Trauma-informed medical care: CME communication training for primary care providers

Trauma exposure predicts mental disorders, medical morbidity, and health care costs. Yet trauma-related impacts have not received sufficient attention in primary care provider (PCP) training programs. This study adapted a theory-based approach to working with trauma survivors, Risking Connection, into a 6-hour CME course, Trauma-Informed Medical Care (TI-Med), and evaluated its efficacy.

We randomized PCPs to training or wait-list (delay) conditions; wait-list groups were trained after reassessment. The primary outcome assessing newly acquired skills was a patient-centeredness score derived from Roter Interactional Analysis System ratings of 90 taped visits between PCPs and standardized patients (SPs). PCPs were family medicine residents (n=17) and community physicians (n=13, 83% family medicine specialty), from four sites in the Washington, DC metropolitan area.

Immediately trained PCPs trended toward a larger increase in patient centeredness than did the delayed PCPs, with a moderate effect size (.66). The combined trained PCP groups showed a significant increase in patient centeredness from before to after training.

This is a promising approach to supporting relationship-based trauma-informed care among PCPs to help promote better patient health and higher compliance with medical treatment plans.