Traumatic events in the psychiatric population are prevalent, complex, and often are repeated and ongoing (1–4). As psychiatry residents progress through their training, they have contact with traumatized patients and families from the initial phases of assessment through the recovery process. For example, according to Kessler (5) PTSD is the third most common anxiety disorder in the United States. An increasingly large body of literature about trauma-associated disorders, treatment modalities, and training exists. However, systematic trauma training remains limited and has yet to be incorporated into the core curriculum of graduate training programs, including residency training in psychiatry (2, 3, 6, 7). Trauma training, adapted for psychiatric residents, is of particular importance considering the specific challenges trainees face during the postgraduate years, where a shift from more concrete to more process-oriented thinking can be observed. Also, teaching psychiatry residents is particularly challenging because residents rotate through different services (8). Each service has its own population, culture, and goals and objectives. A comprehensive teaching program for trauma is difficult to integrate into an already-existing complex teaching curriculum, as it must allow for flexibility. Teaching and supervision serve the purpose of enabling residents to reflect on their clinical experiences, along with peer interactions, study groups, and seminars. The Trauma Training Modular Curriculum (TTMC) was created to address the various needs as well as to integrate into ongoing psychiatric training the growing body of literature ranging from assessment of trauma and trauma associated disorders to various treatment interventions.

The TTMC is structured in a modular fashion and consists of 16 modules. Each module begins with a pre-assessment and ends with a post-assessment. Designed to provide a foundation for teaching, each module can focus either on addressing attitudes, conveying knowledge, and/or teaching specific skills. Each module can stand on its own as a single teaching unit. The modular construction of the TTMC allows for flexibility in including one or more modules into an already-existing curriculum. Since learning can be enhanced by the use of different sensory modalities, each module includes visual, auditory, gustatory, and olfactory and/or tactile stimuli. Some modules include the use of the arts and media, such as film excerpts, video clips, music, and interviews. Active participation of the residents is encouraged, using role-play, case discussion, or vignettes.

The individual modules begin with a general description of the topic, such as epidemiology, biology, psychology, psychopharmacology, or specific treatment approaches. Many of the modules include the teaching of practical skills of assessing trauma and trauma-related symptoms. Residents practice techniques for interviewing traumatized patients and families.

Learning how to develop a treatment alliance with patients who may have attachment difficulties is a cornerstone of the curriculum. Becoming aware of countertransference reactions when exposed to severe affective dysregulation, self-injurious behavior, and traumatic narratives (9) is an essential feature of many of the modules. Depending on the content of the module, the goals and objectives include discussion of latest research findings and current debates. The efficacy of particular interventions and “best practices” approaches to trauma treatment are highlighted.

Included are reading assignments and references. A multisensory, multimedia approach utilizes videos, readings, experiential exercises, and guest speakers. The TTMC takes into consideration the development of a trauma training curriculum that moves from the assessment of traumatic events and related symptomatology to trauma-informed case-formulation and treatment-planning. The impact of trauma on individuals, families, and communities is incorporated into some of the modules.

The TTMC is designed to be used as either a single long course or as individual modules, depending on the needs of the training program. As residents progress through training, their level of sophistication increases. The fund of knowledge and skills improves, and the residents' understanding of clinical material moves from concrete to conceptual. The TTMC includes modules that are targeted to junior residents, such as assessment of trauma and diagnostic aspects, whereas modules targeted to senior residents focus on more complex case-formulations and various treatment approaches. This developmental approach to training addresses the need for phase-specific learning objectives and may help in demonstrating clinical competence as required by regulatory agencies. The individualization of the modules allows residency training directors the option to select those that are particularly useful to the needs of their programs.

The TTMC was developed at an academic psychiatry residency training program in the New York City metropolitan area. The modules have been utilized with a culturally, ethnically, socially, and economically diverse population. Feedback from the residents in the program has been positive, and suggestions have been incorporated into the modules. The use of the TTMC as an adjunct to a pre-existing residency curriculum enhances the resident's attitudes, knowledge, and skills in working with a traumatized population. Limitations include the lack of formal testing of the TTMC in other training sites. The TTMC will have to be tested in various residency training programs in order to assure its validity. The input of training directors will be crucial to improve future versions of the TTMC. Standardized surveys will be needed to avoid selection bias. Recommendations for the future include the implementation of the training into the curricula of other residency programs in order to test its wider usefulness.