Core Competencies in Trauma-Informed Care for Emergency Medicine: A Modified Delphi Consensus

Background Trauma-informed care (TIC) is a framework to recognize and respond to all types of trauma, prevent re-traumatization, and promote resilience. Trauma includes any event that is physically or emotionally harmful and has lasting adverse effects. While TIC strategies are increasingly emphasized in medical education, thus far no core competencies exist to guide competency-based education in postgraduate education. Objective To build consensus on core competencies in TIC for emergency medicine (EM). Methods We recruited experts in TIC via snowball sampling to participate in a modified Delphi process. Panelists ranked competencies on a 5-point Likert scale through electronic survey. Threshold for consensus was defined as a mean of 3.75. Thematic analysis was performed on survey free-text responses and transcripts of virtual discussions using inductive and in vivo codes. Results Sixteen panelists across 12 institutions participated in the modified Delphi, and 49 initial competencies were proposed. During round 1, 100% of the competencies exceeded the consensus level, but many panelists offered suggestions and changes. Thus, we conducted 2 virtual discussions and reorganized the proposed competencies into 19 competencies in round 2. We further narrowed to 16 competencies in round 3. Thematic analyses were used between rounds to organize panelists' comments for revisions. There were no major changes proposed by panelists after round 3, and all competencies exceeded the consensus level. Examples of the final competencies include "define trauma," and "describe the widespread impact of trauma on health." Conclusions We achieved consensus on 16 core competencies for EM physicians in training.