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Wild H, Marfo C, Mock C, Gaarder T, Gyedu A, Wallis L, Makasa E, Hagander L, Reynolds T, Hardcastle T, Jewell T, Stewart B. Operative Trauma Courses: A Scoping Review to Inform the Development of a Trauma Surgery Course for Low-Resource Settings. World J Surg 2023; 47:1662-1683. [PMID: 36988651 DOI: 10.1007/s00268-023-06985-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND A multitude of operative trauma courses exist, most of which are designed for and conducted in high-resource settings. There are numerous barriers to adapting such courses to low- and low-middle-income countries (LMICs), including resource constraints and contextual variations in trauma care. Approaches to implementing operative trauma courses in LMICs have not been evaluated in a structured manner. METHODS We conducted a scoping review of the literature including databases (e.g., PubMed, Web of Science, EMBASE), grey literature repositories, and structured queries of publicly available course materials to identify records that described operative trauma courses offered since 2000. RESULTS The search identified 3,518 non-duplicative records, of which 48 relevant reports were included in analysis. These reports represented 23 named and 11 unnamed operative trauma courses offered in 12 countries. Variability existed in course format and resource requirements, ranging from USD 40 to 3,000 per participant. Courses incorporated didactic and laboratory components, which utilized simulations, cadavers, or live animals. Course content overlapped significantly but was not standardized. Data were lacking on course implementation and promulgation, credentialing of instructors, and standardized evaluation metrics. CONCLUSIONS While many operative trauma courses have been described, most are not directly relatable to LMICs. Barriers include cost-prohibitive fees, lack of resources, limited data collection, and contextual variability that renders certain surgical care inappropriate in LMICs. Gaps exist in standardization of course content as well as transparency of credentialing and course implementation strategies. These issues can be addressed through developing an open-access operative trauma course for low-resource settings.
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Affiliation(s)
- Hannah Wild
- Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA.
| | - Chris Marfo
- Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA
| | - Charles Mock
- Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA
| | - Tina Gaarder
- Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | - Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ghana
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lee Wallis
- World Health Organization, Geneva, Switzerland
| | - Emmanuel Makasa
- Department of Surgery, School of Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - Lars Hagander
- Pediatric Surgery and Global Pediatrics, Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Timothy Hardcastle
- Nelson R Mandela School of Medicine, Surgery (Trauma), University of KwaZulu-Natal, Durban, South Africa
- Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Teresa Jewell
- Health Science Library, University of Washington, Seattle, WA, USA
| | - Barclay Stewart
- Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA
- Global Injury Control Section, Harborview Injury Prevention and Research Center, Seattle, WA, USA
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Turégano Fuentes F, Pérez Díaz D. Teaching courses in the management of visceral trauma. Cir Esp 2018; 96:606-611. [PMID: 30554595 DOI: 10.1016/j.ciresp.2018.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/21/2018] [Accepted: 09/25/2018] [Indexed: 11/30/2022]
Abstract
Several changes introduced in the management of trauma during the last two decades have considerably decreased the practical exposure to bleeding trauma patients by residents and young surgeons. Hemorrhage still represents the second cause of death from trauma worldwide, and the surgical maneuvers required for its control must be learned and practised in specific courses. These courses address the "second hour" of trauma, beyond ATLS©, and also emphasize the decision-making process, communication among team members, and discussion of clinical scenarios. The significant progress made in simulation technologies and virtual reality systems have yet to replace living tissue models to train surgeons in the rapid control of active bleeding, although that replacement is probably not far away.
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Affiliation(s)
| | - Dolores Pérez Díaz
- Sección de Cirugía de Urgencias, Hospital General Universitario Gregorio Marañón, Madrid, España
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Mackenzie CF, Bowyer MW, Henry S, Tisherman SA, Puche A, Chen H, Shalin V, Pugh K, Garofalo E, Shackelford SA. Cadaver-Based Trauma Procedural Skills Training: Skills Retention 30 Months after Training among Practicing Surgeons in Comparison to Experts or More Recently Trained Residents. J Am Coll Surg 2018; 227:270-279. [PMID: 29733906 DOI: 10.1016/j.jamcollsurg.2018.04.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/19/2018] [Accepted: 04/19/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Long-term retention of trauma procedural core-competency skills and need for re-training after a 1-day cadaver-based course remains unknown. We measured and compared technical skills for trauma core competencies at mean 14 months (38 residents), 30 months (35 practicing surgeons), and 46 months (10 experts) after training to determine if skill degradation occurs with time. Technical performance during extremity vascular exposures and lower-extremity fasciotomy in fresh cadavers measured by validated individual procedure score (IPS) was the primary outcome. STUDY DESIGN We performed a prospective study between May 2013 and September 2016. RESULTS Practicing surgeons had lower IPS and IPS component scores (p = 0.02 to 0.001) than residents (p < 0.05) and experts (p < 0.002) for vascular procedures. Frequencies of errors were no different among residents and experts. Practicing surgeons made more critical errors (p < 0.05) than experts or residents. Experts had shortest time to proximal vascular control. Fasciotomy procedural errors occurred in all participants. Cluster analysis of anatomy vs procedural steps identified tertiles of performance and wide variance (32.5% practicing surgeons, 26.5% residents vs 13% experts) for vascular procedures. Vascular control duration > 20 minutes (n = 21) and failure to decompress fasciotomy compartments were correlated with incorrect landmarks and skin incisions. Modeling found interval trauma skills experience, not time since training, was associated with lower IPS. CONCLUSIONS Practicing surgeons with low trauma skills experience since training had lower IPS and component scores (p = 0.02 to 0.001) and more errors compared with experts and residents (p < 0.05). Surgeons, including experts with low interval experience performing trauma procedures, may benefit from refreshing of correct landmarks and skin incision placement identification.
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Affiliation(s)
- Colin F Mackenzie
- Shock Trauma Anesthesiology Research Center, Baltimore, MD; University of Maryland, School of Medicine, Baltimore, MD.
| | - Mark W Bowyer
- Department of Surgery, Uniformed Services University of Health Sciences, and the Walter Reed National Military Medical Center, Bethesda, MD
| | - Sharon Henry
- University of Maryland, School of Medicine, Baltimore, MD; Department of Surgery and Shock Trauma Center of the University of Maryland School of Medicine and Medical Center, Baltimore, MD
| | - Samuel A Tisherman
- Shock Trauma Anesthesiology Research Center, Baltimore, MD; University of Maryland, School of Medicine, Baltimore, MD; Department of Surgery and Shock Trauma Center of the University of Maryland School of Medicine and Medical Center, Baltimore, MD
| | - Adam Puche
- University of Maryland, School of Medicine, Baltimore, MD
| | - Hegang Chen
- University of Maryland, School of Medicine, Baltimore, MD
| | - Valerie Shalin
- Department of Psychology, Wright State University, Dayton, OH
| | - Kristy Pugh
- University of Maryland, School of Medicine, Baltimore, MD
| | - Evan Garofalo
- Department of Anatomy, University of Arizona School of Medicine, Phoenix, AZ
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Abstract
Trauma education and injury prevention are essential components of a robust trauma program. Educational programs address specific knowledge gaps and provide focused and structured learning. Advanced Trauma Life Support is the most well-known. Each offering seems to be valid, although it has been difficult to prove improved patient care outcomes owing specifically to any of them. Injury prevention offers the best opportunity to limit death and disability owing to trauma. Injury prevention initiatives have paid tremendous dividends in reducing the mortality rates for motor vehicle crashes. Modern injury prevention efforts focus on reducing distracted driver rates and increasing helmet use.
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