1. Define trauma and resilience.

2. Describe the epidemiology of different types of trauma and their associated adverse health effects.

3. Describe how building resilience through social support and other strategies may serve to prevent and mitigate adverse health effects and promote healing.

4. Describe how structural and social contexts, including oppression, stigma and discrimination, can be traumatic.

5. Describe how structural and social contexts increase vulnerability to poor health outcomes, decrease access to resilience-enhancing resources, and change presentation to medical care.

6. Describe the theoretical and empirical bio-psycho-social-spiritual mechanisms and drivers by which trauma impacts health and development across the lifespan and generations.

7. Explain the concept of regulation as it relates to the window of tolerance.

8. Describe the principles of a trauma-informed approach.

9. Explain the concept of universal trauma precautions.

10. Describe how trauma impacts interpersonal relationships and healthcare engagement.

11. Describe common physical, mental, and social manifestations of trauma exposure.

12. Analyze the risks and benefits of trauma inquiry, including routine screening.

13. Describe evidence-based strategies for primary and secondary prevention of trauma.

14. Describe evidence-based therapeutic strategies to promote healing and recovery for people who have experienced trauma.

15. Identify community resources that provide supportive services for people who have experienced trauma.

16. Define and describe the effects of compassion fatigue, moral injury, vicarious trauma, secondary trauma, and burnout.

17. Describe historical and ongoing examples of structural trauma inflicted by the medical system on patients, staff, and clinicians.

1. Demonstrate the ability to apply trauma-informed principles to all aspects of patient care, including:
a. History gathering
b. Physical examination
c. Tests and procedures
d. Decision-making
e. Counseling, treatment, and referral

2. Recognize the emergence of a traumatic stress response in a patient during a clinical encounter.

3. Educate patients on the benefits and practice of regulation techniques.

4. Develop preliminary care plans with patients that enable patient autonomy, mutual respect, safety, and ongoing engagement.

1. Describe trauma and resilience literature and explain how it may impact patient care.

1. Apply principles of trauma-informed care in communication with patients.

2. Discuss documentation of sensitive information with patients and the possibility of mandatory reporting when abuse or neglect is disclosed or suspected.

3. Demonstrate the principle of containment by explaining to the patient they are in control of how much, what, and when they disclose.

4. Respond to patient disclosure of trauma with empathic statements that convey acceptance, validation of patient’s experience, and compassion.

5. Demonstrate use of a validated tool to screen for trauma, when appropriate.

6. Demonstrate the use of trauma-informed language in documentation and professional communications.

7. Educate patients on the benefit of protective factors on health and explain how positive experiences and coping strategies can promote health and wellbeing.

8. Educate patients about the impact of trauma on health and explain health risk behaviors as potential adaptations to chronic stress.

9. Elicit patient strengths and use trauma-informed approaches to promote healing.

1. Describe examples of interpersonal and systemic bias and how they might traumatize or re- traumatize patients, colleagues, and staff.

2. Describe strategies to mitigate bias in order to resist traumatization and re-traumatization of patients, colleagues, and staff.

3. Explain how a personal trauma history may influence interactions with patients, peers, supervisors, and healthcare team members.

1. Identify aspects of the healthcare system and other interacting systems that may not be trauma-informed and identify potential areas of improvement.

1. Demonstrate words and actions that incorporate trauma-informed principles during team-based care.

2. Use strengths-based language when discussing patients with healthcare and non-clinical teams.

1. Describe strategies to prevent and mitigate compassion fatigue, moral injury, vicarious trauma, secondary trauma, and burnout.

2. Describe signs or symptoms of moving outside the window of tolerance.

3. Describe regulation skills that are effective in returning to or remaining within the window of tolerance.

4. Identify effective regulation skills and other self-care techniques for healthcare providers to maintain personal health and wellbeing, especially in the face of trauma.

5. Describe the prevalence of mental health distress among medical students and explain the benefits of mental health support.

6. Describe how to access trauma-informed supervision, mentoring, and/or coaching relationships to promote personal and professional vitality.