3311 Trauma Informed Care Needs Assessment of Internal Medicine Residents

Abstract

OBJECTIVES/SPECIFIC AIMS: In the US, 60-90% of adults have experienced emotional trauma-- defined as an event or series of events (such as abuse, loss, or chronic stressors) that negatively affect health. Trauma exposure is strongly associated with proportional increases in chronic diseases, behavioral health disorders, and risky behaviors. These negative sequelae disproportionately affect ethnic minorities and urban, underserved populations. Physicians and healthcare providers can play important roles in intervention or re-traumatization of victims. However, current standard medical training does not include trauma or Trauma Informed Care (TIC). We aimed to examine the knowledge, attitudes, perceived skills, and behaviors of internal medicine residents regarding managing patients with histories of trauma, as well as residents’ desires for additional training in trauma informed care. METHODS/STUDY POPULATION: We conducted an online survey of residents enrolled in 4 internal medicine programs in Baltimore, Maryland to assess the following behaviors: recognizing, screening, managing, and referring patients with trauma histories. The questionnaire was based on PREMIS (Physician Readiness to Manage Intimate Partner Violence Survey) and addressed residents’ knowledge, attitudes, self-assessed preparedness, and close personal experiences with trauma. Nonparametric tests (Kruskal-Wallis, Fisher’s exact, and Wilcoxon rank sum) were used for analysis. RESULTS/ANTICIPATED RESULTS: Of the 168 residents who responded to the survey (54% response rate), 44% were female, 55% White, 28% Asian, 4% Black and 13.2% unknown/other. Knowledge and preparedness were very limited. 83% percent of respondents underestimated trauma prevalence; 31.7% felt inadequately prepared to appropriately respond to positive disclosures. 59.5% reported they seldom asked about trauma in the past 6 months, and 8.8% never asked. Factors significantly associated with higher frequency of screening patients include greater perceived preparedness to identify, respond to, and refer patients (p =.0001 −.012); familiarity with referral resources (p=.005); comfort in discussing trauma with patients (p =.003); and perceived faculty (p =.001) and workplace support (p =.038). 68.7% had previous training on some trauma-related topics in medical school, and 42.2% did in residency; 91.8% wished for additional training on trauma and trauma informed care. Differences among genders, races, years in training, and program sites were minimal. DISCUSSION/SIGNIFICANCE OF IMPACT: Internal medicine residents in Baltimore had very limited knowledge about trauma prevalence and risks for comorbidities. Although most residents feel TIC is relevant to clinical practice, they feel unprepared to identify, respond to, manage, and refer patients with histories of trauma. Our results support the need for integration of trauma and Trauma Informed Care training into graduate medical education for internal medicine residents.