Medical students develop a course to train their peers in trauma-informed care

University at Buffalo medical students working with community anti-violence groups in Buffalo have developed an elective course on "Trauma surgery and trauma-informed care."

The purpose is to train medical students, particularly those interested in surgery, in trauma-informed care in Buffalo's Level 1 Adult Trauma Center at the Erie County Medical Center (ECMC).

Critical partners are Buffalo's two anti-violence organizations—Buffalo SNUG (Should Never Use Guns) and Buffalo Rising Against Violence (BRAVE) Trauma Recovery Center—housed within ECMC. BRAVE is Western New York's only Trauma Recovery Center, having attained that distinction from the National Alliance of Trauma Recovery Centers late last year.

Michael Lamb, Ph.D., director of surgical education in the Jacobs School of Medicine and Biomedical Sciences at UB and instructor for the elective, explains how the course works.

"Students spend half their time working on the trauma service at ECMC alongside attendings and residents, and the other half with BRAVE and SNUG," he says. "The students serve as navigators for trauma patients and their families, offering support and advocacy during their hospital stay, clinical follow-ups and home visits.

"Immersion with BRAVE and SNUG offers these medical students not only longitudinal engagement with this extraordinary team of social workers, psychologists, case managers and credible messengers … but a great deal of time with patients and their families," Lamb adds.

Bridging two worlds

"The whole goal is to bridge two worlds that usually don't collide," says Gaby Cordero, MD, who graduated last month from the Jacobs School and was the first person to take the elective.

The idea to create a trauma-informed curriculum developed from conversations between Jacobs School students Pia Corujo Avila, Katherine Foote and Sydney Johnson, all of whom had been awarded the Department of Surgery's summer diversity research fellowship for underrepresented students in 2022.

That year, Buffalo was in the midst of a significant rise in the number of shootings; it was also the year that 10 Black people were killed in the May 14 racist massacre at the Jefferson Avenue Tops market.

The purpose of the fellowships is to give underrepresented students interested in surgery early access to the operating room under the guidance of experienced attending physicians while also providing them with opportunities to do research on obstacles to care.

Community-based research

The only requirement for the research component was that it align with the principles of community-based participatory research, where the community collaborates as a full partner in deciding what to study and how.

The students decided their project would involve research into community violence and the resulting trauma experienced by many patients and their families.

"As physicians, we are able to play a part in the medical care of patients who may be victims of violence," says Cordero, "then we lose touch with what may happen when they go back home. Working with BRAVE/SNUG allows us to connect with our patients beyond the operating room, and the hope is to begin to understand the experiences of the community we are serving."

The students note their medical school classes do feature patients who share their perspectives.

However, Cordero notes, "With this elective, you see things come full circle that in many ways you didn't before."

They began their work by connecting with community organizers, pastors, local leaders and neighborhood residents. They spent time listening to those who had been victims of gun violence. They did this through their close partnerships with BRAVE and SNUG, which provide survivors with the tools and connections to prevent re-victimization or further perpetration of violence.

"We are committed to removing barriers to care and providing services that treat the whole person, not just their physical injuries," says BRAVE Trauma Recovery Center Director Paula Kovanic-Spiro, who also serves as SNUG site administrator. She notes that this work would not be possible without the support of New York State, ECMC and other local partners.

"We are honored to support the talented Jacobs School students who developed this course and look forward to further advancing the importance of trauma-informed care by tomorrow's doctors," she adds.

Voices of victims of violence

"These medical students, having spoken with so many victims and families, and having themselves, I think, too often experienced what it's like to be discounted, were deeply committed to including the voices of those who have experienced violence," says Lamb, an environmental psychologist.

Cordero explains how she connected with one patient who had a penetrating wound. "I got to go in to see him with the BRAVE/SNUG team and the surgical residents," she says.

"The patient already knew me because I had just cleaned his wound. I asked him if he felt safe going back home and told him about resources. It changes the trajectory. It's like finding a middle ground between the social workers and the medical team, to better understand what people need."

Finding that middle ground is exactly the goal, says Johnson, a founder of the course.

"You want to treat the whole person," says Johnson, who began working on the elective while recovering from a stroke, an experience that provided her with a unique perspective on the patient experience.

"As the surgeon, the only time you may see the patient is in the OR," she says. "You need a bit more humanity. When you understand the world the patient comes from, the injury that brought them to the hospital, and what they are going home to, you can be more proactive in their care. When you, the provider, are able to take all of this into consideration, the patient will have better outcomes."

For Corujo Avila, that understanding is critical. Born and raised in Puerto Rico, she says gun violence is a serious problem there, too, especially in urban areas.

"There's a big Puerto Rican community in Buffalo, too," she says, "and they are also victims of gun violence who end up in the trauma bay here. Sometimes they don't speak English. These communities are suffering. I feel like I'm helping my community here."

Katherine Foote's motivation in developing the course was deeply personal. When she was 7 years old, her father was a victim of gun violence.

"He made it to the hospital, but he didn't make it out," she says. "They did everything they could, but they could not save him. As traumatic as it was for my family, I am honored to be part of these survivors' recovery. It is very important to me. My co-founders and I recognized a need to provide additional support during a difficult time of their lives. I look forward to the positive impact we will have on their journey to recovery."

Provided by University at Buffalo