The research team administered a 52-item survey to 757 medical students and 150 clinical instructors, measuring knowledge, attitudes, and practices of trauma-informed care using a validated instrument known as the KAP-TIC. The survey also assessed conventional and expanded adverse childhood experiences, or ACEs, alongside benevolent childhood experiences, or BCEs, a complementary scale that captures positive early-life factors such as feeling safe, having supportive adults, and experiencing comfort at home. Of those invited, 216 people responded: 102 clinical instructors, a robust 68 percent response rate, and 114 medical students, a 15 percent response rate. The asymmetry in participation itself tells a story about the demands on trainees’ time, though the instructor response rate lends unusual weight to the faculty perspective.

Trauma-informed care is a framework formalized in national guidance from the Substance Abuse and Mental Health Services Administration, built on principles of safety, trustworthiness, peer support, collaboration, empowerment, and sensitivity to cultural and historical contexts. In clinical settings, it means assuming that any patient may carry a trauma history and structuring interactions—physical examinations, sensitive histories, invasive procedures—to minimize re-traumatization. The framework emerged from decades of epidemiology, most famously the original ACE study by Felitti and colleagues, which linked childhood abuse and household dysfunction to leading causes of adult death. Subsequent work expanded the concept beyond the household to community-level adversities such as racism, bullying, and community violence, and demonstrated that adversity shapes healthcare utilization and expenditures across the lifespan.

What makes the new study distinctive is its dual focus on lived experience and professional competence. More than 70 percent of respondents reported at least one conventional ACE, a figure that aligns with, and in some analyses exceeds, prevalence estimates from the general US adult population surveyed through the Behavioral Risk Factor Surveillance System. Yet respondents also scored remarkably high on benevolent childhood experiences, averaging 9.0 out of 10. This coexistence matters scientifically. Research on positive childhood experiences, including a 2025 analysis in JAMA Network Open, shows that supportive early environments predict better adult health and opportunity outcomes even among those with adversity, and that safe, stable, nurturing relationships can interrupt the intergenerational transmission of maltreatment. The medical workforce, in other words, is not defined by its wounds but by a complex mixture of harm and resilience.

The study’s most actionable results concern how trauma-informed competence varies across the training pipeline. Composite Knowledge and Attitudes scores did not differ significantly between students and instructors, suggesting that the conceptual foundations of trauma-informed care are being absorbed reasonably well at every level. Practice, however, told a different story. Clinical instructors reported significantly higher trauma-informed practice scores, with a median of 4.42 on the instrument’s scale compared with 4.17 among students, a difference that was statistically significant with a modest effect size. This gap makes intuitive sense: practice is the domain most dependent on accumulated clinical experience, on having weathered thousands of patient encounters and learned to calibrate disclosure, pacing, and choice in real time.

Item-level analysis sharpened the picture considerably. After correction for multiple comparisons, students expressed a greater desire for trauma-informed care training than their instructors, while instructors reported greater transparency, greater respect for patient choice, and greater tailoring of actions to individual patient needs. Crucially, the differences were concentrated between preclinical students and instructors. When the researchers compared clinical students—those already embedded in wards and clinics—with instructors, no significant differences survived false discovery correction. Direct comparisons confirmed the pattern: clinical students showed greater understanding of trauma-informed care and more tailored interactions with patients than their preclinical peers. The implication is that something about authentic clinical immersion, whether supervised practice, role modeling, or repeated exposure to patients’ lived realities, closes the gap that classroom instruction alone does not.

Perhaps the most methodologically important negative finding involves the relationship between personal adversity and professional capability. Respondents reporting four or more ACEs—the threshold conventionally associated with elevated health risks—were not more or less likely to endorse trauma-informed knowledge, attitudes, and practices overall, with an odds ratio of 1.29 and a confidence interval spanning 0.62 to 2.65. This result pushes back against a tempting but reductive narrative: that personal trauma history automatically confers either special empathy or impaired professionalism. Prior literature has documented both possibilities. Studies have found elevated ACE prevalence among medical students and associated adversity with burnout, depression, and even professionalism lapses, while other work has explored resilience factors that buffer trainees with difficult pasts. The new data suggest that trauma-informed competence is trainable and distributed independently of biography, which is precisely what a curriculum can act upon.

The findings arrive at a moment when medical educators are actively building the infrastructure for trauma-informed training. Recent curricular innovations documented in MedEdPORTAL include trauma-informed approaches to the medical history for first-year medical and dental students, a novel trauma-informed physical examination curriculum, case-based workshops introducing ACEs and resilience, and screening approaches for toxic stress framed through health equity. A 2023 roadmap published in Academic Medicine proposed an essential competency set for trauma-informed medical education, signaling that the field is moving from isolated electives toward systematic integration. The new survey provides a baseline against which such reforms can be measured, and it identifies preclinical years as the highest-yield target for intervention, since that is where the practice gap is widest and the appetite for training is strongest.

The study also carries implications for the learning environment itself. Trauma is common not only among patients but among learners and educators, and vicarious traumatization—the emotional toll of exposure to patients’ suffering—has been documented among medical students in pilot studies. A learning environment that applies trauma-informed principles internally, offering psychological safety, transparency, and choice to its own trainees, may model the very behaviors it seeks to teach. The authors frame their results as highlighting opportunities to strengthen trauma-informed education throughout medical training, and the data support a specific reading: knowledge and attitudes are already broadly shared, so curricular energy should flow toward supervised practice, feedback on real patient interactions, and faculty development that translates experienced clinicians’ implicit skills into teachable content.

Certain limitations warrant attention when weighing the results. The student response rate of 15 percent raises the possibility of self-selection, since respondents interested in trauma may have been more likely to participate, and the cross-sectional design captures a single moment rather than growth over time. The dataset, generated at a single institution, is not publicly available due to privacy and ethical restrictions, though the authors note it is available upon reasonable request. The survey was deemed exempt by the University of North Carolina’s Institutional Review Board as non-human subjects research. Even with these caveats, the study’s convergence of validated measures, high faculty participation, and careful statistical correction makes a compelling case that trauma-informed care should be treated not as a specialty concern but as a core competency woven through every stage of medical training, from the first anatomy lecture to independent practice.

Subject of Research: Trauma-informed care knowledge, attitudes, and practices among medical students and clinical instructors

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

Article References: Trauma-Informed Care Across Medical Training: Knowledge, Attitudes, Practices, and Lived Experiences Among Medical Students and Clinical Instructors. (n.d.). https://doi.org/10.1007/s11606-026-10826-4

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10826-4

Keywords: trauma-informed care, adverse childhood experiences, medical education, medical students, clinical instructors, benevolent childhood experiences, KAP-TIC, learning environment, psychological safety, curriculum, resilience, Journal of General Internal Medicine