Table 2:

Curricular examples by competency domain

Competency	Author/focus	Training level/ curricular phase	Mode/length	Evaluation method	Educational objectives	Primary outcomes
Knowledge for practice	Chokshi17: connection between trauma and health and TIC principles	M2 (preclerkship)	One 4-h symposium: 3 mini-lectures plus interactive small group sessions, integrated into Patients, Populations, and Systems course	Survey, qualitative reflection question	1. Define trauma and the connection between trauma, childhood adversity, and health. 2. Describe the importance and components of a trauma-informed approach to care. 3. Recognize how to address the health effects of trauma exposure for individual patients and within health systems. 4. Practice employing a trauma-informed approach to patient care.	Overall rating of the TIC symposium was 4 out of 5. Strengths included integration of a small group case with discussion on application of TIC in practice, experience of the lecturers and small group facilitators, and review of research relating adversity to specific health outcomes. Content analysis of student reflections mapped to the domains of physician competency.
	Pletcher16: ACEs science, TIC best practices	M1 (longitudinal across preclerkship)	One 3-h didactic followed by small group, case-based discussions, integrated into Health Equity and Social Justice course	Online quiz, course evaluation, focus groups	1. Describe the physical and mental health consequences of ACEs. 2. Discuss the use of the ACE survey in the medical home and how this may assist physicians to better engage and care for their patients. 3. Discuss the impact of resilience on mitigating the negative health consequences of ACEs. 4. Decribe how TIC can benefit patients.	89% agreed to a great or considerable degree that they had gained a deeper understanding of the health effects of ACEs, 82% felt more comfortable asking about ACEs in clinical care, and 82% felt that additional training on this topic would be beneficial to their learning to become doctors.
Patient care	Lee10: TIC principles and application in acute care settings	M1–M4 (students in preclerkship, core clerkship and advanced clerkship); volunteer sample	Didactic lecture, 3 simulation cases	Pre- and postparticipation surveys including Likert scales and free-response questions	1. Identify the importance of incorporating TIC into clinical practice as a universal precaution in the acute care setting. 2. Identify clinical situations in which performing safety screenings for trauma history is indicated in the acute care setting. 3. Improve comfort in using TIC principles during a physical examination in an acute care setting. 4. Increase confidence when responding to colleagues through bystander intervention using TIC principles.	Self-assessed confidence improved across multiple domains, including identifying situations for trauma screenings, inquiring about trauma, and responding as a bystander. Learners felt more familiar with TIC-specific history-taking and physical examination skills. Simulation was perceived as a beneficial educational tool.
	Elisseou18: trauma-informed physical examination	M1 (preclerkship and faculty)	Large group lecture with standardized patient, small group skills sessions, part of clinical skills course	5-point scales were used to evaluate knowledge gained and satisfaction with session	1. Define trauma and TIC. 2. Describe key principles of performing a physical examination in a manner that is sensitive to all patients, particularly those with a history of trauma. 3. List specific examples of trauma-informed language and behaviors that can be utilized during the physical examination. 4. Practice taking vital signs using a trauma-informed approach.	Overall satisfaction with the session was rated as 4.08 (SD = 0.81), and students felt that the session was highly effective in defining a trauma-informed physical examination (4.29, SD = 0.70).
	Elisseou11: trauma-informed peer physical examination	M1 (preclerkship)	Peer PE sessions in fall and spring of doctoring clinical skills course	Pre- and post–student surveys about perceptions of safety, trust, and autonomy	1. Define trauma and TIC. 2. Explain the relevance of a trauma-informed approach to peer physical examination. 3. Identify key principles of performing a trauma-informed physical examination. 4. Describe how trauma-informed language and behaviors can be used throughout the physical examination for both patients and peers. 5. List potential modifications and alternatives to peer physical examination.	Familiarity with TIC principles rose significantly, although overall rating of the experience did not change. Thematic analysis of qualitative data highlighted students’ desire for earlier and increased inclusion of TIC principles in the curriculum.
Practice-based learning and improvement	Hollis12: TIC elective	M1 (preclerkship)	Semester elective: interprofessional didactic lectures, community members, oral presentation on best practices/lessons learned; 14 1-h classes	Combination of anonymous pre- and retrospective pre-/postquestionnaires based on objectives	1. Educate students about the effects of trauma on physical and behavioral health. 2. Familiarize students with TIC skills to incorporate into patient care.	Significant increase in students’ rating of knowledge regarding impact of trauma on health, more comfortable screening for intimate partner violence, performing a physical examination for patients experiencing intimate partner violence, accessing resources for patients experiencing addiction, and caring for patients who have had adverse childhood experiences.
Interpersonal and communication skills	Brown19: screening for and inquiring about trauma and responding to disclosures of trauma	MS1 and dental students (preclerkship)	3.5-h session: live patient interview demonstration, small group discussion sessions and case-based role-plays	Before/after surveys, 5 mo follow-up surveys	1. Define trauma and explain its prevalence and health impacts. 2. Describe the 6 principles of TIC as defined by the Substance Abuse and Mental Health Services Administration. 3. Demonstrate a trauma-informed approach to patient history. 4. Screen for and inquire about trauma, including intimate partner violence, using open-ended questions or a validated screening tool, and respond appropriately to disclosures of trauma using TIC principles.	More than one-third (34%) of respondents reported having received at least one disclosure of trauma from a patient within the first 5 mo of medical school. Students’ comfort with screening for trauma increased from 30% to 56%, and their comfort with responding to disclosure of trauma increased from 35% to 55%. These improvements persisted on reevaluation at 5 mo.
Professionalism	Black13: interactive case-based workshop on responding to bias in the clinical setting, how to avoid/dismantle institutional and racial trauma in clinical settings	PA, APRN, MD (M2/M3) students (preclerkship, core clerkship)	2-h virtual session, part of interprofessional longitudinal clinical experience	Feedback solicited in the form of free-text prompts	1. Teach students basic concepts of TIC. 2. Provide students with sample language and behavior that would allow them to practice TIC with patients in all their clinical experiences.	Learners noted that the lecture provided important insight into and a platform for a topic that has otherwise not been explicitly discussed in their education. Learners also found the presentation engaging and felt the interactive aspects, although limited by Zoom, still allowed for open dialogue with presenters. Feedback indicated that learners wanted more case examples demonstrating the functional application of these tools, especially in relation to their preclinical exposures.
	Goldstein7: trauma knowledge, culturally sensitive assessments, trauma inquiry, trauma-informed response to disclosures	M1, M2 (preclerkship)	6 h of training at Race and Health Summer Institute; included lectures, discussion, and role-play practice	5 open-ended qualitative questions	1. Understand trauma prevalence. 2. Understand ACEs’ and trauma’s impact on mental and physical health and how they affect behavior. 3. Gain a foundation on how to provide TIC in practice.	Qualitative responses: knowledge, recognition, and understanding of trauma’s impact; ability to establish patient safety; and increased confidence and comfort to discuss trauma with patients. A primary skill that respondents reported having acquired from the training was how to ask about trauma.
Systems-based practice	Brennan14: HT training session to educate medical students on recognizing HT red flags and providing TIC to HT survivors; focus on where the system misses survivors	M4 (advanced clerkship)	2-h virtual session, faculty, and community experts, lectures plus small group discussion, part of transition to residency program	Pre- and postsession surveys	1. Discuss the prevalence of HT and the associated vulnerability factors. 2. Identify the major red flags of HT in a clinical setting. 3. Establish comfort in asking appropriate screening questions to identify HT. 4. Respond with increased confidence to HT disclosures using trauma-informed practices (including use of appropriate language). 5. Describe medical care options, safety planning, and state-mandated reporting guidelines in the context of HT.	Significant improvement in all the metrics assessed: awareness, comfort with screening, confidence, ability to safety plan, and knowledge about resources.
Interprofessional collaboration	Black13: as above, curriculum focused on interdisciplinary team	PA, APRN, MD (M2/M3) students (preclerkship)	Virtual session	Feedback solicited in the form of free-text prompts	1. Teach students basic concepts of TIC. 2. Provide students with sample language and behavior that would allow them to practice TIC with patients in all their clinical experiences. 3. Prepare early health professional students to function effectively in the team-based clinical environment.	Outcomes described above under “Professionalism.” All outcomes represent findings from an interprofessional cohort of learners.
Personal and professional development	Ferguson15: curriculum to foster well-being of medical students	MS1, MS2 (preclerkship)	2-y curriculum, 7 didactic sessions, 6 facilitated small group sessions integrated into early clinical learning course (REACH)	Midcurriculum survey and a postcurriculum survey included closed questions (5- to 6-point Likert-type response options) and open-ended questions	1. Appreciate the connection between individual well-being and the quality and safety of the care provided by physicians and trainees to patients. 2. Learn the core concepts and practical skills that allow sustained work with suffering people. 3. Contribute to the cultivation of an equitable, inclusive, and hopeful institutional culture that supports all students to thrive.	Respondents identified skills that the REACH curriculum helped them develop: self-care (84% [85/101]), mindfulness (76% [76/101]), and help-seeking (71% [72/101]). Respondents reported that REACH helped them develop connections with faculty and others different from themselves (71% [72/101]), confidence about tackling unfamiliar problems (67% [67/101]), and connections with other students (65% [65/101]). Only a few (3% [4/101]) indicated that “nothing” from the REACH curriculum helped them.

ACE, adverse childhood experience; APRN, advanced practice registered nurse; HT, human trafficking; MD, medical doctor; PA, physician assistant; PE, professional education; REACH, responsibility, empowerment, aspiration, citizenship, honesty; SD, standard deviation; TIC, trauma-informed care.