Surgical Training Program Boosts Trauma Surgery Skills

NEW YORK (Reuters Health) – A two-day immersive trauma skills course led to improvement in an array of trauma skills among active-duty general surgeons, researchers say.

Sustaining procedural skills in trauma surgery is a problem for surgeons in rural, global, and combat settings, according to Dr. Mark Bowyer of the Uniformed Services University of the Health Sciences in Bethesda and colleagues. “Trauma care often requires open surgical procedures for low-frequency/high-risk injuries at a time when open surgical experience is declining in general and trauma surgery training,” they write in JAMA Surgery.

To assess the value of a two-day standardized trauma skills course on general surgeons’ accuracy and independent performance of specific skills, Dr. Bowyer and colleagues recruited 65 active-duty surgeons (mean age, 38.5; 25% women).

“We did not set out to teach surgeons how to operate, but to provide them ‘coaching’ from four very experienced trauma mentors to ‘up their trauma game,'” Dr. Bowyer told Reuters Health by email. “The design allows for identification of skills deficits in an objective fashion, enabling further training to correct any deficiencies.”

Participants underwent a 2-day standardized, immersive, cadaver-based skills course, developed with best practices in instructional design, that trained them and assessed 24 trauma surgical procedures. The main outcome was trauma surgery capability, as measured by confidence, knowledge, abilities, and independent performance of specific trauma surgical procedures, and skill transfer three months posttraining.

Before and during training, only one participant (1%) was able to accurately perform all 24 procedures without guidance. After training, the other 64 (99%) met the benchmark performance requirements for the 24 procedures, and 51 (78%) were able to perform them without guidance.

Of 41 surgeons who responded to the posttraining survey, 19 (46.3%) reported direct skill transfer to trauma procedures and 10 (24.4%) reported skill transfer to other operations (e.g., non-trauma vascular exposures, intervention for intra-abdominal bleeding, and colon mobilization).

Overall, accounting for overlap, 23 participants (56.1%) reported skill transfer to trauma or other procedures.

In a retention pilot study with eight surgeons at a mean of 10 months posttraining, knowledge remained above benchmark, while procedural abilities remained at or above the benchmark for 21 of 24 procedures (87.5%).

Dr. Bowyer said, “This curriculum will replace all current pre-deployment trauma skills training for military surgeons and will be required every two years. Our ongoing work with this effort will be to look at the durability of the skills learned as well as the application of them to patient care and the effect on outcomes.”

“This educational and assessment paradigm has broad applicability beyond both the military and surgeons, and is translatable to any skills-based healthcare specialty to include all surgical subspecialties, nonsurgical physicians, physician assistants, paramedics and nursing,” he concluded.

Dr. Carla Pugh of Stanford University, author of a related editorial, commented on the study in an email to Reuters Health. “The most important message for clinicians is to find a way to get involved in data gathering and data sharing. This will help data scientists model the learning curve to mastery and build a database of automated performance metrics.”

One example includes a recent announcement by the American Board of Surgery regarding their video-based assessment pilot project,” she noted. “Over 200 surgeons (and counting) have already committed to send videos for artificial intelligence analysis by three companies who are partnering with the ABS.”

SOURCE: https://bit.ly/3lY45Vy and https://bit.ly/2XZ7CLh JAMA Surgery, online September 15, 2021.

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