Trends in Procedures at Major Trauma Centres in New South Wales, Australia: An Analysis of State-Wide Trauma Data

A needs assessment of Canadian general surgery postgraduate trauma training

BACKGROUND

Clinical exposure to operative trauma cases for general surgery residents has decreased over recent decades. However, trainees are still expected to demonstrate competency in trauma care and injury management.

METHODS

A prospective survey based on preliminary qualitative analysis and a trauma education conceptual framework was distributed to general surgery educators, trauma surgeons, and general surgery residents across the country. Participants were asked to describe their trauma training experience, the educational resources available at their training programs, and their level of support for potential curriculum components.

RESULTS

45% (31/69) of educators and 14% (58/405) of trainees responded to the survey. Perceived deficiencies were identified in the operative management of thoracic (educators 13%, trainees 28%), mediastinal (3%, 14%), neck (16%, 33%), and vascular (26%, 47%) injuries. Additional educational deficiencies were also identified in the domains of trauma systems and epidemiology, research and quality improvement, and injury prevention. Educators identified more inadequacies in training than trainees. Both groups supported participation in radiology (77%, 85%) and guideline (74%, 90%) reviews, journal clubs (84%, 81%), education rounds (90%, 88%), leading trauma resuscitations (94%, 98%), and trauma resuscitation simulations (90%, 95%) as valuable educational initiatives.

CONCLUSIONS

Trauma training in Canada is currently perceived to be inadequate to support resident education. The development and implementation of competency-based curricular components will be essential to address the identified deficiencies. This data will be used to inform the development of a national trauma training curriculum and initiatives to enhance resident education.

The swing shift: Opportunity to enhance trauma training in Australia

BACKGROUND

Training in trauma forms a fundamental component of general surgical training in Australia. It faces a number of challenges, including the limitations of working hours and increasing use of non-operative management techniques. Adjustment of rosters to encompass a "swing shift" (12pm-midnight) is one proposed solution to maximise exposure of junior surgical doctors to trauma. This proposal prompted a review of the timing of major trauma presentations and interventions at a Level 1 trauma centre.

METHODS

A retrospective observational study was performed of all major trauma presentations to Westmead Hospital, Australia over ten-years (2008-2017). Trauma operative procedures and major resuscitations were reviewed across three potential shifts: day shift (0730-1930), night shift (1930-0730) and "swing shift" (1200-midnight). Operative interventions included: laparotomy, thoracotomy/sternotomy, re-look laparotomy, rib fixation and tracheostomy. Descriptive statistics were obtained for between-shift comparisons.

RESULTS

Over the ten-years there were 3745 full trauma team activations (FTTAs). The "swing shift" had the highest number of FTTAs, patients with injury severity scores >15, patients requiring resuscitation and emergency operations (laparotomies, sternotomies/thoracotomies).

CONCLUSIONS

More major trauma calls, laparotomies and thoracotomies occurred during a theoretical "swing shift" rather than the standard day and night shifts. Changing trauma rostering for junior doctors to reflect this peak in clinical and operative demand could change exposure to trauma training.