Trauma-Informed Care Across Medical Training: Knowledge, Attitudes, Practices, and Lived Experiences Among Medical Students and Clinical Instructors.

BACKGROUND: Trauma is common among patients, learners, and healthcare professionals and has important consequences for health, clinical care, and medical learning environments. Trauma-informed care (TIC) provides a framework for recognizing and responding to trauma while promoting safety, trust, choice, and collaboration. OBJECTIVE: To characterize medical students' and clinical instructors' adverse and benevolent life experiences and knowledge, attitudes, and practices of TIC; assess differences by educational role and training stage; and identify opportunities for curricular and learning-environment improvement. DESIGN: Cross-sectional survey study. PARTICIPANTS: A 52-item survey was offered to medical students (n = 757) and clinical instructors (n = 150). MAIN MEASURES: Validated measures included knowledge, attitudes, and practices of trauma-informed care (KAP-TIC); conventional and expanded adverse childhood experiences (ACEs); and benevolent childhood experiences (BCEs). KEY RESULTS: Two hundred sixteen participants responded, including 102 clinical instructors (68% response) and 114 medical students (15% response). More than 70% reported at least one conventional ACE, and respondents had high levels of BCEs (mean 9.0 out of 10). Composite Knowledge and Attitudes scores did not differ significantly between students and instructors, while instructors reported higher trauma-informed Practice scores (median [IQR], 4.42 [4.00-4.83] vs 4.17 [3.83-4.50]; P < 0.001; rrb = 0.27). After correction for multiple comparisons, students expressed greater desire for TIC training, while instructors reported greater transparency, respect for patient choice, and tailoring actions to individual needs. Item-level differences were concentrated between preclinical students and instructors; no differences between clinical students and instructors remained significant after false discovery correction. Direct comparisons showed greater TIC understanding and more tailored interactions among clinical versus preclinical students. Greater early-life adversity (≥ 4 ACEs) was not associated with overall KAP-TIC agreement (OR 1.29, 95% CI 0.62-2.65). CONCLUSIONS: Substantial lived experiences of adversity and differences in trauma-informed practice, particularly among preclinical students, highlight opportunities to strengthen TIC education throughout medical training.