The Support Service was invited to participate in a day of Simulation games, hosted by CHU Sainte-Justine Hospital and organized as a shared event between the obstetrics and gynecology medical schools at McGill University and l’Université de Montréal. The title of this year’s games was ‘Prendre soins des survivantes?’ and the Support Service was asked to provide expert training on how to integrate Trauma informed care into medical interventions.  

 

The goal of simulation training is to provide professionals with hands-on training in difficult and potentially dangerous procedures without risk to patients. Actors are hired, scenarios are written and real medical equipement is used in order to provide a safe learning environment in which to practice. This year, the event organisers, Dr Andrée Sansregret and Dr Luis Monton, in recognizing the impact of past sexual violence on patients, wished to create an event that would support medical residents in navigating this type of patient history. The goal is to minimize re-traumatization in procedures by understanding the nature of sexual violence trauma and integrating Trauma informed care into all of their interventions with patients.   

  

Perspectives from the organizers: 

• What is learning through simulation and why is it important for doctors to learn this way? 

•  Dr Sansregret: Simulation is an established educational modality for physician continuing professional development (CPD). More broadly, simulation is recommended by most international health and accreditation organizations throughout the education continuum, driving increasing demands for its utilization. Simulation-based training in its various forms has demonstrated benefits for individual learning, improving the functioning of teams, and auditing existing health care systems. 

• Dr Monton: I got involved in simulation because I recognized it was a new way of teaching and learning. I also learned after several years that apart from the difficult clinical situations it was the best way to talk, teach and learn about communication and difficult topics like assault, rape and victim and trauma informed care (TIC). We try to do so in a non-confrontational, and safe environment but we cannot protect everyone as we saw and felt ourselves. This is how we learn.  

  

• What made you decide to dedicate an entire training day on victims of sexual violence and why was Trauma and victim informed care an important topic to address during this training day? 

• Dr Sansregret:  It has been brought to our attention, that trauma informed care was not part of our residency curriculum despite important national conferences and nation-wide effort to increase awareness on that subject. It became urgent to teach the next generation of OBGYN. This annual simulation training day was the perfect opportunity for both universities. 

• Dr Monton: Several years ago, I met a young physician, Dr Heather Millar, at a conference. She was part of a morning session on trauma informed care. Dr Millar is planning a simulation-based research project on TIC. I opened it to the National Simulation group which Dr Sansregret chairs. Our hope is that every university will be part of this research project which will embed TIC principles and care into the curriculum. It is not currently but needs to be. Dr Sansregret recognized the need, and quickly built a day of simulation around it.  

  

  

The Support Service gave a 45 minute introduction to the practical application of Trauma informed care to medical interventions for victims of sexual violence and provided feedback to the medical residents who were brave enough to volunteer to do the simulations in front of their peers. It was a great day of learning and growth for everyone involved. Learning to talk about past sexual violence in the context of how to avoid re-traumatization can be intimidating! But by applying the 4 C’s of Trauma informed care, they were able to practice creating a compassionate environment for their patients.   

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The Support Service also profited by discussing the referral process to designated centre services and the vital collaboration that must occur between designated centres and the rest of the Réseau de santé and services sociaux.  

  

A great thank you to the Dr Sansregret, Dr Monton and all the organisers for the invitation and recognition that all medical training should include a component on sexual violence and trauma informed care.  

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For a quick refresher, here are the 4 C’s of Trauma informed care :  

The 4Cs principles: Calm, Contain, Care, Cope (Gerber, 2019)  

   

A) Calm = Calm yourself and the other person by creating a reassuring climate   

• Mindfulness: Pay attention to the other person's breathing, tone, non-verbal language and emotional reactions as well as your own.   

• Offer to practice grounding techniques to promote a state of calm.   

• Adapting the space: meeting basic needs.   

   

B) Contain = contain emotions and promote a sense of control   

• Open-ended exploration, allowing the choice to give details or not.   

• Explore how to improve the person's comfort and sense of security.   

• Safety net: explain steps and possible responses as you go along; refer to another professional if necessary.  

• Avoiding promises that cannot be kept and assumptions that everything will be okay.   

   

C) Care = compassion for self and others   

• Self-care and compassion for oneself: practice of cultural humility.   

• Self-care and compassion for the victim.   

• Destigmatize "negative" or destructive coping mechanisms and behaviors; understand their function.   

   

D) Cope = Coping Strategies   

• Positive, strength-based exploration of coping strategies.   

• Examples of strategies: talents, behaviors, experiences, relationships with others, interventions.   

• Helping the person cultivate a positive self-image by using the technique of reformulation or mirroring.   

   

   

ANDRÉE SANSREGRET, M.D., F.R.C.S.C.  

Contract Associate Professor, Université de Montréal  

Co-medical director of the CAAHC at CHU Mère-enfant Ste-Justine  

In charge of obstetrics and gynecology residents at CHU Ste-Justine  

Simulation training leader  

Medical co-leader of simulation training at Université de Montréal's CAAHC  

   

LUIS MONTON, M.D., F.R.C.S.C.   

Assistant Professor, Department of Obstetrics and Gynecology, McGill University  

Director, McGill OBGYN Simulation, Steinberg Centre for Simulation and Interactive Learning  

Obstetrician-Gynecologist at the Jewish General Hospital  

 

Feel free to contact us with any questions you may have by email at: infoserviceconseil@cvasm.ca