Trauma-informed procedural training in emergency medicine: a multi-site randomized control pilot study.

backgroundTrauma-informed care (TIC) is increasingly recognized as an essential component of emergency medicine. Emergency departments frequently care for individuals with a history of trauma, and standard emergency care may inadvertently trigger distress or re-traumatization. Procedures, which often involve discomfort, may be particularly activating. Despite this relevance, TIC training is rarely embedded into procedural education. This study evaluates the feasibility and effectiveness of a pilot trauma-informed procedural skills curriculum for senior medical students.

methodsA pilot, multi-center randomized controlled trial was implemented among senior medical students completing an elective emergency medicine rotation. Participants were randomized to either receive a TIC-focused didactic and case-based curriculum prior to simulation (intervention group) or after simulation (control group). All learners completed pre- and post-training surveys assessing familiarity with TIC principles, knowledge, and attitudes. Performance during a standardized patient simulation was evaluated using a clinical skills checklist measuring TIC procedural behaviors. Statistical analysis included paired and independent non-parametric tests.

resultsBaseline familiarity with TIC was low, with only 9% (3/35) reporting being “very” familiar with TIC principles prior to the session. Following training, 70% (23/33) reported being “very” or “extremely” familiar (p < 0.0001). Learners demonstrated significant improvements in comfort performing procedures on patients with a trauma history and guiding grounding techniques. The intervention group outperformed the control group on the procedural checklist (67% vs. 44% mean completion; p = 0.0036), with no difference in time to scenario completion (10.58 vs. 10.68 min, p = 0.8348). Attitudes reflecting the importance of TIC were strongly endorsed at baseline and did not change significantly.

conclusionsThis pilot randomized control trial demonstrates that trauma-informed procedural training is both feasible to implement within existing emergency medicine curricula and effective in enhancing learner performance. Integration of TIC principles into procedural instruction may enhance clinical competency while maintaining efficiency in emergency care settings. Larger studies are needed to assess long-term retention and translation into clinical practice. CLINICAL TRIAL NUMBER: Not applicable.