Emergency Medicine · Medical Literature
Trauma-informed procedural training in emergency medicine: a multi-site randomized control pilot study.
Abstract
BACKGROUND: Trauma-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. METHODS: A 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. RESULTS: Baseline 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. CONCLUSIONS: This 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.
Clinical relevance
In senior medical students completing an emergency medicine elective, does a trauma-informed care (TIC) didactic and case-based curriculum delivered prior to simulation improve TIC procedural behaviors, knowledge, and comfort compared to delayed (post-simulation) curriculum delivery? __SNAPSHOT__ {"studyDesign":"Pilot multi-site randomized controlled trial","setting":"Multiple academic medical centers (specific institutions not reported in abstract); United States","sampleSize":"n=35 enrolled; n=33 completed post-training surveys (intervention and control arm sizes not individually reported in abstract)","population":"Senior medical students completing an elective emergency medicine rotation; baseline TIC familiarity low (9% reporting 'very' familiar with TIC principles pre-intervention)","intervention":"TIC-focused didactic and case-based curriculum delivered prior to a standardized patient simulation exercise","comparator":"Delayed TIC curriculum: same didactic and case-based content delivered after the simulation (active control / waitlist design)","primaryOutcome":"Performance on a clinical skills checklist measuring TIC procedural behaviors during standardized patient simulation; pre/post survey measures of TIC familiarity, knowledge, comfort, and attitudes","followUp":"Single training session (immediate pre/post assessment); longer-term retention not reported","fundingSource":"Not reported"}
Key findings
At baseline, only 9% (3/35) of participants reported being 'very' familiar with TIC principles. Following training, 70% (23/33) reported being 'very' or 'extremely' familiar (p < 0.0001). Learners in both groups demonstrated significant improvements in comfort performing procedures on patients with a trauma history and in guiding grounding techniques (effect sizes not reported). On the primary performance outcome, the pre-simulation intervention group outperformed the control group on the TIC procedural checklist (mean completion 67% vs. 44%; p = 0.0036). The absolute difference in checklist completion was 23 percentage points (calculated). There was no statistically significant difference between groups in time to scenario completion (10.58 vs. 10.68 minutes; p = 0.8348), suggesting TIC behaviors were achievable without extending procedural time. Attitude scores reflecting the perceived importance of TIC were strongly endorsed at baseline and did not change significantly post-training, indicating a possible ceiling effect for attitudinal outcomes. Number needed to treat and confidence intervals were not reported.
Practice implications
This pilot RCT establishes proof-of-concept feasibility for embedding a TIC procedural curriculum within existing emergency medicine educational rotations and demonstrates statistically significant improvement in simulated TIC-congruent procedural behaviors when didactic content precedes simulation (67% vs. 44% checklist completion, p = 0.0036). However, several important limitations constrain interpretation: (1) Only an abstract is available for full critical appraisal; complete methods, randomization and allocation concealment details, blinding procedures, checklist psychometric properties, and full statistical outputs are not evaluable. (2) The sample size is small (n=35), limiting power and generalizability. (3) The population is exclusively senior medical students; findings may not extend to residents, advanced practice providers, or practicing clinicians. (4) Outcomes are entirely surrogate and educational (simulation checklist performance, self-reported familiarity/comfort); no patient-centered outcomes — such as re-traumatization rates, patient-reported experience, or clinical adherence to TIC in actual practice — were measured. (5) The waitlist control design means both groups ultimately received the intervention, which is appropriate for a pilot but prevents assessment of long-term comparative retention. (6) Immediate post-training assessment only; whether knowledge and behavioral gains persist in the clinical environment is unknown. The lack of change in attitudinal scores likely reflects a pre-existing values-practice gap rather than a ceiling effect of the intervention per se — a clinically important finding for curriculum designers. Results do not yet support changes to established medical education standards but strongly support larger, adequately powered trials with patient-centered outcomes. __LIMITATIONS__ Very small pilot sample (n=35) with insufficient statistical power for subgroup analyses or definitive efficacy conclusions.,Abstract-only availability: randomization method, allocation concealment, assessor blinding, checklist validity/reliability, and full statistical outputs cannot be critically appraised.,All outcomes are surrogate and learner-centered (simulation performance, self-report); no patient-centered outcomes measured.,Immediate post-test design only; retention of TIC behaviors in real clinical practice and over time is not assessed.,Restricted to senior medical students on elective EM rotations; generalizability to other learner levels, specialties, and clinical settings is unknown.,Waitlist control design prevents long-term comparison between intervention and control arms.,Potential for performance bias given that blinding of participants to group assignment is inherently difficult in educational intervention trials.,Potential ceiling effect for attitudinal outcomes: strong baseline endorsement of TIC importance may have limited measurable attitudinal change.,Funding source not reported, precluding assessment of potential sponsorship bias.,Clinical significance of the 23 percentage-point difference in checklist completion is uncertain in the absence of a validated minimum clinically important difference for this tool. __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ This pilot RCT demonstrates that a TIC-focused didactic and case-based curriculum delivered before simulation significantly improves medical students' TIC procedural behaviors on a standardized checklist (67% vs. 44% completion, p = 0.0036) without increasing procedural time, and markedly increases self-reported TIC familiarity. Results establish feasibility of integration into existing EM curricula but are limited by small sample size, surrogate outcomes, and abstract-only reporting; patient-centered and long-term outcomes remain unmeasured. A fully powered multi-site trial with validated behavioral instruments and real clinical practice outcomes is needed before this curriculum model can be considered standard-of-care in EM education.