Evaluation of just-in-time trauma training for international surgical military preparedness at a US Civilian Level I Trauma Center: A proof of concept
DOI:
https://doi.org/10.5055/ajdm.0484Keywords:
surgical education, simulation, military, civilianAbstract
Background: Increasing global conflicts continue to heighten the need for increased focus on preparedness for military physicians and surgeons. Simulation has recently been adopted by civilian surgical trainees to offset the problem of increased work hour restrictions and shift the current focus toward minimally invasive techniques. We hypothesized that just-in-time trauma training, incorporating both focused clinical and simulated experience at our civilian Level I Trauma Center, would increase the competence and confidence of international military physicians in trauma care.
Methods: We performed a feasibility study of five Ukrainian physicians (four surgeons and one anesthesiologist) undergoing an intensive 2-week trauma course taught by 25 American clinicians. The training consisted of several previously validated courses including Advanced Trauma Life Support (ATLS®), Advanced Surgical Skills for Exposure in Trauma (ASSET®), Advanced Trauma Operative Management (ATOM®), and Basic Endovascular Skills for Trauma (BEST®), among several additional simulated and clinical experiences. Pre- and post-course surveys were analyzed using paired t-tests to assess improvement in trauma care.
Results: All five physicians had significant improvement in confidence following the completion of the course, including the management of injuries to the neck, chest, abdomen, and extremities. Additionally, each clinician significantly improved in their confidence to perform common ATLS procedures and resuscitative endovascular balloon occlusion of the aorta skills. Overall, the mean confidence over all survey responses improved significantly following the completion of the course, 2.28 (precourse confidence range 1.25-3.35) to 3.66 (post-course confidence range 2.95-4.22), p-value = 0.002. All five Ukrainian physicians successfully passed the corresponding post-tests and were certified as having completed ATLS, ATOM, ASSET, and BEST.
Conclusions: A military and civilian partnership in trauma preparedness is feasible to improve surgeon confidence in trauma care.
References
Issenberg SB, McGaghie WC, Petrusa ER, et al.: Features and uses of high-fidelity medical simulations that lead to effective learning: A BEME systematic review. Med Teach. 2005; 27(1): 10-28. DOI: 10.1080/01421590500046924. DOI: https://doi.org/10.1080/01421590500046924
Ziv A, Wolpe PR, Small SD, et al.: Simulation-based medical education: An ethical imperative. Acad Med. 2003; 78(8): 783-788. DOI: 10.1097/00001888-200308000-00006. DOI: https://doi.org/10.1097/00001888-200308000-00006
Igra NM, Schmulevich D, Geng Z, et al.: Optimizing mass casualty triage: Using discrete event simulation to minimize time to resuscitation. J Am Coll Surg. 2024; 238(1): 41-53. DOI: 10.1097/XCS.0000000000000894. DOI: https://doi.org/10.1097/XCS.0000000000000894
Aebersold M: The history of simulation and its impact on the future. AACN Adv Crit Care. 2016; 27(1): 56-61. DOI: 10.4037/aacnacc2016436. DOI: https://doi.org/10.4037/aacnacc2016436
DeMaria AN: Medicine, aviation, and simulation. J Am Coll Cardiol. 2011; 57(11): 1328-1329. DOI: 10.1016/j.jacc.2011.02.007. DOI: https://doi.org/10.1016/j.jacc.2011.02.007
Kao LS, Thomas EJ: Navigating towards improved surgical safety using aviation-based strategies. J Surg Res. 2008; 145(2): 327-335. DOI: 10.1016/j.jss.2007.02.020. DOI: https://doi.org/10.1016/j.jss.2007.02.020
Doucet J, Shatz DV, Kaplan LJ, et al.: Are trauma surgeons prepared? A survey of trauma surgeons’ disaster preparedness before and during the COVID-19 pandemic. Trauma Surg Acute Care Open. 2023; 8(1): e001073. DOI: 10.1136/tsaco-2022-001073. DOI: https://doi.org/10.1136/tsaco-2022-001073
Keating J, Jacobs L, Ricaurte D, et al.: A Connecticut healthcare system's response to the COVID-19 pandemic. Am J Disaster Med. 2021; 16(3): 195-202. DOI: 10.5055/ajdm.2021.0401. DOI: https://doi.org/10.5055/ajdm.2021.0401
Holcomb JB, Dorlac WC, Drew BG, et al.: Rethinking limb tourniquet conversion in the prehospital environment. J Trauma Acute Care Surg. 2023; 95(6): e54-e60. DOI: 10.1097/TA.0000000000004134. DOI: https://doi.org/10.1097/TA.0000000000004134
Available at https://global-response.org/. Accessed June 13, 2024.
Jacobs LM, Burns KJ, Kaban JM, et al.: Development and evaluation of the Advanced Trauma Operative Management course. J Trauma. 2003; 55(3): 471-479. DOI: 10.1097/01.TA.0000059445.84105.26. DOI: https://doi.org/10.1097/01.TA.0000059445.84105.26
Kuhls DA, Risucci DA, Bowyer MW, et al.: Advanced Surgical Skills for Exposure in Trauma: A new surgical skills cadaver course for surgery residents and fellows. J Trauma Acute Care Surg. 2013; 74(2): 664-670. DOI: 10.1097/TA.0b013e31827d5e20. DOI: https://doi.org/10.1097/TA.0b013e31827d5e20
Brenner M, Hoehn M, Pasley J, et al.: Basic Endovascular Skills for Trauma course: Bridging the gap between endovascular techniques and the acute care surgeon. J Trauma Acute Care Surg. 2014; 77(2): 286-291. DOI: 10.1097/TA.0000000000000310. DOI: https://doi.org/10.1097/TA.0000000000000310
Jacobs L, Keating JJ, Hunt RC, et al.: Stop the Bleed®. Curr Probl Surg. 2022; 59(10): 101193. DOI: 10.1016/j.cpsurg.2022. 101193. DOI: https://doi.org/10.1016/j.cpsurg.2022.101193
Sims JK: Advanced Trauma Life Support laboratory: Pilot implementation and evaluation. JACEP. 1979; 8(4): 150-153. DOI: 10.1016/s0361-1124(79)80342-1. DOI: https://doi.org/10.1016/S0361-1124(79)80342-1
Available at https://translate.google.com/?sl=en&tl=uk&op=translate. Accessed June 13, 2024.
Bingmer K, Ofshteyn A, Stein SL, et al.: Decline of open surgical experience for general surgery residents. Surg Endosc. 2020; 34(2): 967-972. DOI: 10.1007/s00464-019-06881-0. DOI: https://doi.org/10.1007/s00464-019-06881-0
Smith ME, Andraska EA, Sutzko DC, et al.: The decline of open abdominal aortic aneurysm surgery among individual training programs and vascular surgery trainees. J Vasc Surg. 2020; 71(4): 1371-1377. DOI: 10.1016/j.jvs.2019.06.204. DOI: https://doi.org/10.1016/j.jvs.2019.06.204
Curet MJ: Resident work hour restrictions: Where are we now? J Am Coll Surg. 2008; 207(5): 767-776. DOI: 10.1016/j.jamcollsurg.2008.07.010. DOI: https://doi.org/10.1016/j.jamcollsurg.2008.07.010
Grabski DF, Goudreau BJ, Gillen JR, et al.: Compliance with the accreditation council for graduate medical education duty hours in a general surgery residency program: Challenges and solutions in a teaching hospital. Surgery. 2020; 167(2): 302-307. DOI: 10.1016/j.surg.2019.05.029. DOI: https://doi.org/10.1016/j.surg.2019.05.029
Schwartz SI, Galante J, Kaji A, et al.: Effect of the 16-hour work limit on general surgery intern operative case volume: A multi-institutional study. JAMA Surg. 2013; 148(9): 829-833. DOI: 10.1001/jamasurg.2013.2677. DOI: https://doi.org/10.1001/jamasurg.2013.2677
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