration of educator knowledge and practice. Educators at UK medical schools were invited to participate in semi-structured interviews exploring familiarity with TIAs, benefits and drawbacks. Data were analysed using reflexive thematic analysis. RESULTS: Twenty-three educators from 16 medical schools were interviewed. Knowledge, routes to familiarisation and practice varied considerably among participants, who broadly recognised need for and value of TIAs. Practice often mirrored trauma-informed principles. Motivations related to person-centred care, inclusive education, and learner wellbeing, with concerns regarding avoidance of distressing content. Compatibility of TIME recommendations with education and healthcare contexts was discussed, with facilitators, and more commonly, barriers identified. DISCUSSION: Variable knowledge, opportunistic familiarisation, and individually determined practice indicate the need for more precise understanding of evidence regarding trauma sources and impacts and TIAs amongst education stakeholders at all levels to harness benefits. Wider contextual factors are not addressed in the current framework. Greater consideration of contextual factors and more cohesive approaches across medical education, alongside stakeholder engagement, are needed to meet healthcare policy intentions.