Internal Medicine Residents' Challenges in Trauma-Informed Care and Impact on Patient Care: A Multiple-Methods Study.

Abstract

Trauma-informed care (TIC) acknowledges the events, experiences, and effects of trauma. Research shows that TIC may improve patient trust in providers, yet remains poorly integrated into graduate medical education. We conducted a needs assessment of internal medicine (IM) residents to (1) quantify knowledge, attitudes, perceived competence, practices, and barriers; (2) explore experiences with TIC; (3) identify factors shaping TIC implementation; and (4) determine unmet needs. We conducted a multi-phase study involving a survey and a focus group. Survey data analysis included descriptive statistics, composite scores, Spearman's correlations, and ANOVAs. Qualitative data analysis used an inductive and deductive thematic approach. We surveyed 69 IM residents at a large urban academic medical center (56% response rate). Ten residents participated in a focus group. The Trauma-Informed Care Provider Survey assessed TIC knowledge, opinions, perceived competence, barriers, and practices. The focus group explored experiences with trauma disclosures, barriers, facilitators, and training needs. Residents demonstrated moderate knowledge (74%) and favorable opinions (80%) of TIC, but low self-rated competence (42%). Time constraints and lack of training were the most common barriers. Residents performed fewer than half of TIC practices on average; self-rated competence (ρ = 0.42, p = 0.0003) and attitudes (ρ = 0.33, p = 0.005) were positively associated, while lack of training predicted lower practice (F = 5.81, p = 0.005). Focus group themes include (1) residents understand TIC's impact; (2) barriers hinder trauma screening; (3) residents feel unprepared to address trauma disclosures; (4) continuity of care is crucial for TIC; and (5) residents desire improved training. IM residents recognize TIC's role in strengthening therapeutic relationships, yet multiple factors constrain consistent implementation. Addressing these barriers through improved training, clinical frameworks, and organizational support is essential to improving residents' capacity to deliver patient-centered, trust-building care.