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Saberi RA, Parker GB, Mohsin N, Gilna GP, Cioci AC, Urrechaga EM, Buzzelli CMD, Schulman CI, Proctor KG, Garcia LRGD. Advanced Surgical Skills for Exposure in Trauma (ASSET) course improves military surgeon confidence. Am J Disaster Med 2024; 19:45-51. [PMID: 38597646 DOI: 10.5055/ajdm.0469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Active duty military surgeons often have limited trauma surgery experience prior to deployment. Consequently, military-civilian training programs have been developed at high-volume trauma centers to evaluate and maintain proficiencies. Advanced Surgical Skills for Exposure in Trauma (ASSET) was incorporated into the predeployment curriculum at the Army Trauma Training Detachment in 2011. This is the first study to assess whether military surgeons demonstrated improved knowledge and increased confidence after taking ASSET. DESIGN Retrospective cohort study. SETTING Quaternary care hospital. PATIENTS AND PARTICIPANTS Attending military surgeons who completed ASSET between July 2011 and October 2020. MAIN OUTCOME MEASURE(S) Pre- and post-course self-reported comfort level with procedures was converted from a five-point Likert scale to a percentage and compared using paired t-tests. RESULTS In 188 military surgeons, the median time in practice was 3 (1-8) years, with specialties in general surgery (52 percent), orthopedic surgery (29 percent), trauma (7 percent), and other disciplines (12 percent). The completed self-evaluation response rate was 80 percent (n = 151). The self-reported comfort level for all body regions improved following course completion (p < 0.001): chest (27 percent), neck (23 percent), upper extremity (22 percent), lower extremity (21 percent), and abdomen/pelvis (19 percent). The overall score on the competency test improved after completion of ASSET, with averages increasing from 62 ± 18 percent pretest to 71 ± 13 percent post-test (p < 0.001). CONCLUSIONS After taking the ASSET course, military surgeons demonstrated improved knowledge and increased confidence in the operative skills taught in the course. The ASSET course may provide sustainment of knowledge and confidence if used at regular intervals to maintain trauma skills and deployment readiness.
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Affiliation(s)
- Rebecca A Saberi
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of Miami/Ryder Trauma Center at Jackson Memorial Hospital, Miami, Florida
| | - Graham B Parker
- Department of Medicine, Los Angeles General Medical Center, Los Angeles, California. ORCID: https://orcid.org/0000-0002-0446-3446
| | - Noreen Mohsin
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Gareth P Gilna
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of Miami/Ryder Trauma Center at Jackson Memorial Hospital, Miami, Florida
| | - Alessia C Cioci
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of Miami/Ryder Trauma Center at Jackson Memorial Hospital, Miami, Florida
| | - Eva M Urrechaga
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of Miami/Ryder Trauma Center at Jackson Memorial Hospital, Miami, Florida
| | - Col Mark D Buzzelli
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of Miami/Ryder Trauma Center at Jackson Memorial Hospital, Miami, Florida
| | - Carl I Schulman
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of Miami/Ryder Trauma Center at Jackson Memorial Hospital, Miami, Florida; Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Kenneth G Proctor
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care; United States Army Trauma Training Detachment, University of Miami/Ryder Trauma Center at Jackson Memorial Hospital, Miami, Florida
| | - Ltc Ret George D Garcia
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care; United States Army Trauma Training Detachment, University of Miami/Ryder Trauma Center at Jackson Memorial Hospital, Miami, Florida
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Scharringa S, Dijkink S, Krijnen P, Schipper IB. Maturation of trauma systems in Europe. Eur J Trauma Emerg Surg 2024; 50:405-416. [PMID: 37249592 PMCID: PMC10227384 DOI: 10.1007/s00068-023-02282-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/12/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE To provide an overview of trauma system maturation in Europe. METHODS Maturation was assessed using a self-evaluation survey on prehospital care, facility-based trauma care, education/training, and quality assurance (scoring range 3-9 for each topic), and key infrastructure elements (scoring range 7-14) that was sent to 117 surgeons involved in trauma, orthopedics, and emergency surgery, from 24 European countries. Average scores per topic were summed to create a total score on a scale from 19 to 50 per country. Scores were compared between countries and between geographical regions, and correlations between scores on different sections were assessed. RESULTS The response rate was 95%. On the scale ranging from 19 to 50, the mean (SD, range) European trauma system maturity score was 38.5 (5.6, 28.2-48.0). Prehospital care had the highest mean score of 8.2 (0.5, 6.9-9.0); quality assurance scored the lowest 5.9 (1.7, 3.2-8.5). Facility-based trauma care was valued 6.9 (1.4, 4.1-9.0), education and training 7.0 (1.2, 5.2-9.0), and key infrastructure elements 10.3 (1.6, 7.6-13.5). All aspects of trauma care maturation were strongly correlated (r > 0.6) except prehospital care. End scores of Northern countries scored significantly better than Southern countries (p = 0.03). CONCLUSION The level of development of trauma care systems in Europe varies greatly. Substantial improvements in trauma systems in several European countries are still to be made, especially regarding quality assurance and key infrastructure elements, such as implementation of a lead agency to oversee the trauma system, and funding for growth, innovation and research.
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Affiliation(s)
- Samantha Scharringa
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - Suzan Dijkink
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Pieta Krijnen
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Network Acute Care West, Leiden, The Netherlands
| | - Inger B Schipper
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Network Acute Care West, Leiden, The Netherlands
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Mitchnik IY, Regev S, Rivkind AI, Fogel I. Disparities in trauma care education: An observational study of the ATLS course within a national trauma system. Injury 2023; 54:110860. [PMID: 37328347 DOI: 10.1016/j.injury.2023.110860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 05/15/2023] [Accepted: 06/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Disparities in trauma systems, including gaps between trauma center levels, affect patient outcomes. Advanced Trauma Life Support (ATLS) is a standard method of care that improves the performance of lower-level trauma systems. We sought to study potential gaps in ATLS education within a national trauma system. METHODS This prospective observational study examined the characteristics of 588 surgical board residents and fellows taking the ATLS course. The course is required for board certification in adult trauma specialties (general surgery, emergency medicine, and anesthesiology), pediatric trauma specialties (pediatric emergency medicine and pediatric surgery), and trauma consulting specialties (all other surgical board specialties). We compared the differences in course accessibility and success rates within a national trauma system which includes seven level 1 trauma centers (L1TC) and twenty-three non-level 1 hospitals (NL1H). RESULTS Resident and fellow students were 53% male, 46% employed in L1TC, and 86% were in the final stages of their specialty program. Only 32% were enrolled in adult trauma specialty programs. Students from L1TC had a 10% higher ATLS course pass rate than NL1H (p = 0.003). Trauma center level was associated with higher odds to pass the ATLS course, even after adjustment to other variables (OR = 1.925 [95% CI = 1.151 to 3.219]). Compared to NL1H, the course was two-three times more accessible to students from L1TC and 9% more accessible to adult trauma specialty programs (p = 0.035). The course was more accessible to students at early levels of training in NL1H (p < 0.001). Female students and trauma consulting specialties enrolled in L1TC programs were more likely to pass the course (OR = 2.557 [95% CI = 1.242 to 5.264] and 2.578 [95% CI = 1.385 to 4.800], respectively). CONCLUSIONS Passing the ATLS course is affected by trauma center level, independent of other student factors. Educational disparities between L1TC and NL1H include ATLS course access for core trauma residency programs at early training stages. Some gaps are more pronounced among consulting trauma specialties and female surgeons. Educational resources should be planned to favor lower-level trauma centers, specialties dealing in trauma care, and residents early in their postgraduate training.
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Affiliation(s)
- Ilan Y Mitchnik
- Israel Defense Force Medical Corps, Tel Hashomer, Ramat Gan, Israel; Department of Military Medicine, Hebrew University, Jerusalem, Israel; Military Medical Academy, Israel Defense Force, Negev, Israel.
| | - Stav Regev
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avraham I Rivkind
- Department of General Surgery and Shock Trauma Center, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Itay Fogel
- Israel Defense Force Medical Corps, Tel Hashomer, Ramat Gan, Israel; Department of Military Medicine, Hebrew University, Jerusalem, Israel; Military Medical Academy, Israel Defense Force, Negev, Israel
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McCotter EL, Peterson AL, Savell TC, Orr LC, Besel JM, Thompson SJ. Bringing Trauma Education to the Frontier: Overcoming Distance Barriers Utilizing a Virtual Platform. J Trauma Nurs 2023; 30:235-241. [PMID: 37417675 DOI: 10.1097/jtn.0000000000000734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
BACKGROUND The American College of Surgeons and state regulations mandate that trauma facilities offer trauma-specific continuing education throughout the region they serve. These requirements come with unique challenges when serving a rural and sparsely populated state. A novel approach to providing education was necessitated by the coronavirus disease 2019 pandemic, travel distance, and limited local specialists. OBJECTIVE The purpose of this article is to describe the development of a virtual educational program used to improve access to quality trauma education and decrease barriers to obtaining continuing education hours inherent in the region. METHODS This article describes the development and implementation of the Virtual Trauma Education program, which provided one free continuing education hour per month from October 2020 to October 2021. The program reached more than 2,000 viewers and established a method to provide continuous monthly educational offerings throughout the region. RESULTS After the Virtual Trauma Education program implementation, monthly educational attendance increased from an average of 55 to 190. Viewership data indicate that trauma education across our region is far more robust, available, and accessible using a virtual platform. With more than 2,000 views from October 2020 to October 2021, Virtual Trauma Education offerings have spread far beyond regional borders, reaching 25 states and 169 communities. CONCLUSION Virtual Trauma Education delivers easily accessible trauma education and is a program that has proven its sustainability.
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Youssef Y, Hättich A, Friemert B. Orthopädie und Unfallchirurgie – Zehnkampf der Medizin. Unfallchirurgie 2022; 126:281-284. [PMID: 36534362 DOI: 10.1007/s00113-022-01271-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND When the specialties of orthopedics and trauma surgery were merged in 2006 in Germany, the learning content significantly increased while the training time remained the same. Less and less junior doctors learn the whole spectrum of orthopedics and trauma surgery for diagnosis, treatment and aftercare options. OBJECTIVE How can continuing education concepts be designed to meet the wide range of theoretical and practical content required in residency training to become an orthopedic and trauma surgeon? RESULTS AND CONCLUSION Orthopedics and trauma surgery is one of the most diverse specialties in terms of patients, clinical pictures and fields of activity. Accordingly, residency training must also be broadly based. This can be achieved through structured and well-planned training concepts. Furthermore, digital simulators could be used to prepare residents for working with patients. Rotation models in the outpatient area could also be beneficial in order to gain an insight into the outpatient care of musculoskeletal diseases. In addition to the active involvement of the resident in the training, the interest and participation of the trainers is also important in order to actively promote junior physicians and prepare them for their later work.
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Affiliation(s)
- Yasmin Youssef
- Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - Annika Hättich
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Deutschland
| | - Benedikt Friemert
- Klinik für Unfallchirurgie und Orthopädie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
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Adl Amini D, Herbolzheimer M, Lutz PM, Lacheta L, Oezel L, Haffer H, Schömig F, Schreiner A, Limmer J, Muellner M. Effects of the SARS-CoV‑2 pandemic on residency training in orthopedics and traumatology in Germany : A nationwide survey. Orthopadie (Heidelb) 2022; 51:844-852. [PMID: 36006432 PMCID: PMC9406266 DOI: 10.1007/s00132-022-04295-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The spread of the coronavirus disease has impacted healthcare systems worldwide; however, restrictions due to the SARS-CoV‑2 (severe acute respiratory syndrome coronavirus 2) pandemic are particularly drastic for physicians in residency training. Imposed restrictions interrupt the standard educational curricula, and consequently limited residents to meet mandatory requirements. AIM The aim of this study was to evaluate the effects of the SARS-CoV‑2 pandemic on residency training in orthopedics and trauma surgery in Germany. METHODOLOGY An online-based, voluntary, and anonymous survey of physicians in residency training for orthopedics and trauma surgery was conducted. Through email lists of junior physician organizations the survey was sent to 789 physicians. Participation was possible between October and November 2021. RESULTS A total of 95 participants (female 41.1%) with a mean age of 31.3 ± 2.8 years were analyzed. In the everyday clinical practice and care 80% of participants thought that they were set back in time of their general training due to the pandemic. There was an average reduction of 25.0% in time spent in the OR and 88.4% agreed that their surgical training was delayed due to the pandemic. Of the respondents 33.6% were able to attend external continuing education courses. Only 4.2% were able to invest more time in research and 55.8% of participants agreed that their residency training will be extended due to the pandemic. CONCLUSION The COVID pandemic has had a significant impact on the residency training in orthopedics and trauma surgery in Germany. In almost all areas of training, residents had to accept restrictions due to the imposed restrictions, which potentially negatively affected their training.
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Affiliation(s)
- Dominik Adl Amini
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
| | | | - Patricia Maria Lutz
- Department for Trauma Surgery, Feldkirch Academic Hospital, Feldkirch, Austria
| | - Lucca Lacheta
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Lisa Oezel
- Department of Orthopedic Surgery and Traumatology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Henryk Haffer
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Friederike Schömig
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Anna Schreiner
- Department for Trauma and Reconstructive Surgery, BG Unfallklinik Tübingen, University of Tübingen, Tübingen, Germany
| | - Jonas Limmer
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Maximilian Muellner
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
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Mert L, Demirel M, Kendirci AŞ, Akgül T, Kılıçoğlu Öİ. Reasons for resident resignations from Orthopedic Residency Programs in Turkey: A cross-sectional survey from residents' perspectives. Acta Orthop Traumatol Turc 2022; 56:222-227. [PMID: 35703512 DOI: 10.5152/j.aott.2022.21384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to analyse the factors that led to resignations from Orthopaedics and Traumatology Residency pro- grammes in Turkey, and to determine the overall rate of resignation among residents from Orthopaedics and Traumatology programmes. METHODS In this cross-sectional survey,120 residents who either resigned or transferred to other OT clinics between autumn of 2013 and spring of 2020 were included. They were asked to complete a questionnare which was sent via Whatssapp application or e-mail. The ques- tionnare was comprised of 2 sections; Section A, which adressed resignation, consisted of 15 questions and Section B, which adressed transfer to another OT programme, consisted of 12 questions. Both sections had open ended and multiple choice questions. RESULTS Of 120 residents, 96 (6.6%) resigned and then transferred to another specialty, and 24 (1.6%) transferred to another orthopedics and traumatology clinic based on our review. The overall resignation rate as per the total quotas for orthopedics and traumatology residency from 2013 to 2020 was 8.2%. Of the 120 orthopedics and traumatology residents who were eligible for the survey, 83 (70%) completed the questionnaire. Sixty-one (60 males, 1 female; median age = 26 years; age range = 25-35) of 96 residents who resigned from the orthopedics and traumatology residency completed section A (the response rate was 63.5%); 22 (22 males; median age=27.6 years; age range=25-34) out of 24 residents who transferred to another orthopedics and traumatology clinic completed section B (the response rate was 91.6%). In section A, 40 out of 61 individuals (65.5%) preferred orthopedics and traumatology specialty as the first choice in TUS, and 34 residents (55.7%) reported not to have had enough information regarding the residency program before starting their clinics. In section B, out of the 22 residents, 13 (59%) stated that orthopedics and traumatology residency was not their first choice in TUS, and 18 (81.8%) reported not to have had sufficient knowledge about the preferred clinic. The most common reason for resignation or transfer to another specialty was heavy workload (n=46, 74.19%), followed by excessive hours of work (n=45, 72.58%). The most common reason for transfer to another orthopedics and traumatology clinic was drudgery (n=10, 45.5%), followed by problems with the hierarchy in orthopedics and traumatology residency (n = 9, 40.9%). CONCLUSION The results of this survey have shown us, with an overall resignation rate of 8.2% as per the total quotas for OT residency from 2013 to 2020, that resignation from OT residency represents an important problem in Turkey. Workload and excessive hours of work were the most common reasons for resignation from orthopaedic residency programmes. Furthermore, extra work that diverted residents from their actual job responsibilities, as well as academic and educational concerns, were the main factors leading to transfer to another OT residency programme.
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Affiliation(s)
- Lezgin Mert
- Department of Orthopedics and Traumatology, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Mehmet Demirel
- Department of Orthopedics and Traumatology, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Alper Şükrü Kendirci
- Department of Orthopedics and Traumatology, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Turgut Akgül
- Department of Orthopedics and Traumatology, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Önder İsmet Kılıçoğlu
- Department of Orthopedics and Traumatology, Koç University, School of Medicine, İstanbul, Turkey
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Abul K. Adequacy of spine surgery fellowship training in Turkey: Results of a survey. Acta Orthop Traumatol Turc 2022; 56:71-75. [PMID: 35234133 DOI: 10.5152/j.aott.2022.21211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to determine the adequacy of spine surgery fellowship training (SSFT) in Turkey and what is needed for further development by interviewing current fellows. METHODS Forty male orthopaedics and traumatology or neurosurgery specialists who had completed SSFT in three different spine centers in Turkey between 2010 and 2018 were asked to complete a survey with 29 questions about SSFT in Turkey. Thirty specialists responded, and the collected data were analyzed. RESULTS Twenty-seven (90%) participants were orthopaedic and traumatology specialists and three (10%) were neurosurgery specialists, with a mean age of 39 (range = 35-53) years. Most participants received their residency training in the provinces where their fellowship training took place (11 (37%) in İstanbul and 7 (23%) in Ankara). The mean duration between residency training and the start of SSFT was 4 (range = 0-14) years, and the mean SSFT duration was 8 (range = 1-18) months. Seventy percent of participants had participated in spine surgery cases during their residency. Twenty-three (77%) participants reported that spine surgery training in their hospital during their residency was inadequate. Seventeen (57%) participants felt that they could not independently perform spine surgery cases before SSFT. All three centers (100%) participating in the study that offered SSFT were non-public institutions such as private hospitals and private university hospitals of medicine managed by a dedicated mentor with personal commitment, without any accreditation for SSFT. While 25 (83%) participants indicated that they felt competent enough to perform a standard spinal deformity surgery case independently at the end of SSFT, 5 (17%) indicated the opposite. This proportion, which was 43% at the end of residency, increased to 83% after SSFT. CONCLUSION The results of this study have demonstrated the importance of SSFT in spine surgery as a specialty with a potentially high risk of complications that require prolonged case observation, challenging work-up, and adequate equipment. In this regard, there is a need for regulations on accreditation in government health facilities that provide ideal conditions. We propose to offer SSFT to all surgeons interested in spine surgery in Turkey by conducting further studies supported by an optimal health sector that ensures the appropriate requirements, in accordance with the declaration of TOTEK (The Turkish Orthopaedics and Traumatology Education Council), training workshops, and an accredited master's degree program in spine surgery or subspecialty.
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Affiliation(s)
- Kadir Abul
- Department of Orthopaedics and Traumatology, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
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Abstract
Numerous surgical advances have resulted from exchanges between military and civilian surgeons. As part of the U.S. National Library of Medicine Michael E. DeBakey Fellowship in the History of Medicine, we conducted archival research to shed light on the lessons that civilian surgery has learned from the military system and vice-versa. Several historical case studies highlight the need for immersive programs where surgeons from the military and civilian sectors can gain exposure to the techniques, expertise, and institutional knowledge the other domain provides. Our findings demonstrate the benefits and promise of structured programs to promote reciprocal learning between military and civilian surgery.
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Affiliation(s)
- Divyansh Agarwal
- Medical Scientist Training Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Clyde F Barker
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Ali Naji
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - C William Schwab
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Penn Presbyterian Medical Center, Philadelphia, PA
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Brown T, Berman S, McDaniel K, Radford C, Mehta P, Potter J, Hirsh DA. Trauma-Informed Medical Education (TIME): Advancing Curricular Content and Educational Context. Acad Med 2021; 96:661-667. [PMID: 32675789 DOI: 10.1097/acm.0000000000003587] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The majority of patients and medical students experience some form of psychological trauma or adversity across their life course. All forms of trauma can be associated with adverse health consequences and can negatively affect learning and professional development. Trauma-informed care (TIC) offers a framework to address and mitigate these consequences and promote safety and health. The Substance Abuse and Mental Health Services Administration describes 6 domains of TIC: safety; trust and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and cultural, historic, and gender issues. At present, TIC is not taught routinely in undergraduate medical education (UME)-a crucial educational gap given that UME grounds the development of key perspectives and practices that students use throughout their careers. Further, given the prevalence of preexisting trauma among learners and the likelihood of new traumatic exposures during training, medical schools' processes, practices, and learning environments may risk exacerbating or even causing trauma. To address this educational need and support students and their future patients, the authors propose a trauma-informed medical education (TIME) framework. TIME informs medical schools' curricular content and educational context. In UME, curricular content should address trauma epidemiology, physiology, and effects; trauma-informed clinical skills including sensitive communication and physical exam techniques; and trauma-informed self-care techniques including education on organizational resources, how to elicit supports, and personal self-care practices. A trauma-informed educational context encompasses curricular development, including student-faculty coproduction of educational content; curricular delivery, including faculty development on TIC principles; and learning environment, including trauma-informed educational practices, medical student advising, institutional policies, and recruitment. TIME offers practical strategies to support teaching, learning, educational administration, and professional development and aims to inspire new strategies for effective learner and faculty engagement. TIME aims to foster students' development of competency in TIC and promote student engagement, learning, health, and well-being.
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Affiliation(s)
- Taylor Brown
- T. Brown is a third-year medical student, Harvard Medical School, Boston, Massachusetts
| | - Sarah Berman
- S. Berman is a fourth-year medical student, Harvard Medical School, Boston, Massachusetts
| | - Katherine McDaniel
- K. McDaniel is a third-year medical student, Harvard Medical School, Boston, Massachusetts
| | - Caitlin Radford
- C. Radford is a third-year medical student, Harvard Medical School, Boston, Massachusetts
| | - Pooja Mehta
- P. Mehta is a first-year resident, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jennifer Potter
- J. Potter is professor of medicine, Harvard Medical School, Boston, Massachusetts
| | - David A Hirsh
- D.A. Hirsh is the George E. Thibault Academy Associate Professor and director, HMS Academy, Harvard Medical School, Boston, Massachusetts
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Huffman EM, Anton NE, Athanasiadis DI, Ahmed R, Cooper D, Stefanidis D, Lee NK. Multidisciplinary simulation-based trauma team training with an emphasis on crisis resource management improves residents' non-technical skills. Surgery 2021; 170:1083-1086. [PMID: 33858682 DOI: 10.1016/j.surg.2021.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/10/2021] [Accepted: 03/06/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Non-technical skills impact trauma resuscitation time. Crisis resource management teaches non-technical skills required for effective teamwork in a crisis. We developed a simulation-based multidisciplinary trauma team training, with an emphasis on crisis resource management and a goal of improving residents' non-technical skills. METHODS Twenty-five post-graduate year-1 general surgery and emergency medicine residents were divided into multidisciplinary teams with embedded nurse participants. Teams underwent 3 trauma resuscitation scenarios followed by a crisis resource management debrief. Additionally, a Just-In-Time crisis resource management didactic was delivered before 1 scenario. Teams' non-technical skills in each scenario were assessed by expert raters using non-technical skills scale for trauma and scenario scores before and after the Just-In-Time didactic were compared. Multiple linear-regression calculating the impact of clinical scenario, case order, and timing relative to the Just-In-Time didactic on a teams' non-technical skills scale for trauma score was performed. RESULTS Seventy-four team T-NOTECHS ratings were completed. T-NOTECHS total score was significantly higher on the third training case regardless of clinical scenario or timing relative to the Just-In-Time didactic (pre = 15.58 vs post = 18.11, P = .117). Teams scored an average of 15.44 on the first scenario of the day, 16.63 on the second, and 19.04 on the last (P < .001). CONCLUSION Crisis resource management-focused multidisciplinary team training significantly improves residents' non-technical skills in the simulated environment. Case repetition followed by crisis resource management focused debriefings outweighed the effect of a single Just-In-Time crisis resource management didactic.
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Affiliation(s)
- Elizabeth M Huffman
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. https://twitter.com/BetsyHuffmanMD
| | - Nick E Anton
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Dimitrios I Athanasiadis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. https://twitter.com/dimitrios_iu
| | - Rami Ahmed
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN. https://twitter.com/RamiAhmedDO
| | - Dylan Cooper
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. https://twitter.com/dstefanidis1
| | - Nicole Kissane Lee
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
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Tung L, Long AM, Bonne S, Tseng ES, Bruns B, Joseph B, Williams BH, Stein D, Freischlag JA, Goulet N, Khandelwal C, Kiselak E, Hoofnagle M, Gelbard R, Rattan R, Joseph D, Bernard A, Zakrison TL. Equity on the frontlines of trauma surgery: An #EAST4ALL roundtable. J Trauma Acute Care Surg 2021; 90:129-136. [PMID: 33009339 DOI: 10.1097/ta.0000000000002965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inequity exists in surgical training and the workplace. The Eastern Association for the Surgery of Trauma (EAST) Equity, Quality, and Inclusion in Trauma Surgery Ad Hoc Task Force (EAST4ALL) sought to raise awareness and provide resources to combat these inequities. METHODS A study was conducted of EAST members to ascertain areas of inequity and lack of inclusion. Specific problems and barriers were identified that hindered inclusion. Toolkits were developed as resources for individuals and institutions to address and overcome these barriers. RESULTS Four key areas were identified: (1) harassment and discrimination, (2) gender pay gap or parity, (3) implicit bias and microaggressions, and (4) call-out culture. A diverse panel of seven surgeons with experience in overcoming these barriers either on a personal level or as a chief or chair of surgery was formed. Four scenarios based on these key areas were proposed to the panelists, who then modeled responses as allies. CONCLUSION Despite perceived progress in addressing discrimination and inequity, residents and faculty continue to encounter barriers at the workplace at levels today similar to those decades ago. Action is needed to address inequities and lack of inclusion in acute care surgery. The EAST is working on fostering a culture that minimizes bias and recognizes and addresses systemic inequities, and has provided toolkits to support these goals. Together, we can create a better future for all of us.
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Affiliation(s)
- Lily Tung
- From the Division of Trauma (L.T.), Vancouver General Hospital, Vancouver, British Columbia, Canada; Acute Care Surgery(A.M.D.), University of California San Francisco Fresno, Fresno, California; Division of Trauma and Surgical Critical Care (S.B.), Rutgers New Jersey Medical School, Newark, New Jersey; Division of Trauma, Critical Care, Burns, and Emergency General Surgery, Department of Surgery (E.S.T.), MetroHealth Medical Center, Cleveland, Ohio; R Adams Cowley Shock Trauma Center (B.B.), University of Maryland, Baltimore, Maryland; Trauma, Critical Care, Burn and Emergency Surgery (B.J.), University of Arizona College of Medicine, Tucson, Arizona; Section for Trauma and Acute Care Surgery (B.H.W., T.L.Z.), The University of Chicago Medicine, Chicago, Illinois; Department of Surgery (D.S.), University of California San Francisco, San Francisco, California; CEO Wake Forest Baptist Health, Dean Wake Forest School of Medicine (J.E.F.), Winston-Salem, North Carolina; Division of Trauma, Critical Care and Emergency of Surgery (N.G.), NYU Langone, New York University School of Medicine, New York, New York; Department of Surgery (C.K.), Cleveland Clinic, Cleveland, Ohio; Department of Trauma, Surgical Critical Care and Injury Prevention (E.K.), Hackensack University Medical Center, Hackensack University Medical Center, Hackensack, New Jersey; Division of Acute and Critical Care Surgery (M.H.), Washington University in St. Louis, St. Louis, Missouri; Division of Trauma (R.G.), University of Alabama at Birmingham, Birmingham, Alabama; Division of Trauma Surgery and Critical Care (R.R.), DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida; Division of Trauma and Acute Care Surgery, Department of Surgery (DA.J.), NYU Winthrop Hospital & NYU Long Island School of Medicine, Mineola, New York; Acute Care Surgery (A.B.), University of Kentucky College of Medicine, Lexington, Kentucky
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ORCA Collaborative (Orthopaedic Research Collaborative East Anglia). Electronic address: orca@eoeortho.com., ORCA Collaborative (Orthopaedic Research Collaborative East Anglia). The response of Trauma & Orthopaedic Departments to the first four weeks of lockdown for the COVID-19 pandemic - A trainee-led analysis of the East of England. Surgeon 2021; 19:e14-9. [PMID: 32830040 DOI: 10.1016/j.surge.2020.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/27/2020] [Accepted: 07/17/2020] [Indexed: 11/16/2022]
Abstract
Through a trainee research collaborative, we have studied the changes in practice of 12 T&O departments across the East of England over the first four weeks of the UK lockdown and COVID-19 pandemic, comparing to activity levels with the corresponding period in 2019. We focused on changes in T&O practice, training and redeployment of Trainees. Units differ considerably in several aspects of practice. We found a 97% reduction in elective operating, 64% reduction in elective outpatient activity and 37% reduction in operative trauma. 58% of trainees continued working in T&O clinics, with an average of 6 operative cases over this period. Our modelling suggests that the impact on training will persist; counter-measures must be incorporated into central recovery planning.
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15
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Affiliation(s)
- Miloni Parekh
- Third-year medical student, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania;
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16
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Demirtaş A, Karadeniz H, Akman YE, Duymuş TM, Çarkcı E, Azboy İ. Academic productivity and obstacles encountered during residency training: A survey among residents in orthopedics and traumatology programs in Turkey. Acta Orthop Traumatol Turc 2020; 54:311-319. [PMID: 32442120 DOI: 10.5152/j.aott.2020.03.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to investigate the academic productivity of and the obstacles encountered by orthopedic residents in Turkey. METHODS Overall, 220 orthopedic specialists who were registered in the Ministry of Health and had started orthopedic residency between 2009 and 2010 were invited to participate in a survey through e-mail. The survey comprised a total of 19 questions to evaluate the academic works conducted and obstacles encountered during residency. Academic work was defined as an article published in the peer-reviewed journals as well as an oral or poster presentation at a national or international congress. Case reports, letters to the editor, and technical notes were excluded. RESULTS Data were obtained from 116 respondents who completed the survey. In peer-reviewed journals in Science Citation Index (SCI) or SCI-Expanded, the mean number of articles published with and without the first name per resident was 0.09 and 0.73, respectively. In peer-reviewed journals other than those in SCI and SCI-Expanded, the mean number of articles published with and without the first name per resident was 0.37 and 1, respectively. The mean number of oral and poster presentations per resident at national and international congresses was 2.63 and 4.67, respectively. No significant difference in the number of academic works was noted between the regions and institutions (p>0.05). A significant positive correlation was observed between the number of associate professors and assistant professors in the clinic and the total number of academic works (article plus presentation) (p<0.01 and p=0.017, respectively). Regarding encouragement and support to academic works, 6.9% of the respondents found the clinic to be excellent, 20.7% good, 24.1% moderate, and 48.3% bad. No significant difference in encouragement and support to academic works was noted among the institutions (p=0.115). The most common obstacle encountered in conducting academic works was long working hours (74.5%). CONCLUSION Regardless of the region and institution, the participation of orthopedic residents in academic works is low in Turkey. Several obstacles were encountered in conducting academic works, with the most common being long working hours. LEVEL OF EVIDENCE Level IV, Diagnostic study.
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Affiliation(s)
- Abdullah Demirtaş
- Department of Orthopaedics and Traumatology, Medeniyet University, School of Medicine, İstanbul, Turkey
| | - Hilmi Karadeniz
- Department of Orthopaedics and Traumatology, Bahçelievler Medical Park Hospital, İstanbul, Turkey
| | - Yunus Emre Akman
- Department of Orthopaedics and Traumatology, Metin Sabancı Baltalimanı Bone and Joint Diseases Training and Research Hospital, İstanbul, Turkey
| | - Tahir Mutlu Duymuş
- Clinic of Orthopedics and Traumatology, Özel Saygı Hospital, İstanbul, Turkey
| | - Engin Çarkcı
- Department of Orthopaedics and Traumatology, Bahçelievler Medical Park Hospital, İstanbul, Turkey
| | - İbrahim Azboy
- Department of Orthopaedics and Traumatology, Medipol University, School of Medicine, İstanbul, Turkey
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Dırvar F, Dırvar SU, Yıldırım T, Cengiz Ö, Talmaç MA. Survey on the surgical skills of orthopedics and traumatology residents from accredited and nonaccredited institutions in İstanbul. Acta Orthop Traumatol Turc 2020; 54:168-177. [PMID: 32254033 PMCID: PMC7286170 DOI: 10.5152/j.aott.2020.02.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/19/2019] [Accepted: 12/30/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate whether orthopedic and traumatology residents who are undergoing training achieve competence in surgical techniques after completion of their specialization and to determine whether there are significant differences between the responses of residents from accredited and nonaccredited institutions. METHODS A total of 131 orthopedics and traumatology residents from nine institutions in the İstanbul province answered the questionnaire during the morning training meeting. In addition to basic demographic data, level of seniority, equipment competence, and theoretical and practical training, the residents were asked about their opinion on what type of surgeries they could perform after their specialization, considering the surgery and follow-up of the case as well as the complications occurring during this period. The residents responded to questions on 46 surgeries under the main headings of trauma, arthroscopy, arthroplasty, spine, pediatric orthopedics, hand surgery, deformity, and bone and soft tissue tumors. In addition to descriptive statistical methods, one-way analysis of variance, Tukey's multiple comparison test, and chi square test were used to evaluate the data. The significance level for the results was set at p<0.05. RESULTS In total, 131 orthopedics and traumatology residents answered the questionnaire. Furthermore, 53 (40.5%) specialization students were employed at accredited institutions and 78 (59.5%) at nonaccredited institutions. According to the responses, case presentations, article-writing sessions, and in-province meetings held regularly at accredited institutions showed a significant difference compared to non-accredited institutions (p<0.05), and the residents at the accredited institutions benefited significantly more from the availability of books and electronic media in gaining theoretical knowledge (p<0.05). When the responses of the residents from accredited and nonaccredited institutions regarding 46 different surgeries were compared, a significant difference was found in 17 of them (p<0.05). There was a significant difference between the averages of residents' responses on the surgical fields they have interest for (p<0.05). It was determined that the residents believed that they could mostly perform surgeries in the fields of trauma, followed by arthroplasty, deformity, arthroscopy, pediatric orthopedics, hand surgery, and spine and tumor surgery. According to their level of seniority, a significant difference was found between the averages of residents' opinions regarding their surgical skill levels (p=0.02). CONCLUSION We believe that it would be beneficial for the trainers to take necessary precautions to increase the skill levels of the residents of orthopedic surgery. Accreditation significantly contributes to the standardization of education as well as quality improvement. Further action should be taken to increase the number of accredited clinics.
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Affiliation(s)
- Ferdi Dırvar
- Department of Orthopedics and Traumatology, Metin Sabancı Baltalimanı Bone and Joint Diseases Training and Research Hospital, İstanbul, Turkey
| | - Sevda Uzun Dırvar
- Department of Education, Metin Sabancı Baltalimanı Bone and Joint Diseases Training and Research Hospital, İstanbul, Turkey
| | - Timur Yıldırım
- Department of Orthopedics and Traumatology, Health Sciences University Turkey, Metin Sabancı Baltalimanı Bone and Joint Diseases Training and Research Center, İstanbul, Turkey
| | - Ömer Cengiz
- Clinic of Orthopedics and Traumatology, Muş State Hospital, Muş, Turkey
| | - Mehmet Ali Talmaç
- Department of Orthopedics and Traumatology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
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Riaz Q, Saqib SU, Siddiqui NA. Changing face of trauma and surgical training in a developing country: A literature review. J PAK MED ASSOC 2020; 70(Suppl 1):S89-S94. [PMID: 31981343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Trauma continues to be the major cause of disability and death globally and surgeons are often involved in immediate care. However there has been an exponential decrease in the number of the trained trauma surgeons. The purpose of the current review article is to summarize the published literature pertaining to trauma education in postgraduate surgical training programmes internationally and in a developing country as Pakistan. Several electronic databases like MEDLINE, PubMed, Google scholar and PakMediNet were searched using the keywords 'trauma education' or 'trauma training' AND 'postgraduate medical education', 'surgery residency training', 'surgery residents' and 'surgeons'. The current training in most surgical residency programmes, locally and globally, is suboptimal. Change in trauma management protocols, and decrease in volume of trauma cases results in variable and/ or inadequate exposure and hands-on experience of the surgical trainees in operative and non-operative management of trauma. This warrants collaborative measures for integration of innovative educational interventions at all levels of the surgical educational programmes.
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Affiliation(s)
- Qamar Riaz
- Department of Surgery, Aga Khan University, Karachi, Pakistan
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19
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Tolppa T, Vangu AM, Balu HC, Matondo P, Tissingh E. Impact of the primary trauma care course in the Kongo Central province of the Democratic Republic of Congo over two years. Injury 2020; 51:235-242. [PMID: 31864671 DOI: 10.1016/j.injury.2019.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/15/2019] [Accepted: 12/09/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The two-day Primary Trauma Care (PTC) course covers the management of injured patients and takes into account resource constraints experienced in low and middle-income countries. Currently, there are no studies on the long-term impact of the course on knowledge or attitudes. The PTC course was introduced in Kongo Central Central province in the Democratic Republic of Congo (DRC) as part of a series of interventions to improve trauma care. The aim of this study was to evaluate the impact of PTC on the trauma knowledge, confidence and attitudes regarding trauma care of healthcare workers (HCWs) in the DRC over two years. METHOD A retrospective cohort study was conducted comparing multiple-choice questionnaire (MCQ) and confidence matrix results of PTC attendees prior to the course, immediately after, and at the time of follow up at either 12, 16 or 24 months. A semi-structured questionnaire was additionally administered at follow up to explore the effect of PTC on key areas of trauma learning: skills, attitudes and relationships. RESULTS A total of 59/80 HCWs who attended the PTC course completed follow-up questionnaires. Participants were predominantly male (42/59) with a mean age of 41.6 years. There was an increase of 4.8 in MCQ scores and 9.6 in confidence scores (p < 0.01) post-PTC. MCQ scores were maintained 24 months after the course, whereas confidence scores declined (p = 0.03). At follow-up, 36/59 participants reported that equipment was not available for procedures and 52/59 felt more could be done to better manage injured patients locally. All participants believed trauma services were important and felt that the course contributed to improving the management of trauma patients. CONCLUSIONS This study found that knowledge gained from the PTC course was maintained over two years, although individuals felt less clinically confident. A refresher course may be appropriate within two years to improve relatively low overall knowledge scores and participants' confidence. Whilst resource constraints within the DRC may hinder trauma care development, the PTC course has equipped attendees with the knowledge, skills, confidence and attitudes to improve trauma service development in their region.
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Affiliation(s)
- T Tolppa
- King's Kongo Central Partnership, United Kingdom; King's Centre for Global Health, United Kingdom; King's College, London, United Kingdom; King's Health Partner, United Kingdom.
| | - A M Vangu
- King's Kongo Central Partnership, United Kingdom; King's Centre for Global Health, United Kingdom; King's College, London, United Kingdom; King's Health Partner, United Kingdom
| | - H C Balu
- Université Joseph Kasa Vubu, Boma, Kongo Central, United Kingdom
| | - P Matondo
- Hôpital Provincial de Reference de Kinkanda, Matadi, Kongo Central, United Kingdom
| | - E Tissingh
- King's Kongo Central Partnership, United Kingdom; King's Centre for Global Health, United Kingdom; King's College, London, United Kingdom; King's Health Partner, United Kingdom
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Pearce AP, Marsden MER, Newell N, Hancorn K, Lecky F, Brohi K, Tai N. Trends in admission timing and mechanism of injury can be used to improve general surgical trauma training. Ann R Coll Surg Engl 2020; 102:36-42. [PMID: 31660752 PMCID: PMC6937604 DOI: 10.1308/rcsann.2019.0135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The temporal patterns and unit-based distributions of trauma patients requiring surgical intervention are poorly described in the UK. We describe the distribution of trauma patients in the UK and assess whether changes in working patterns could provide greater exposure for operative trauma training. METHODS We searched the Trauma Audit and Research Network database to identify all patients between 1 January 2014 to 31 December 2016. Operative cases were defined as all patients who underwent laparotomy, thoracotomy or open vascular intervention. We assessed time of arrival, correlations between mechanism of injury and surgery, and the effect of changing shift patterns on exposure to trauma patients by reference to a standard 10-hour shift assuming a dedicated trauma rotation or fellowship. RESULTS There were 159,719 patients from 194 hospitals submitted to the Network between 2014 and 2016. The busiest 20 centres accounted for 57,568 (36.0%) of cases in total. Of these 2147/57,568 patients (3.7%) required a general surgical operation; 43% of penetrating admissions (925 cases) and 2.2% of blunt admissions (1222 cases). The number of operations correlated more closely with the number of penetrating rather than blunt admissions (r = 0.89 vs r = 0.51). A diurnal pattern in trauma admissions enabled significant increases in trauma exposure with later start times. CONCLUSIONS Centres with high volume and high penetrating rates are likely to require more general surgical input and should be identified as locations for operative trauma training. It is possible to improve the number of trauma patients seen in a shift by optimising shift start time.
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Affiliation(s)
- AP Pearce
- Department of General Surgery, Royal London Hospital, Barts’ Health NHS Trust, London, UK
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - MER Marsden
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
- Centre for Trauma Sciences, Queen Mary University of London, UK
| | - N Newell
- Department of Mechanical Engineering, Imperial College, London, UK
| | - K Hancorn
- Department of General Surgery, Royal London Hospital, Barts’ Health NHS Trust, London, UK
| | - F Lecky
- Trauma and Audit Research Network, University of Manchester, UK
| | - K Brohi
- Department of General Surgery, Royal London Hospital, Barts’ Health NHS Trust, London, UK
- Centre for Trauma Sciences, Queen Mary University of London, UK
| | - N Tai
- Department of General Surgery, Royal London Hospital, Barts’ Health NHS Trust, London, UK
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
- Centre for Trauma Sciences, Queen Mary University of London, UK
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21
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Johnson LS, Travis TE, Shupp JW. What Is the Value of a Burn Surgery Rotation in Surgical Residency? Am Surg 2019; 85:1314-1317. [PMID: 31908211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Declining case volumes on trauma rotations and early specialization of traditional surgical rotations have limited the service lines on which general surgery residents can obtain critical operative and management experience. Meanwhile, a significant portion of residents have no exposure to a burn rotation during their training. A burn rotation may address both of these issues in a meaningful way. Surgical case volumes and burn ICU patient volume were queried for an urban regional verified burn referral center. General surgery program resident case logs were queried for procedures performed during a burn rotation during that same time period. Over a four-year time period, three burn surgeons performed a total of 2374 procedures on burn and wound service patients. In the burn ICU over that same time period, 419 individual critical care patients were managed. Twenty-seven general surgery program residents logged 632 major operations and 67 critical care patients; more than 50 per cent of cases performed were not captured by the Accreditation Council for Graduate Medical Education case log system. A high volume burn service can adequately provide surgical and critical care exposure to junior surgical residents. Accreditation Council for Graduate Medical Education surgical case logs may not fully represent the full scope of exposure sustained on a high-volume burn service.
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Affiliation(s)
- Laura S Johnson
- From *The Burn Center, Medstar Washington Hospital Center, Washington, DC and
| | - Taryn E Travis
- From *The Burn Center, Medstar Washington Hospital Center, Washington, DC and
| | - Jeffrey W Shupp
- From *The Burn Center, Medstar Washington Hospital Center, Washington, DC and
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Garcia DFV, Domingues CA, Collet E Silva FS, Mori ND, Brasel KJ, Kortbeek J, Ali J, Poggetti RS. Efficacy of a Novel Surgical Manikin for Simulating Emergency Surgical Procedures. Am Surg 2019; 85:1318-1326. [PMID: 31908212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The practical component of the Advanced Trauma Life Support (ATLS®) course typically includes a TraumaMan® manikin. This manikin is expensive; hence, a low-cost alternative (SurgeMan®) was developed in Brazil. Our primary objective was to compare user satisfaction among SurgeMan, TraumaMan, and porcine models during the course. Our secondary objective was to determine the user satisfaction scores for SurgeMan. This study included 36 ATLS students and nine instructors (4:1 ratio). Tube thoracostomy, cricothyroidotomy, pericardiocentesis, and diagnostic peritoneal lavage were performed on all the three models. The participants then rated their satisfaction both after each activity and after the course. The porcine and TraumaMan models fared better than SurgeMan for all skills except pericardiocentesis. In the absence of ethical or financial constraints, 58 per cent of the students and 66 per cent of the instructors indicated preference for the porcine model. When ethical and financial factors were considered, no preference was evident among the students, whereas 66 per cent of instructors preferred SurgeMan over the others. The students gave all three models an overall adequacy rating of >80 per cent; the instructors gave only the animal models an adequacy rating of <80 per cent. Although the users were more satisfied with TraumaMan than with SurgeMan, both were considered acceptable for the ATLS course.
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Affiliation(s)
- Diogo F V Garcia
- From the *Discipline of Trauma Surgery, Department of Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Cristiane A Domingues
- †Brazilian Committee on Trauma of the American College of Surgeons, São Paulo, Brazil
| | - Francisco S Collet E Silva
- From the *Discipline of Trauma Surgery, Department of Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Newton D Mori
- From the *Discipline of Trauma Surgery, Department of Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Karen J Brasel
- ‡Division of Trauma, Critical Care and Acute Care Surgery School of Medicine Oregon Health and Science University, Portland, Oregon
| | - John Kortbeek
- §Departments of Surgery, Anaesthesia and Critical Care, University of Calgary and Alberta Health Services, Calgary, Canada; and
| | - Jameel Ali
- ║Division of General Surgery Trauma Program, St. Michael's Hospital, Toronto, Canada
| | - Renato S Poggetti
- From the *Discipline of Trauma Surgery, Department of Surgery, University of São Paulo Medical School, São Paulo, Brazil
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Butler BA, Lawton CD, Johnson DJ, Nicolay RW, Yamaguchi JT, Stover MD. The Experiential Benefit of an Orthopedic Trauma Fellowship: An Analysis of ACGME Case Log Data From 2006 to 2017. J Surg Educ 2019; 76:1556-1561. [PMID: 31196768 DOI: 10.1016/j.jsurg.2019.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/16/2019] [Accepted: 05/20/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The Accreditation Council for Graduate Medical Education (ACGME) has published orthopedic case log data since the 2006/2007 academic year. Here, we use this data to analyze the variability in orthopedic trauma case experience reported by orthopedic trainees and to better understand the impact of an orthopedic trauma fellowship on orthopedic surgical training. DESIGN, SETTING, AND PARTICIPANTS Data were gathered from ACGME case log reports for orthopedic residents (reporting the cumulative case experience of graduating residents) and orthopedic trauma fellows (reporting the case experience of their fellowship year only) for all available years. RESULTS The average orthopedic trauma fellow reported significantly more trauma cases in multiple body regions ("Pelvis/Hip", "Femur/Knee", and "Foot/Toes") and "Open Complex" reductions (as defined by the ACGME) in their 1 year of fellowship than the average resident reported in their 5 years of residency. CONCLUSION On average, orthopedic trauma fellowships substantially increase the trauma case volumes of orthopedic trainees, especially with respect to lower extremity trauma.
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Affiliation(s)
- Bennet A Butler
- Northwestern Memorial Hospital Department of Orthopaedic Surgery, Chicago, Illinois.
| | - Cort D Lawton
- Northwestern Memorial Hospital Department of Orthopaedic Surgery, Chicago, Illinois
| | - Daniel J Johnson
- Northwestern Memorial Hospital Department of Orthopaedic Surgery, Chicago, Illinois
| | - Richard W Nicolay
- Northwestern Memorial Hospital Department of Orthopaedic Surgery, Chicago, Illinois
| | | | - Michael D Stover
- Northwestern Memorial Hospital Department of Orthopaedic Surgery, Chicago, Illinois
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Hopkins L, Robinson DBT, Brown C, Egan R, Iorwerth A, Holt M, Lewis WG. Trauma and Orthopedic Surgery Curriculum Concordance: An Operative Learning Curve Trajectory Perspective. J Surg Educ 2019; 76:1569-1578. [PMID: 31147300 DOI: 10.1016/j.jsurg.2019.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/07/2019] [Accepted: 05/15/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Certification of completion of training in Trauma and Orthopedic (T&O) surgery in the UK requires the demonstration of operative competence in 12 index procedures, achieved through attaining a level 4 consultant-validated procedure-based assessment (PBA). The aim of this study was to evaluate the trajectory of operative learning curves related to PBA performance with respect to operative caseload and training time. DESIGN Logbook data from consecutive 24 higher T&O trainees were compared with PBA evaluations to determine the relationship between PBA level, operative experience, training time, and indicative numbers. Learning curve gradients were calculated using trigonometry related to operative experience and training time. SETTING A higher surgical orthopedic training program serving a single UK (Wales) Deanery. PARTICIPANTS Twenty-four consecutive higher T&O surgery trainees. RESULTS Median caseload to achieve level 4 competences ranged from 9 (interquartile range 6-12) for tension band wiring (olecranon or patella) to 101 (61-127) for arthroscopy, with significant variation between all 12 procedures (p < 0.001). Median number of PBAs to reach level 4 competences was 4 (2-6) with significant variation between procedures (p < 0.001). Median learning curve gradients to achieve level 4 competence for tension band wiring were 68.2° and 33.7° by caseload and training time respectively, compared with 12.2° and 45° for arthroscopy, with significant learning curve variation for all procedures related to caseload between first level 3 and first level 4 PBA (p < 0.001). Competence ratios were <1 (median 0.99, range 0.70-2.53) for 6 of the 12 indicative procedures. CONCLUSIONS Significant learning curve trajectory variance was observed, with discrepancies between indicative operative numbers and the point at which competence was judged achieved. Numbers of index operations to achieve certification of completion of training warrant further examination.
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Affiliation(s)
- Luke Hopkins
- Wales PGMDE School of Surgery, Health Education and Improvement Wales, Cardiff, United Kingdom.
| | - David B T Robinson
- Wales PGMDE School of Surgery, Health Education and Improvement Wales, Cardiff, United Kingdom
| | - Christopher Brown
- Wales PGMDE School of Surgery, Health Education and Improvement Wales, Cardiff, United Kingdom
| | - Richard Egan
- Department of Surgery, Morriston Hospital, Heol Maes Eglwys, Swansea, United Kingdom
| | - Awen Iorwerth
- Wales PGMDE School of Surgery, Health Education and Improvement Wales, Cardiff, United Kingdom
| | - Mark Holt
- Wales PGMDE School of Surgery, Health Education and Improvement Wales, Cardiff, United Kingdom
| | - Wyn G Lewis
- Wales PGMDE School of Surgery, Health Education and Improvement Wales, Cardiff, United Kingdom
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Noonan M, Olaussen A, Mathew J, Mitra B, Smit DV, Fitzgerald M. What Is the Clinical Evidence Supporting Trauma Team Training (TTT): A Systematic Review and Meta-Analysis. ACTA ACUST UNITED AC 2019; 55:medicina55090551. [PMID: 31480360 PMCID: PMC6780651 DOI: 10.3390/medicina55090551] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 02/03/2023]
Abstract
Background and Objectives: Major trauma centres manage severely injured patients using multi-disciplinary teams but the evidence-base that targeted Trauma Team Training (TTT) improves patients’ outcomes is unclear. This systematic review aimed to identify the association between the implementation of TTT programs and patient outcomes. Materials and Methods: We searched OVID Medline, PubMed and The Cochrane Library (CENTRAL) from the date of the database commencement until 10 of April 2019 for a combination of Medical Subject Headings (MeSH) terms and keywords relating to TTT and clinical outcomes. Reference lists of appraised studies were also screened for relevant articles. We extracted data on the study setting, type and details about the learners, as well as clinical outcomes of mortality and/or time to critical interventions. A meta-analysis of the association between TTT and mortality was conducted using a random effects model. Results: The search yielded 1136 unique records and abstracts, of which 18 full texts were reviewed. Nine studies met final inclusion, of which seven were included in a meta-analysis of the primary outcome. There were no randomised controlled trials. TTT was not associated with mortality (Pooled overall odds ratio (OR) 0.83; 95% Confidence Interval; 0.64–1.09). TTT was associated with improvements in time to operating theatre and time to first computerized tomography (CT) scanning. Conclusions: Despite few publications related to TTT, its introduction was associated with improvements in time to critical interventions. Whether such improvements can translate to improvements in patient outcomes remains unknown. Further research focusing on the translation of standardised trauma team reception “actions” into TTT is required to assess the association between TTT and patient outcome.
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Affiliation(s)
- Michael Noonan
- National Trauma Research Institute, Melbourne 3004, Australia
- Trauma Service, The Alfred Hospital, Melbourne 3004, Australia
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne 3004, Australia
| | - Alexander Olaussen
- National Trauma Research Institute, Melbourne 3004, Australia
- Department of Community Emergency Health and Paramedic Practice (DCEHPP), Monash University, Melbourne 3199, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Joseph Mathew
- National Trauma Research Institute, Melbourne 3004, Australia
- Trauma Service, The Alfred Hospital, Melbourne 3004, Australia
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne 3004, Australia
| | - Biswadev Mitra
- National Trauma Research Institute, Melbourne 3004, Australia.
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne 3004, Australia.
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia.
| | - De Villiers Smit
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne 3004, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Mark Fitzgerald
- National Trauma Research Institute, Melbourne 3004, Australia
- Trauma Service, The Alfred Hospital, Melbourne 3004, Australia
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Hall MA, Speegle D, Glaser CJ. Civilian-Military Trauma Partnerships and the Visiting Surgeon Model for Maintaining Medical Readiness. J Surg Educ 2019; 76:738-744. [PMID: 30472059 DOI: 10.1016/j.jsurg.2018.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 09/13/2018] [Accepted: 10/08/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The main objective of this paper is to create a model to predict the amount of trauma experience at a level 1 trauma center a visiting surgeon can expect to obtain with near certainty, in a specific amount of time, to maintain trauma skills. DESIGN The trauma database of level 1 trauma center (Saint Louis University Hospital, a military civilian partnership site) was examined to identify all urgent trauma cases between 1 October 2015 and 30 September 2017. Using retrospective data, a prospective hypothesis of a mixture of various case exposures a visiting surgeon may experience was made using Monte Carlo statistical methods, various probabilities for wartime relevant specialties were examined. SETTING Saint Louis University Hospital, a level 1 trauma and tertiary referral center. PARTICIPANTS Trauma patients between the dates October 1, 2015 and September 30, 2017 that underwent an operation at Saint Louis University Hospital. RESULTS Orthopedics and general/trauma surgery had the largest number of urgent trauma cases with an average daily amount of 1.03 and 0.49 cases, respectively. Using Monte Carlo methods, various scenarios and probabilities were tabulated. For example, a general surgeon on shift for 10days could expect to experience 4.9 (95% confidence interval 1-11) urgent cases or a visiting surgeon would require twenty-six 24-hour shifts in the summer to have a 95% certainty to experience at least 10 cases. CONCLUSIONS Other than for orthopedics, prolonged training timelines would be required to expose a visiting surgeon to multiple operative trauma cases. Though a specific number of cases to achieve "readiness" is undefined, a visiting-surgeon model may be unacceptable if a large number of cases are required prior to military deployment. This predictive model could be extrapolated to other centers and assist in identifying adequate settings and durations of trauma training sites.
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Affiliation(s)
- Maj Andrew Hall
- Center for the Sustainment of Trauma and Readiness Skills, St. Louis, Missouri.
| | - Darrin Speegle
- Department of Mathematics and Statistics, Saint Louis University, St. Louis, Missouri
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Mackenzie CF, Tisherman SA, Shackelford S, Sevdalis N, Elster E, Bowyer MW. Efficacy of Trauma Surgery Technical Skills Training Courses. J Surg Educ 2019; 76:832-843. [PMID: 30827743 DOI: 10.1016/j.jsurg.2018.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/07/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Because open surgical skills training for trauma is limited in clinical practice, trauma skills training courses were developed to fill this gap, The aim of this report is to find supporting evidence for efficacy of these courses. The questions addressed are: What courses are available and is there robust evidence of benefit? DESIGN We performed a systematic review of the training course literature on open trauma surgery procedural skills courses for surgeons using Kirkpatrick's framework for evaluating complex educational interventions. Courses were identified using Pubmed, Google Scholar and other databases. SETTING AND PARTICIPANTS The review was carried out at the University of Maryland, Baltimore with input from civilian and military trauma surgeons, all of whom have taught and/or developed trauma skills courses. RESULTS We found 32 course reports that met search criteria, including 21 trauma-skills training courses. Courses were of variable duration, content, cost and scope. There were no prospective randomized clinical trials of course impact. Efficacy for most courses was with Kirkpatrick level 1 and 2 evidence of benefit by self-evaluations, and reporting small numbers of respondents. Few courses assessed skill retention with longitudinal data before and after training. Three courses, namely: Advanced Trauma Life Support (ATLS), Advanced Surgical Skills for Exposure in Trauma (ASSET) and Advanced Trauma Operative Management (ATOM) have Kirkpatrick's level 2-3 evidence for efficacy. Components of these 3 courses are included in several other courses, but many skills courses have little published evidence of training efficacy or skills retention durability. CONCLUSIONS Large variations in course content, duration, didactics, operative models, resource requirements and cost suggest that standardization of content, duration, and development of metrics for open surgery skills would be beneficial, as would translation into improved trauma patient outcomes. Surgeons at all levels of training and experience should participate in these trauma skills courses, because these procedures are rarely performed in routine clinical practice. Faculty running courses without evidence of training benefit should be encouraged to study outcomes to show their course improves technical skills and subsequently patient outcomes. Obtaining Kirkpatrick's level 3 and 4 evidence for benefits of ASSET, ATOM, ATLS and for other existing courses should be a high priority.
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Affiliation(s)
- Colin F Mackenzie
- Shock Trauma Anesthesiology Research Center, Baltimore, Maryland; University of Maryland School of Medicine, Baltimore, Maryland.
| | | | | | - Nick Sevdalis
- Center for Implementation Science, Kings College, London, UK.
| | - Eric Elster
- Department of Surgery, The Uniformed Services University of Health Sciences and the Walter Reed National Military Medical Center, Bethesda, Maryland.
| | - Mark W Bowyer
- Department of Surgery, The Uniformed Services University of Health Sciences and the Walter Reed National Military Medical Center, Bethesda, Maryland.
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Onufer EJ, Cullinan DR, Wise PE, Punch LJ. Trauma Technical Skill and Management Exposure for Junior Surgical Residents - The "SAVE Lab 1.0". J Surg Educ 2019; 76:824-831. [PMID: 30595474 PMCID: PMC6615483 DOI: 10.1016/j.jsurg.2018.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 11/28/2018] [Accepted: 12/08/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The "Surgery for Abdomino-thoracic ViolencE (SAVE)" animate lab engages surgical residents in the management of complex penetrating injuries. We hypothesized that residents will improve their understanding of the management of trauma patients and will perform skills that they have not previously performed in training. DESIGN Pre- and postlab assessments were reviewed from surgical residents participating in the SAVE lab over 2 years (2017-2018). Residents of varying levels were grouped and reviewed "real-life" trauma scenarios with supplemental imaging. Seniors were tasked with creating injuries while juniors performed as primary surgeons under supervision. Each successive scenario increased in difficulty, from hollow viscus injury and solid organ disruption, to great vessel and cardiac injuries with the goal to "SAVE" the patient. Assessments included a pre- and postlab multiple-choice questionnaire of trauma management knowledge and a survey of completed technical skills. SETTING Academic General Surgery residency program. PARTICIPANTS General, Vascular, Urology, and Plastic Surgery PGY1 to PGY5 residents. RESULTS One hundred and nineteen residents participated in the SAVE lab in 2017 and 2018. PGY1 to PGY4 residents showed significant improvement in knowledge of trauma management on matched pre- and postlab assessments. The most significant improvement was seen in the PGY1 and PGY2 residents, with scores increasing by 21% (p < 0.001) and 13% (p < 0.001), respectively. PGY1-3 residents had a significant increase in new technical skills acquisition. PGY5 residents showed no significant changes in either realm. CONCLUSIONS The SAVE lab was effective in increasing junior surgical residents' technical skills as well as fund of knowledge related to complex trauma care. While seniors had previously performed most of these skills as reflected in their assessments, the SAVE lab provided a way for them to assume the role of team leader, guiding management of complex, and high acuity situations. Future endeavors include teamwork and leadership skills' assessment through the SAVE lab.
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Affiliation(s)
- Emily J Onufer
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
| | - Darren R Cullinan
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Paul E Wise
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Laurie J Punch
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
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Schyma BM, Cole E, Wren SM, Brohi K, Brundage SI. Delivering trauma mastery with an international trauma masters. Injury 2019; 50:877-882. [PMID: 30935745 DOI: 10.1016/j.injury.2019.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/14/2018] [Accepted: 03/16/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Trauma is a global problem. The goal of optimising multidisciplinary trauma care through speciality education is a challenge. No single pathway exists to educate care providers in trauma knowledge, management and skills. Queen Mary University of London (QMUL) devised an online electronic learning (e-learning) Master's degree (MSc) in Trauma Sciences in 2011. E-learning is increasingly popular however low progression rates question effectiveness. The further post-graduate impact is unknown. Our goal was to establish whether this program is a successful method of delivering multidisciplinary trauma education to an international community. We hypothesized that graduating students make a global impact in trauma care, education and research. METHODS The Trauma Sciences MSc programs launched in 2011. Electronic surveys were distributed worldwide to students who successfully completed the program between 2013-2016. Graduation rates, degree/qualification awarded, clinical involvement in trauma management, presentation of MSc work, academic progression and roles in trauma education were explored. Supporting demographics were extracted from the QMUL student database. RESULTS A total of 176 students, of 29 nationalities, enrolled in the two year course between 2011 and 2014. Clinical backgrounds included multi-speciality physicians (83.5%), nurses (9.6%) and paramedics (6.8%). 119 (67.6%) graduated within the study period, 108 (60.8%) with the full masters award. Completion was independent of clinical background (p = 0.20) and age (p = 0.99). Highest completion rates were seen in students from Australia and New Zealand, Asia and Europe (p = 0.03). All survey responders were currently providing regular clinical care to trauma patients. 73% (n = 36) were delivering trauma education, many at national or international level. 49% (n = 24) had presented work from the MSc and 23% (n = 11) published their dissertation.12% (n = 6) subsequently enrolled in a PhD program. CONCLUSION Compared with other e-learning courses this Masters program has an enviable completion rate. Graduates go on to make an international multidisciplinary impact with diverse roles in clinical management, research and trauma education. This programme provides a robust trauma education curriculum. The QMUL Trauma Sciences MSc program is an excellent resource for clinicians participating in any form of trauma care or who wish to augment sub-speciality training in trauma.
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Affiliation(s)
- Barry M Schyma
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, UK.
| | - Elaine Cole
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, UK
| | - Sherry M Wren
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, UK; Department of Surgery, Stanford University, USA
| | - Karim Brohi
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, UK
| | - Susan I Brundage
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, UK
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Rodríguez-Pozos E, Medina-Pontaza O, Quintela-Núñez Del Prado H, Medina-Rodríguez F, Torres-González R, Takajashi-Medina FE, Quiroz-Williams J, Pérez-Hernández E, Barrera-García MI, Amaya-Zepeda RA. [Evaluation of the educational intervention in orthopaedic and traumatology residents for the taking, measurement and preparations of the hamstring graft]. Acta Ortop Mex 2019; 33:102-106. [PMID: 31480111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The education process is understood as an activity focused on developing competencies through the use of educational tools and strategies that can be evaluated. The training of the residents in traumatology and orthopedics requires you to acquire knowledge and develop skills that will affect the diagnosis, treatment and prognosis of the patient. Therefore, what will be the evaluation of the educational intervention on the theoretical and practical knowledge in this group of physicians on the technique of taking, measuring and preparation of hamstring graft for the reconstruction of anterior cruciate ligament? MATERIAL Y METHODS A prospective, quasi-experimental study was conducted to evaluate the impact of educational intervention in 23 Traumatology and orthopaedic residents on the use of hamstring in the anterior cruciate ligament reconstruction through theoretical sessions and Practice on cadaverous knees with preand post-intervention evaluations. RESULTS The correlation between the pre and post evaluation educational intervention, both theoretical and practical, was statistically significant (p = 0.004 and p = 0.4, respectively). CONCLUSION The statistically significant correlation between preand post-educational intervention evaluations speaks of the value of learning strategies, in the case of this study, the intervention through a theoretical and practical session by a simulated patient promotes knowledge acquisition and development of skills.
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Affiliation(s)
- E Rodríguez-Pozos
- Unidad Médica de Alta Especialidad (UMAE) Traumatología, Ortopedia y Rehabilitación «Dr. Victorio de la Fuente Narváez», Instituto Mexicano del Seguro Social (IMSS), Ciudad de México. México
| | - O Medina-Pontaza
- Departamento Clínico del Servicio de Cirugía Articular Reconstructiva. Unidad Médica de Alta Especialidad (UMAE) Traumatología, Ortopedia y Rehabilitación «Dr. Victorio de la Fuente Narváez», Instituto Mexicano del Seguro Social (IMSS), Ciudad de México. México
| | - H Quintela-Núñez Del Prado
- Departamento Clínico del Servicio de Cirugía Articular Reconstructiva. Unidad Médica de Alta Especialidad (UMAE) Traumatología, Ortopedia y Rehabilitación «Dr. Victorio de la Fuente Narváez», Instituto Mexicano del Seguro Social (IMSS), Ciudad de México. México
| | - F Medina-Rodríguez
- Unidad Médica de Alta Especialidad (UMAE) Traumatología, Ortopedia y Rehabilitación «Dr. Victorio de la Fuente Narváez», Instituto Mexicano del Seguro Social (IMSS), Ciudad de México. México
| | - R Torres-González
- Educación e Investigación. Unidad Médica de Alta Especialidad (UMAE) Traumatología, Ortopedia y Rehabilitación «Dr. Victorio de la Fuente Narváez», Instituto Mexicano del Seguro Social (IMSS), Ciudad de México. México
| | | | - J Quiroz-Williams
- División de Investigación en Salud. Unidad Médica de Alta Especialidad (UMAE) Traumatología, Ortopedia y Rehabilitación «Dr. Victorio de la Fuente Narváez», Instituto Mexicano del Seguro Social (IMSS), Ciudad de México. México
| | - E Pérez-Hernández
- División de Educación en Salud. Unidad Médica de Alta Especialidad (UMAE) Traumatología, Ortopedia y Rehabilitación «Dr. Victorio de la Fuente Narváez», Instituto Mexicano del Seguro Social (IMSS), Ciudad de México. México
| | - M I Barrera-García
- División de Educación e Investigación en Salud. Unidad Médica de Alta Especialidad (UMAE) Traumatología, Ortopedia y Rehabilitación «Dr. Victorio de la Fuente Narváez», Instituto Mexicano del Seguro Social (IMSS), Ciudad de México. México
| | - R A Amaya-Zepeda
- Coordinación Clínica de Educación e Investigación en Salud. Unidad Médica de Alta Especialidad (UMAE) Traumatología, Ortopedia y Rehabilitación «Dr. Victorio de la Fuente Narváez», Instituto Mexicano del Seguro Social (IMSS), Ciudad de México. México
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Gotlib Conn L, Nathens AB, Soobiah C, Tien H, Haas B. Uncovering Cultural Barriers to Quality Improvement Learning in a Trauma Program: An Ethnographic Study. J Surg Educ 2019; 76:497-505. [PMID: 30111519 DOI: 10.1016/j.jsurg.2018.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/03/2018] [Accepted: 07/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Quality improvement (QI) training is an essential component of postgraduate surgical education and can occur through formal and informal education programs. Informal QI education requires that faculty take advantage of learning opportunities in the hospital setting. Trauma rotations appear ideal opportunities for informal QI learning given that performance improvement is a mandatory component of care at verified trauma centers. It is unclear, however, whether QI initiatives within trauma programs are well integrated into trainee education. This study explored the QI learning environment in a level 1 academic trauma center. STUDY DESIGN An ethnographic study using observation and interviews methods. The theoretical lens of hidden curriculum was used to interpret the data and generate hypotheses around faculty and trainee experiences. SETTING University of Toronto and Sunnybrook Health Sciences Center. PARTICIPANTS Twenty-seven observations involving more than 50 faculty and trainees; seventeen interviews with faculty and surgical trainees. RESULTS All faculty and trainees endorsed QI and informal QI learning. Discrepant experiences were found regarding opportunities to learn and do QI in the clinical setting. Faculty viewed themselves as perpetually doing and teaching QI while trainees perceived little to no QI learning. Trainees identified Morbidity and Mortality rounds as the main opportunity for QI learning; however, traditional teaching style through "pimping" and a largely clinical focus acted as barriers to QI education. Furthermore, trainees chiefly viewed QI as service to the institution, rather than as a form of learning, which contributed to their disinterest in taking up informal QI lessons. CONCLUSION Informal QI education is highly valued and desired in academic trauma centers but enduring teaching methods, inconsistencies in the cultural learning environment and a hidden curriculum devaluing QI learning are persistent barriers to change.
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Affiliation(s)
- Lesley Gotlib Conn
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario Canada.
| | - Avery B Nathens
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario Canada; Department of Surgery, University of Toronto, Toronto, Ontario Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario Canada.
| | - Charlene Soobiah
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario Canada.
| | - Homer Tien
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario Canada; Department of Surgery, University of Toronto, Toronto, Ontario Canada.
| | - Barbara Haas
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario Canada; Department of Surgery, University of Toronto, Toronto, Ontario Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario Canada.
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Rosales RS, Landin L, Corella F. Hand surgery in Spain. J Hand Surg Eur Vol 2019; 44:332-334. [PMID: 30784374 DOI: 10.1177/1753193418818945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - Luis Landin
- 2 Plastic Surgery Division, IdiPaz-FIBHULP University Hospital La Paz, Madrid, Spain
| | - Fernando Corella
- 3 Orthopedic and Trauma Department, Infanta Leonor University Hospital, Madrid, Spain
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Gala SG, Crandall ML. Global Collaboration to Modernize Advanced Trauma Life Support Training. J Surg Educ 2019; 76:487-496. [PMID: 30245060 DOI: 10.1016/j.jsurg.2018.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/13/2018] [Accepted: 08/07/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Each year, thousands of surgeons and other trauma health care providers participate in the American College of Surgeon's Advanced Trauma Life Support (ATLS) program, which historically has allowed trainees to practice cricothyroidotomy, chest tube insertion, pericardiocentesis, venous cutdown, and diagnostic peritoneal lavage on live dogs, pigs, sheep, and goats. However, more than 99% of ATLS programs in the United States and Canada have now ended animal use, driven primarily by simulation technology advancements. OBJECTIVE This review details an international survey of animal versus simulation use in ATLS programs and summarizes the surgical training impact of a novel collaboration between the industry manufacturer of the TraumaMan human simulator, Simulab Corporation (Seattle, Washington), and an animal protection nongovernmental organization (NGO) based in Norfolk, Virginia, to replace animal use in ATLS programs with human simulators. METHODS From 2012 through 2017, the NGO e-mailed formal surveys concerning program statistics and animal use practices to ATLS officials in various countries (N = 64). The survey response rate was 87.5% and included pre- and post-comparison surveys relative to the industry-NGO simulation collaboration. RESULTS Eighteen ATLS programs (32.1%) initially replied that they use nonanimal training methods, whereas 38 ATLS programs (67.8%) replied that they use animals for surgical skills training and cited financial constraints as the primary barrier to adopting human simulation methods. Through the industry-NGO collaboration, the NGO donated 119 TraumaMan models valued at nearly $3 million (USD) to ATLS programs in 22 countries, such that 75% of those ATLS programs surveyed by the NGO now use exclusively nonanimal simulation models. CONCLUSIONS The industry-NGO collaboration successfully transformed the surgical skills laboratories of 22 international ATLS programs to replace animal use with nonanimal simulation models that are more anatomically realistic, cost less, and allow trainees to repeat surgical skills until proficiency.
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Affiliation(s)
- Shalin G Gala
- Laboratory Investigations Department, People for the Ethical Treatment of Animals, Norfolk, Virginia.
| | - Marie L Crandall
- Department of Surgery, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida
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Hättich A, Münzberg M, Plugge C, Seemann R, Wenzel L. [Not Available]. Z Orthop Unfall 2019; 157:19. [PMID: 30795015 DOI: 10.1055/a-0785-0609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Tugnoli G, Ribaldi S, Calderale SM. Learning on animal models: a 16-year experience with the theoretical-practical course on surgery of polytrauma. Ann Ital Chir 2019; 90:379-381. [PMID: 31815734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The aim of this paper was to highlight, the important features of this course: - an update on the pathophysiology of the trauma patient, on the common maneuvers of damage control surgery and their indications, on surgical techniques and their rationale in the various regions of the body, and indications and modalities of non-operative treatment (NOM); - participants test their knowledge and skills through an interactive approach, considering the resources of the hospitals of origin; - an extremely realistic approach to trauma surgery and likewise a possibility to observe and test, "in the field", products such as topical hemostatic agents, which are frequently used in this kind of surgery. KEY WORDS: Animal models, Training simulation.
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Gülenç B, Yalçin S, Sürücü S, Mahiroğullari M, Erdil M, Bülbül M. Orthopedics and Traumatology Residency - Working Conditions, Training, and Psychological Stress. Acta Chir Orthop Traumatol Cech 2019; 86:281-285. [PMID: 31524590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE OF THE STUDY The specialty of orthopedics and traumatology that is completed in the 5 years period in our country is a challenging educational process and our purpose in this study is to demonstrate through a survey training conditions of the orthopedic assistants in our country and the effects of this process on assistants. MATERIAL AND METHODS 524 (70.05%) of 748 assistants who receive specialization training in Turkey were reached. There were 20 multiple choice questions ( 1 mark each) and 3 questions (more than 1 mark each) in the survey consisting of twenty-three questions. Our study group was formed by doctors who have still worked as assistant in our country and have accepted to participate in the study. The doctors who finished assistantship with any reason and did assistantship for time less than 6 months and did not exactly fill the questionnaire form were excluded from the study. RESULTS 524 (71.97%) of 728 assistant who are in 40 (100%) of 40 provinces where assistant training given in Turkey were reached. 474 (90.45%) participants were satisfied to do orthopedic specialization. When considering working hours, it was observed that 337 (64.31%) participants had over 90 hours weekly including night shift and 521 (99.42%) participants had to work after night shift. The majority of participants (361 persons 68.89%) were receiving salaries between TL 4000-6000. When looking at the entire working group, the rate of participants who said that scientific training is weak or there is no scientific training was 427 (81.48%). CONCLUSIONS Our survey study is one of the first statistical study which investigating professional and social problems of orthopedic assistants. Some of important problems as training satisfaction, abuse by patients and/or manager, the average monthly income and psychological status assessment is emphasized. Orthopedics and Traumatology assistantship is a challenging process to cause physical and psychological problems with the hard working conditions in our Turkey. Key words:residency training, orthopedic surgery, life quality, salary.
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Affiliation(s)
- B Gülenç
- Medipol University, Orthopaedics & Traumatology Department, Istanbul-Turkey
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Mathieu F, Ellis MJ, Tator CH. Concussion education in Canadian medical schools: a 5 year follow-up survey. BMC Med Educ 2018; 18:316. [PMID: 30572879 PMCID: PMC6302298 DOI: 10.1186/s12909-018-1416-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/03/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Despite concussion now being recognized as a public health priority in Canada, recent studies-including our 2012 survey of Canadian medical schools-have revealed major gaps in concussion education at the undergraduate medical school level. METHODS We re-surveyed all 17 Canadian medical schools using a questionnaire divided in two categories: (1) concussion-specific education (2) head injury education incorporating a concussion component to determine whether there have been any improvements in concussion education at the medical school level during the last five years. For each year of medical school, respondents were asked to provide the estimated number of hours and teaching format for each category. RESULTS We received replies from 13 of the 17 medical schools (76%). 11 of the 13 (85%) medical schools now reported providing concussion-specific education compared to 29% in our 2012 survey. The mean number of hours dedicated to category 1 learning in 2017 was 2.65 h compared to 0.57 in 2012, and the mean number of hours of category 2 increased to 7.5 from 1.54. CONCLUSION Our follow-up study reveals increased exposure to concussion-related teaching in Canadian medical schools during the last five years. Persistent deficiencies in a minority of schools are highlighted. These should be addressed by reiterating the importance of concussion education for undergraduate medical students and by developing clear concussion-specific objectives at the national licensure level.
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Affiliation(s)
- François Mathieu
- Division of Neurosurgery, Department of Surgery, University of Toronto, 399 Bathurst St, Toronto, ON M5T2S8 Canada
| | - Michael J. Ellis
- Pan Am Clinic, Section of Neurosurgery, University of Manitoba, 75 Poseidon Bay, Winnipeg, MB R3M3E4 Canada
| | - Charles H. Tator
- Canadian Concussion Center, Division of Neurosurgery, University Health Network, Toronto Western Hospital, 399 Bathurst St, Toronto, ON M5T2S8 Canada
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Hall MA, Boecker MF, Englert MZ, Hanseman D, Fields MA. Objective Military Trauma Team Performance Improvement from Military-Civilian Partnerships. Am Surg 2018; 84:e555-e557. [PMID: 30606375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Hall MAB, Englert MZ, Hanseman D, Klein MA. Self-Efficacy Improvement for Performance of Trauma-Related Skills due to a Military-Civilian Partnership. Am Surg 2018; 84:e505-e507. [PMID: 30606357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Thompson R, Sullivan S, Campbell K, Osman I, Statz B, Jung HS. Does a Written Tool to Guide Structured Debriefing Improve Discourse? Implications for Interprofessional Team Simulation. J Surg Educ 2018; 75:e240-e245. [PMID: 30093336 DOI: 10.1016/j.jsurg.2018.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/01/2018] [Accepted: 07/02/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Timely debriefing following a simulated event supports learners in critically reflecting on their performance and areas for improvement. Content of debriefing has been shown to affect learner skill acquisition and retention. The use of good judgment statements from debriefing facilitators is considered superior to judgmental or nonjudgmental statements. Ideally, the majority of the conversation will consist of learner self-reflection and focused facilitation rather than directive performance feedback. We hypothesized that the introduction of a written tool to help facilitate high-quality debriefing techniques could improve the ratio of judgmental, nonjudgmental, and good judgment statements from facilitators, as well as shift the percentage of talk in the debrief away from directive performance feedback and toward self-assessment and focused facilitation. METHODS The University of Wisconsin Joint Trauma Simulation Program is an interdisciplinary project to improve quality of trauma care through simulation. Simulations use teams of five trauma trainees: two surgery residents, an emergency medicine resident, and two nurses. Three faculty members conducted the scenarios and debriefings. Debriefings were video recorded. Videos were transcribed and dialogue analyzed according to the teaching/learning strategy used in each turn of talk. Discourse was coded into three categories: (1) learner self-assessment; (2) focused facilitation; and (3) directive performance feedback. Each facilitation statement was coded as either (1) judgmental; (2) nonjudgmental, or (3) good judgment. The TEAM Debrief Tool is a written guide designed to help facilitators adhere to best practices, with example structure and phrasing, similar to the Promoting Excellence and Reflective Learning in Simulation tool. Pre- and post-implementation analysis was completed to assess for efficacy of the tool. RESULTS Seven videos before the implementation of the tool and seven videos after implementation were analyzed. The percentage of learner self-assessment increased significantly with tool use (7.23% vs 24.99%, p = 0.00004), and directive performance feedback decreased significantly (56.13% vs 32.75%, p = 0.0042). There was no significant change in the percentage of talk using focused facilitation. After implementation of the tool, there was a significant decrease in use of the nonjudgmental debriefing style (60.63% vs 37.31%, p = 0.00017), and a significant increase in the use of good judgment debriefing (38.77% vs 59.82%, p = 0.00038). There was also a slight increase in judgmental debriefing (0.60% vs 2.87%, p = 0.0027). CONCLUSIONS The discourse in our interprofessional trauma simulation debriefings unaided by a written debriefing tool skewed heavily toward direct performance feedback, with a preponderance of nonjudgmental statements. After introduction of the tool, dialogue shifted significantly toward learner self-assessment, and there was a large increase in utilization of debriefing with good judgment. This shift toward higher quality debriefing styles demonstrates the utility of such a tool in the debriefing of interprofessional simulations.
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Affiliation(s)
- Ryan Thompson
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
| | - Sarah Sullivan
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Krystle Campbell
- Clinical Simulation Program, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Ingie Osman
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Brianna Statz
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Hee Soo Jung
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
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Hoffmann R, Pennig D. [10 years German Society for Orthopedics and Trauma Surgery (DGOU): trauma surgery-quo vadis?]. Unfallchirurg 2018; 121:850-854. [PMID: 30178107 DOI: 10.1007/s00113-018-0548-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
On the occasion of the 10th anniversary of the foundation of the German Society for Orthopedics and Trauma Surgery (DGOU), the current General Secretary of the German Society for Trauma Surgery sees the need for a standpoint on trauma surgery in Germany. This manuscript outlines future options and perspectives for the development of trauma surgery in Germany.
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Affiliation(s)
- R Hoffmann
- Deutsche Gesellschaft für Unfallchirurgie e. V. (DGU), Straße des 17. Juni 106-108, 10623, Berlin, Deutschland.
- BG Unfallklinik Frankfurt am Main gGmbH, Friedberger Landstraße 430, 60389, Frankfurt am Main, Deutschland.
| | - D Pennig
- Deutsche Gesellschaft für Unfallchirurgie e. V. (DGU), Straße des 17. Juni 106-108, 10623, Berlin, Deutschland.
- Klinik für Unfallchirurgie, Orthopädie, Hand- und Wiederherstellungschirurgie, St. Vinzenz-Hospital, Akademisches Lehrkrankenhaus der Universität zu Köln, Merheimer Straße 221-223, 50733, Köln, Deutschland.
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Anderson GA, Kayima P, Ilcisin L, Benitez NP, Albutt KH, Briggs SM, Nehra D. Development of a Comprehensive Trauma Training Curriculum for the Resource-Limited Environment. J Surg Educ 2018; 75:1317-1324. [PMID: 29555307 DOI: 10.1016/j.jsurg.2018.02.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/05/2018] [Accepted: 02/20/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The goal of this project was to create a multitiered trauma training curriculum that was designed specifically for the low-resource setting. DESIGN We developed 2 courses designed to teach principles and skills necessary for trauma care. The first course, "Emergency Ward Management of Trauma (EWMT)," is designed to teach interns the initial assessment and stabilization of trauma patients in the emergency ward. The second course for mid-level surgical residents, "Surgical Techniques and Repairs in Trauma for the Low-resource Environment" (STaRTLE), is a cadaver-based operative trauma course designed to teach surgical exposures and techniques. The courses were rolled out at Mbarara Regional Referral Hospital in the low-income country of Uganda. Precourse and postcourse tests and surveys were administered. SETTING This study took place at Mbarara Regional Referral Hospital (MRRH). This is a hospital in southwest Uganda with a subspecialty care, a medical school, nursing school, and multiple residency programs. PARTICIPANTS Students in the EWMT course were interns at MRRH. After 1 year of training, most of these interns will become medical officers as the only provider at a district hospital in Uganda. The students in the STARTLE course were second-year residents in the general surgery program at MRRH. RESULTS Scores on knowledge based tests improved significantly with both courses. Survey results from the EWMT course suggest that participants feel better prepared to care for the injured patient (median Likert [IQR]: 5.0 [5.0-5.0]) and that their practice improved (5.0 [5.0-5.0]). Similarly, following the STaRTLE course we found participants felt significantly more comfortable with performing 20 of the 22 operative procedures taught. CONCLUSIONS These courses represent a feasible, cost-effective, and resource appropriate trauma education curriculum that if standardized and implemented may improve trauma care and outcomes in the resource-limited setting.
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Affiliation(s)
- Geoffrey A Anderson
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
| | - Peter Kayima
- Department of Surgery, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Lenka Ilcisin
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Noralis Portal Benitez
- Department of Surgery, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Katherine H Albutt
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
| | - Susan M Briggs
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Deepika Nehra
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Sullivan S, Campbell K, Ross JC, Thompson R, Underwood A, LeGare A, Osman I, Agarwal SK, Jung HS. Identifying Nontechnical Skill Deficits in Trainees Through Interdisciplinary Trauma Simulation. J Surg Educ 2018; 75:978-983. [PMID: 29100919 PMCID: PMC5955804 DOI: 10.1016/j.jsurg.2017.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/08/2017] [Accepted: 10/11/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The goal of this study was to investigate nontechnical skills in a simulated trauma setting both before and after a debriefing session in order to better understand areas to target for the development of educational interventions. DESIGN Wilcoxon signed rank tests were used to compare scores on the 5 domains of the T-NOTECHS pre- and postdebriefings. A qualitative analysis using the PEARLS debriefing framework was performed to provide a rich description of the strategies used by the debriefing facilitators. SETTING The Joint Trauma Simulation Program is an interdisciplinary project designed to improve the quality of trauma care through simulation exercises emphasizing nontechnical skills development. PARTICIPANTS Thirteen teams of 5 trauma trainees participated in trauma resuscitation simulations: a surgical chief resident, a surgical junior resident, an emergency medicine resident, and 2 emergency medicine nurses. RESULTS Teams significantly improved on communication and interaction skills in the simulation scenarios from pre- to postdebriefing. The debrief facilitators spent most of their time engaged in Directive Performance Feedback (56.13%). CONCLUSIONS Interprofessional team simulation in trauma resuscitation scenarios followed by debriefing differently affected individual nontechnical skills domains. Additional facilitation strategies, such as focused facilitation and encouraging learner self-assessment, may target other nontechnical skills in different ways.
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Affiliation(s)
- Sarah Sullivan
- Department of Surgery, University of Wisconsin, Madison, Wisconsin.
| | | | - Joshua C Ross
- Department of Emergency Medicine, University of Wisconsin, Madison, Wisconsin
| | - Ryan Thompson
- Department of Emergency Medicine, University of Wisconsin, Madison, Wisconsin
| | - Alyson Underwood
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Anne LeGare
- Nursing, UWHC Emergency Services, Madison, Wisconsin
| | - Ingie Osman
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Suresh K Agarwal
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Hee Soo Jung
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
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Gutenstein M, Kiuru S. Development of an otitis media strategy in the Pacific: key informant perspectivesThe Matthew effect in New Zealand rural hospital trauma and emergency care: why rural simulation-based education matters. N Z Med J 2018; 131:81-84. [PMID: 29879729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We describe a phenomenon of self-reinforcing inequality between New Zealand rural hospitals and urban trauma centres. Rural doctors work in remote geographical locations, with rare exposure to managing critical injuries, and with little direct support when they do. Paradoxically, but for the same reasons, they also have little access to the intensive training resources and specialist oversight of their university hospital colleagues. In keeping with international experience, we propose that using simulation-based education for rural hospital trauma and emergency team training will mitigate this effect. Along with several different organisations in New Zealand, the University of Otago rural postgraduate programme is developing inter-professional simulation content to address this challenge and open new avenues for research.
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Affiliation(s)
- Marc Gutenstein
- Professional Practice Fellow, Rural Postgraduate Programme, Dean's Department Dunedin, University of Otago
| | - Sampsa Kiuru
- Clinical Senior Lecturer in Rural Health, Rural Health Academic Centre Ashburton, University of Otago
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Knobel A, Overheu D, Gruessing M, Juergensen I, Struewer J. Regular, in-situ, team-based training in trauma resuscitation with video debriefing enhances confidence and clinical efficiency. BMC Med Educ 2018; 18:127. [PMID: 29879979 PMCID: PMC5992768 DOI: 10.1186/s12909-018-1243-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 05/25/2018] [Indexed: 05/22/2023]
Abstract
BACKGROUND To assess the clinical impact of a regular, multidisciplinary, video debriefed training intervention for trauma team members on real trauma resuscitations. In addition, attending personnel evaluated the training program via questionnaire. METHODS The training intervention is a regular (monthly), video debriefed, team-based trauma simulation. Training takes place in the fully functional resuscitation bay (in-situ) of the Department of Traumatology at the Klinikum Oldenburg (Level 1, primary teaching hospital for the Carl von Ossietzky University Oldenburg) involving a complete trauma team. Laerdal® Resusci Anne® dummy serves as the patient simulator. A special feature is a structured video debriefing of each participating team to analyse team performance. Data before and after implementation of training was retrospectively analysed. RESULTS We found a significant decrease in the time from arrival of the patient to computer tomography (CT, Spearman rank coefficient r = - 0.236, p = 0.001). Evaluation of the questionnaire by team members described a significant increase in self-confidence (p < 0.05). CONCLUSION Monthly video assisted team based in situ training with video debriefing significantly reduces resuscitation time in the emergency bay.
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Affiliation(s)
- Alexander Knobel
- Department of Orthopaedics and Trauma Surgery, Carl von Ossietzky Universität Oldenburg, Klinikum Oldenburg, Rahel-Straus Str. 10, 26133 Oldenburg, Germany
| | - Daniel Overheu
- Department of Anaesthesiology, Carl von Ossietzky Universität Oldenburg, Klinikum Oldenburg, Rahel-Straus Str. 10, 26133 Oldenburg, Germany
| | - Matthias Gruessing
- Department of Orthopaedics and Trauma Surgery, Carl von Ossietzky Universität Oldenburg, Klinikum Oldenburg, Rahel-Straus Str. 10, 26133 Oldenburg, Germany
| | - Ingke Juergensen
- Department of Orthopaedics and Trauma Surgery, Carl von Ossietzky Universität Oldenburg, Klinikum Oldenburg, Rahel-Straus Str. 10, 26133 Oldenburg, Germany
| | - Johannes Struewer
- Department of Orthopaedics and Trauma Surgery, Carl von Ossietzky Universität Oldenburg, Klinikum Oldenburg, Rahel-Straus Str. 10, 26133 Oldenburg, Germany
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Murphy M, Curtis K, Lam MK, Palmer CS, Hsu J, McCloughen A. Simulation-based multidisciplinary team training decreases time to critical operations for trauma patients. Injury 2018; 49:953-958. [PMID: 29338852 DOI: 10.1016/j.injury.2018.01.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/22/2017] [Accepted: 01/08/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Simulation has been promoted as a platform for training trauma teams. However, it is not clear if this training has an impact on health service delivery and patient outcomes. This study evaluates the association between implementation of a simulation based multidisciplinary trauma team training program at a metropolitan trauma centre and subsequent patient outcomes. METHOD This was a retrospective review of trauma registry data collected at an 850-bed Level 1 Adult Trauma Centre in Sydney, Australia. Two concurrent four-year periods, before and after implementation of a simulation based multidisciplinary trauma team training program were compared for differences in time to critical operations, Emergency Department (ED) length of stay (LOS) and patient mortality. RESULTS There were 2389 major trauma patients admitted to the hospital during the study, 1116 in the four years preceding trauma team training (the PREgroup) and 1273 in the subsequent 4 years (the POST group). There were no differences between the groups with respect to gender, body region injured, incidence of polytrauma, and pattern of arrival to ED. The POST group was older (median age 54 versus 43 years, p < 0.001) and had a higher incidence of falls and assaults (p < 0.001). There was a reduction in time to critical operation, from 2.63 h (IQR 1.23-5.12) in the PRE-group to 0.55 h (IQR 0.22-1.27) in the POST-group, p < 0.001. The overall ED LOS increased, and there was no reduction in mortality. Post-hoc analysis found LOS in ED was reduced in the cohort requiring critical operations, p < 0.001. CONCLUSION The implementation of trauma team training was associated with a reduction in time to critical operation while overall ED length of stay increased. Simulation is promoted as a platform for training teams; but the complexity of trauma care challenges efforts to demonstrate direct links between multidisciplinary team training and improved outcomes. There remain considerable gaps in knowledge as to how team training impacts health service delivery and patient outcomes. LEVEL OF EVIDENCE Retrospective comparative therapeutic/care management study, Level III evidence.
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Affiliation(s)
- Margaret Murphy
- Sydney Nursing School, University of Sydney, Australia; Emergency Department, Westmead Hospital, Australia.
| | - Kate Curtis
- Sydney Nursing School, University of Sydney, Australia; Emergency Department, Illawarra Shoalhaven, Australia
| | - Mary K Lam
- Faculty of Health, University of Technology, Sydney, Australia
| | - Cameron S Palmer
- Trauma Service, Royal Children's Hospital Melbourne, Melbourne, Australia; Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia
| | - Jeremy Hsu
- Trauma Service, Westmead Hospital, Australia
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Zhang LY, Zhang XZ, Bai XJ, Zhang M, Zhao XG, Xu YA, Tan H, Li Y. Current trauma care system and trauma care training in China. Chin J Traumatol 2018; 21:73-76. [PMID: 29395429 PMCID: PMC5911734 DOI: 10.1016/j.cjtee.2017.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 02/04/2023] Open
Abstract
Trauma is a life-threatening "modern disease". The outcomes could only be optimized by cost-efficient and prompt trauma care, which embarks on the improvement of essential capacities and conceptual revolution in addition to the disruptive innovation of the trauma care system. According to experiences from the developed countries, systematic trauma care training is the cornerstone of the generalization and the improvement on the trauma care, such as the Advance Trauma Life Support (ATLS). Currently, the pre-hospital emergency medical services (EMS) has been one of the essential elements of infrastructure of health services in China, which is also fundamental to the trauma care system. Hereby, the China Trauma Care Training (CTCT) with independent intellectual property rights has been initiated and launched by the Chinese Trauma Surgeon Association to extend the up-to-date concepts and techniques in the field of trauma care as well to reinforce the generally well-accepted standardized protocols in the practices. This article reviews the current status of the trauma care system as well as the trauma care training.
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Affiliation(s)
- Lian-Yang Zhang
- Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Daping Hospital, Amry Medical University, Chongqing, 400042, China.
| | - Xiu-Zhu Zhang
- Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Daping Hospital, Amry Medical University, Chongqing, 400042, China
| | - Xiang-Jun Bai
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Mao Zhang
- Department of Emergency Medicine, The Second Affiliated Hospital of Medical College, Zhejiang University, Zhejiang, 310009, China
| | - Xiao-Gang Zhao
- Department of Emergency Medicine, The Second Affiliated Hospital of Medical College, Zhejiang University, Zhejiang, 310009, China
| | - Yong-An Xu
- Department of Emergency Medicine, The Second Affiliated Hospital of Medical College, Zhejiang University, Zhejiang, 310009, China
| | - Hao Tan
- Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Daping Hospital, Amry Medical University, Chongqing, 400042, China
| | - Yang Li
- Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Daping Hospital, Amry Medical University, Chongqing, 400042, China
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Kurdin A, Caines A, Boone D, Furey A. TEAM: A Low-Cost Alternative to ATLS for Providing Trauma Care Teaching in Haiti. J Surg Educ 2018; 75:377-382. [PMID: 28843959 DOI: 10.1016/j.jsurg.2017.08.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/25/2017] [Accepted: 08/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Trauma resuscitation protocols have unified the care of trauma patients and significantly improved outcomes. However, the success of the Advanced Trauma Life Support course is difficult to reproduce in developing countries due to set-up costs, limitations of resources, and variations of practice. The objective of this study is to assess the Trauma Evaluation and Management (TEAM) course as a low-cost alternative for trauma resuscitation teaching in Low and Middle Income Countries (LMIC). DESIGN As part of the Team Broken Earth initiative, TEAM course was provided to the health care professionals in Haiti. At its conclusion, participants were asked to complete a survey evaluating the course. Qualitative and quantitative data were analyzed to evaluate the perception of the course. SETTING The course was provided in Port-au-Prince, Haiti. PARTICIPANTS A total of 80 health care professionals participated in the course. Response was obtained from 69 participants, which comprised of 32 physicians, 10 Emergency Medical Technicians (EMT), 22 nurses, and 5 medical trainees. RESULTS The course was well received by physicians, nurses, and EMT with an average score of 90.6%. Question analysis revealed a lower satisfaction of physicians for the course manual and teaching materials, and information related to decisions for transfer of patients. EMT consistently felt that the course was not tailored to their learning and practice needs. Written feedback demonstrated several areas of weaknesses including need for improvements in translations, hands-on practice, and educational materials. CONCLUSIONS Overall, the TEAM course was well received. Analysis demonstrated a need for adjustments specific to LMIC including a focus on prehospital assessment, increased nursing responsibilities, and unavailability of specialist's referrals. Team Broken Earth intends to take these findings into consideration and continue to provide the TEAM course to other LMIC.
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Affiliation(s)
- Anton Kurdin
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.
| | - Andrew Caines
- Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Darrell Boone
- Division of General Surgery, Department of Surgery, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Andrew Furey
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
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George JR, Tyroch AH, Milan SA. Third-Year Medical Student Impressions of Resident Teaching in Simulated and Clinical Settings. Am Surg 2018; 84:334-337. [PMID: 29559045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We sought to determine whether simulation-based medical education using Trauma Evaluation and Management® (TEAM®) training module contributes to a positive impression of resident and faculty teaching. Qualitative and quantitative data regarding medical students' experience of TEAM® training and their interaction with instructors were collected using anonymous surveys after the completion of the training module. A combination of yes or no responses, as well as classification of student confidence and perceptions on the utility of TEAM® training obtained using Likert-type scales, was evaluated. Qualitative data regarding student perceived strengths and weaknesses of this training and their perception of the quality of teaching were collected and analyzed. Most of the students felt the quality of teaching was better when compared with clinical settings, with 91 per cent of the respondents who provided additional feedback stating that residents were better teachers in the simulated setting. The application of TEAM® training in the surgical clerkship curriculum provides an environment to foster high-quality resident-led education.
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Affiliation(s)
- Michael S Weinstein
- From the Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia
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