title: Trauma-informed medical care: CME communication training for primary care providers.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Georgetown University Medical School.
authors: Bonnie L
authors: BL
authors: Green
authors: Pamela A
authors: PA
authors: Saunders
authors: Elizabeth
authors: E
authors: Power
authors: Priscilla
authors: P
authors: Dass-Brailsford
authors: Kavitha Bhat
authors: KB
authors: Schelbert
authors: Esther
authors: E
authors: Giller
authors: Larry
authors: L
authors: Wissow
authors: Alejandra
authors: A
authors: Hurtado-de-Mendoza
authors: Mihriye
authors: M
authors: Mete
mesh_terms: D001291:Attitude of Health Personnel; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D018802:Patient-Centered Care / Q000379:methods*; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000193:education*; D011320:Primary Health Care; D014850:Waiting Lists; D014947:Wounds and Injuries / Q000628:therapy*
references: Can J Psychiatry. 1999 Oct;44(8):769-74
references: 10566106
references: Bull Menninger Clin. 2001 Winter;65(1):92-103
references: 11280961
references: J Am Med Womens Assoc. 2001 Spring;56(2):79-85
references: 11326804
references: Am J Psychiatry. 2002 Feb;159(2):201-7
references: 11823259
references: J Gend Specif Med. 2002 Jan-Feb;5(1):34-40
references: 11859685
references: Patient Educ Couns. 2002 Apr;46(4):243-51
references: 11932123
references: Arch Gen Psychiatry. 2003 Apr;60(4):369-74
references: 12695314
references: Med Educ. 2004 Feb;38(2):145-57
references: 14871385
references: Menopause. 2004 Mar-Apr;11(2):208-13
references: 15021451
references: Gen Hosp Psychiatry. 2004 May-Jun;26(3):178-83
references: 15121345
references: Arch Gen Psychiatry. 1987 Feb;44(2):152-6
references: 3813810
references: Gen Hosp Psychiatry. 1988 Mar;10(2):79-87
references: 3282988
references: Med Care. 1988 Jul;26(7):657-75
references: 3292851
references: Med Care. 1989 Mar;27(3 Suppl):S110-27
references: 2646486
references: JAMA. 1992 Jun 17;267(23):3157-60
references: 1593735
references: Arthritis Care Res (Hoboken). 2013 Feb;65(2):227-34
references: 22740431
references: JAMA. 1992 Sep 2;268(9):1111-7
references: 1501333
references: Am J Public Health. 1994 Apr;84(4):628-33
references: 8154568
references: J Trauma Stress. 1994 Jul;7(3):341-62
references: 8087399
references: CMAJ. 1995 May 1;152(9):1423-33
references: 7728691
references: Arch Intern Med. 1995 Sep 25;155(17):1877-84
references: 7677554
references: Arch Gen Psychiatry. 1995 Dec;52(12):1048-60
references: 7492257
references: J Trauma Stress. 1997 Oct;10(4):539-55
references: 9391940
references: Ann Intern Med. 1998 Jan 15;128(2):118-26
references: 9441572
references: Psychol Rep. 1998 Apr;82(2):579-82
references: 9621732
references: Am J Prev Med. 1998 May;14(4):245-58
references: 9635069
references: J Am Med Womens Assoc. 1999 Spring;54(2):85-90
references: 10319597
references: JAMA. 1999 Aug 4;282(5):468-74
references: 10442663
references: Am J Med. 1999 Oct;107(4):332-9
references: 10527034
references: J Gen Intern Med. 2004 Nov;19(11):1096-103
references: 15566438
references: Ann Fam Med. 2004 Nov-Dec;2(6):595-608
references: 15576546
references: BMC Public Health. 2004 Dec 15;4:62
references: 15601463
references: Gen Hosp Psychiatry. 2005 May-Jun;27(3):169-79
references: 15882763
references: Depress Anxiety. 2005;21(4):193-202
references: 16075453
references: Patient Educ Couns. 2005 Sep;58(3):296-304
references: 16122641
references: Gen Hosp Psychiatry. 2005 Nov-Dec;27(6):392-9
references: 16271653
references: J Consult Clin Psychol. 2005 Oct;73(5):790-9
references: 16287379
references: J Trauma Stress. 2006 Feb;19(1):45-56
references: 16568470
references: Fam Pract. 2006 Jun;23(3):308-16
references: 16461452
references: Adm Policy Ment Health. 2006 Jul;33(4):433-48
references: 16240076
references: Ann Intern Med. 2007 Mar 6;146(5):317-25
references: 17339617
references: J Gen Intern Med. 2007 Jun;22(6):719-26
references: 17503105
references: Health Psychol. 2008 Sep;27(5):513-22
references: 18823177
references: Med Educ. 2010 Jan;44(1):50-63
references: 20078756
references: Patient Educ Couns. 2011 Jan;82(1):21-9
references: 20219315
references: J Clin Psychiatry. 2011 Mar;72(3):304-12
references: 20584519
references: J Trauma Dissociation. 2012;13(2):190-208
references: 22375807
references: Cochrane Database Syst Rev. 2012;12:CD003267
references: 23235595