Résumés
Abstract
Background: Psychological trauma among resident physicians (residents) is common yet underrecognized, even though it can significantly impact learning, patient care, and well-being. Trauma-informed approaches are one way in which trauma can be mitigated. The purpose of this study was to examine institutional policies related to resident-focused trauma-informed medical education (RF-TIME) at Canadian institutions involved in providing and governing physician training.
Methods: We conducted an environmental scan of publicly available online content related to RF-TIME at Canadian medical schools (n = 18) and partner organizations (n = 42), initially focusing on policy, and then broadening our scan to include strategic planning, standards, guidelines, reports, educational documents and support resources. Findings were tabulated and synthesized.
Results: We were unable to find RF-TIME-specific policies at any Canadian medical school or partner organization. Thirteen schools briefly mentioned RF-TIME approaches within strategic planning (n = 3 schools), policies not focused on trauma (n = 9), guidelines (n = 1), reports (n = 3), educational resources (n = 3), and/or support resources (n = 8). Seventeen partner organizations included RF-TIME content within strategic planning (n = 2 organizations), standards (n = 2), guidelines (n = 1), reports (n = 9), educational resources (n = 2), and/or support resources (n = 4).
Conclusions: Resident-focused policies around trauma-informed approaches to medical education are absent within Canadian institutions and organizations involved in the training and regulation of physicians. Developing and implementing RF-TIME policies may help establish more supportive learning environments for medical trainees with psychological post-traumatic injury.
Résumé
Contexte : Les traumatismes psychologiques chez les médecins résidents sont courants mais sous-estimés, même s'ils peuvent avoir un impact significatif sur l'apprentissage, les soins aux patients et le bien-être. Les approches tenant compte des traumatismes sont un moyen d'atténuer ces derniers. L'objectif de cette étude était d'examiner les politiques institutionnelles liées à la formation médicale tenant compte des traumatismes et centrée sur les résidents (resident-focused trauma-informed medical education [RF-TIME]) dans les établissements canadiens impliqués dans la formation et la réglementation des médecins.
Méthodes : Nous avons procédé à une analyse environnementale du contenu accessible au public en ligne lié à la RF-TIME dans les facultés de médecine canadiennes (n = 18) et les organisations partenaires (n = 42), en nous concentrant initialement sur les politiques, puis en élargissant notre analyse pour inclure la planification stratégique, les normes, les lignes directrices, les rapports, les documents éducatifs et les ressources de soutien. Les résultats ont été compilés et synthétisés.
Résultats : Nous n'avons trouvé aucune politique spécifique à la RF-TIME dans aucune faculté de médecine ou organisation partenaire canadienne. Treize facultés ont brièvement mentionné les approches RF-TIME dans leur planification stratégique (n = 3 facultés), leurs politiques non axées sur les traumatismes (n = 9), leurs lignes directrices (n = 1), leurs rapports (n = 3), leurs ressources pédagogiques (n = 3) et/ou leurs ressources de soutien (n = 8). Dix-sept organisations partenaires ont inclus du contenu RF-TIME dans leur planification stratégique (n = 2 organisations), leurs normes (n = 2), leurs lignes directrices (n = 1), leurs rapports (n = 9), leurs ressources éducatives (n = 2) et/ou leurs ressources de soutien (n = 4).
Conclusions : Les politiques axées sur les résidents et fondées sur des approches tenant compte des traumatismes dans l'enseignement font défaut au sein des institutions et des organisations canadiennes impliquées dans la formation et la réglementation des médecins. L'élaboration et la mise en oeuvre de politiques RF-TIME pourraient contribuer à créer des environnements d'apprentissage plus favorables pour les personnes en formation médicale souffrant de traumatismes psychologiques.
Parties annexes
Bibliography
- Brown T, Berman S, McDaniel K, et al. Trauma-informed medical education (TIME): Advancing curricular content and educational context. Acad Med. 2021;96(5):661-667. https://doi.org/10.1097/ACM.0000000000003587
- Roze des Ordons AL, Ellaway RH. Storylines of trauma in health professions education: A critical metanarrative review. Teach Learn Med. 2025;37(3):323-335. https://doi.org/10.1080/10401334.2024.2342443
- Substance Abuse and Mental Health Services Administration. SAMHSA’s concept of trauma and guidance for a trauma-informed approach. HHS Publication No. (SMA)14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration. 2014. Available from: https://store.samhsa.gov/system/files/sma14-4884.pdf [Accessed Mar 23, 2025].
- Wilson JP. PTSD and complex PTSD: Symptoms, syndromes, and diagnoses. In: Wilson JP, Keane TM, editors. Assessing Psychological Trauma and PTSD. 2nd ed. New York: Guilford Press; 2004. p. 7-44.
- Caldas MP, Ostermeier K, Cooper, D. When helping hurts: COVID-19 critical incident involvement and resource depletion in health care workers. J App Psychol. 2021;106(1):29-47. https://doi.org/10.1037/apl0000850
- Canadian Association for Mental Health (CAMH). Trauma. c.2021. Available from: https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/trauma [Accessed Mar 23, 2025].
- Leaune E, Ravella N, Vieux M, Poulet E, Chauliac N, Terra JL. Encountering patient suicide during psychiatric training: An integrative systematic review. Harv Rev Psychiatry. 2019;27(3):141-149. https://doi.org/10.1097/HRP.0000000000000208.
- Roze des Ordons AR, Kassam A, Ellaway RE. Landscapes of trauma in residency education: An exploration of lived experiences. Med Educ. 2025;59(9):983-995.
- Berman S, Brown T, Mizelle C, et al. Roadmap for trauma-informed medical education: Introducing an essential competency set. Acad Med. 2023;98(8):882-888. https://doi.org/10.1097/ACM.0000000000005196
- Bloom SW. Structure and ideology in medical education: An analysis of resistance to change. J Health Social Behav. 1988;29(4):294-306. https://doi.org/10.2307/2136864
- McGaghie WC, Barsuk JH, Cohen ER, Kristopaitis T, Wayne DB. Dissemination of an innovative mastery learning curriculum grounded in implementation science principles: A case study. Acad Med. 2015;90(11):1487-1494. https://doi.org/10.1097/ACM.0000000000000907
- Gadsby EW, Wilding H. Systems thinking in, and for, public health: A call for a broader path. Health Promot Int. 2024;39(4):daae086. https://doi.org/10.1093/heapro/daae086
- Stewart DW. What is policy? And why it matters. JPP&M. 2014;33(1):1-3. https://doi.org/10.1509/jppm.33.1.1
- University of Calgary Legal Services. Policies and procedures: frequently asked questions. University of Calgary. c.2025. Available from: https://www.ucalgary.ca/legal-services/ucalgarys-policies-and-procedures/faqs-university-policies-and-procedures [Accessed Mar 23, 2025].
- Colebatch HK. Policy. 3rd ed. UK: McGraw-Hill Education; 2009.
- Charlton P, Kean T, Liu RH, et al. Use of environmental scans in health services delivery research: A scoping review. BMJ Open. 2021;11(11):e050284. https://doi.org/10.1136/bmjopen-2021-050284
- Albright KS. Environmental scanning: Radar for success. Inf Manag J. 2004;38(3):38-45.
- Choo CW. Environmental scanning as information seeking and organizational learning. Inf Res. 2001;7(1):1–14.
- College of Family Physicians of Canada. The assessment of competence for enhanced skills – family practice anesthesia 2017. Available from: https://www.cfpc.ca/CFPC/media/Resources/Education/FPA_KF_Final_ENG.pdf. [Accessed Mar 23, 2025].
- Royal College of Physicians and Surgeons of Canada. Discipline-specific competencies. c.2025. Available from: https://www.royalcollege.ca/en/standards-and-accreditation/information-by-discipline. [Accessed Mar 23, 2025].
- The Association of Faculties of Medicine of Canada. Report on mental health activities: Focus on physician health. 2018. Available from: https://www.afmc.ca/wp-content/uploads/2022/10/2018-AFMC_Report_on_Mental_Health_Activities_EN.pdf. [Accessed Mar 23, 2025].
- Canadian Medical Association. Summary report: CMA roundtables on equity, diversity and discrimination. 2021. Available from: https://digitallibrary.cma.ca/viewer?file=%2Fmedia%2FDigital_Library_PDF%2F2021%2520Roundtables%2520on%2520EDI%2520EN.pdf#page=1. [Accessed Mar 23, 2025].
- Canadian Medical Association. COVID-19 wellness resources c.2019. Available from: https://www.cma.ca/physician-wellness-hub/topics/covid-19-wellness-resources. [Accessed Mar 23, 2025].
- Canadian Medical Association. Trauma-informed education c.2025. Available from: https://www.cma.ca/physician-wellness-hub/content/trauma-informed-medical-education. [Accessed Mar 23, 2025].
- Canadian Medical Association. Responding to and recovering from distress. c.2025. Available from: https://www.cma.ca/physician-wellness-hub/content/responding-and-recovering-distress. [Accessed Mar 23, 2025].
- Frank JR, Snell L, Sherbino J, editors. CanMEDS 2015 Physician Competency Framework. Ottawa: Royal College of Physicians and Surgeons of Canada; 2015. Available from: https://www.royalcollege.ca/en/standards-and-accreditation/canmeds [Accessed Mar 23, 2025].
- Shaw E, Oandasan I, Fowler N, editors. CanMEDS-FM 2017: A competency framework for family physicians across the continuum. Mississauga, ON: The College of Family Physicians of Canada; 2017. https://www.cfpc.ca/CFPC/media/Resources/Medical-Education/CanMEDS-Family-Medicine-2017-ENG.pdf
- Helms JE, Nicolas G, Green CE. Racism and ethnoviolence as trauma: Enhancing professionals training. Traumatology. 2010;16(4):53-62. https://doi.org/10.1177/1534765610389595
- Wyatt TR, Taylor TR, White D, Rockich-Winston N. "When no one sees you as Black": The effect of racial violence on Black trainees and physicians. Acad Med. 2021;96(11S):S17-S22. https://doi.org/10.1097/ACM.000000000000426
- Metzl JM, Hansen H. Structural competency: theorizing a new medical engagement with stigma and inequality. Soc Sci Med. 2014;103:126-133. https://doi.org/10.1016/j.socscimed.2013.06.032
- Canadian Union of Public Employees (CUPE). Guide for post-secondary institutional policies on sexual violence and harassment. 2021. Available from: https://cupe.ca/guide-post-secondary-institutional-policies-sexual-violence-and-harassment. [Accessed Mar 23, 2025].
- Shanafelt TD, Schein E, Minor LB, Trockel M, Schein P, Kirch D. Healing the professional culture of medicine. Mayo Clin Proc. 2019;94(8):1556-1566. https://doi.org/10.1016/.mayocp.2019.03.026
- Ferrel VK. A culture of supremacy in medicine. Acad Med. 2017;92(8):1071-1072. https://doi.org/10.1097/ACM.0000000000001800
- Queen’s University. Academic consideration for students in extenuating circumstances policy. c.2025. Available from: https://www.queensu.ca/secretariat/policies/senate/academic-consideration-students-extenuating-circumstances-policy/academic-0#:~:text=Students%20requesting%20consideration%20are%20to,or%20more%20than%203%20days. [Accessed Mar 23, 2025].
- Jain NR. Political disclosure: Resisting ableism in medical education. Disabil Soc. 2020;35(3):389-412. https://doi.org/10.1080/09687599.2019.1647149
- Queens University. Digital engagement. c.2025. Available from: https://www.queensu.ca/digital-engagement/. [Accessed Mar 23, 2025].
- VanderKaay S, Begin D, Lisogurski R, Robb C, Pheonix M, Vrkljan B. Trauma-informed pedagogical practices in post-secondary education: an integrative review of the literature. 2023. Available from: https://doitanyway.ca. [Accessed Mar 23, 2025].
- Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implement Sci. 2009;4(1):50. https://doi.org/10.1186/1748-5908-4-50
- McGaghie WC. Implementation science: Addressing complexity in medical education. Med Teach. 2011;33(2):97-98. https://doi.org/10.3109/0142159X.2011.550971
- Wong BM, Headrick LA. Application of continuous quality improvement to medical education. Med Educ. 2021;55(1):72-81. https://doi.org/10.1111/medu.14351
- Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP. The improvement guide: a practical approach to enhancing organizational performance. 2nd ed. San Francisco: Jossey-Bass; 2009.
- International Conference on Health Promoting Universities and Colleges / VII International Congress. Okanagan Charter: an international charter for health promoting universities and colleges. 2015; Kelowna, B.C. Available from: https://open.library.ubc.ca/cIRcle/collections/53926/items/1.0132754 . [Accessed Mar 23, 2025].
- National Dialogues and Action for Inclusive Higher Education and Communities. Scarborough Charter on Anti-Black Racism and Black Inclusion in Canadian higher education: Principles, actions, and accountabilities. c.2021. Available from: https://www.utsc.utoronto.ca/principal/scarborough-charter [Accessed Mar 23, 2025].

