2005 APDS spring meetingSuccessful Collaborative Model for Trauma Skills Training of Surgical and Emergency Medicine Residents in a Laboratory Setting
Introduction
The care of the trauma patient involves a highly disciplined and systematic approach. To address the need for uniformity in delivering trauma care, the American College of Surgeons Committee on Trauma, in 1979, adopted the Advanced Trauma Life Support (ATLS) course.1 All physicians directly involved with providing resuscitative care to a trauma patient, including emergency room physicians and surgeons, are required to be ATLS-certified. When evaluating any injured patient, one must rely on the simultaneous application of physical examination skills, critical decision-making skills, and both invasive and noninvasive procedural skills. The proper implementation of procedural skills could mean the difference between life and death for the trauma patient.
Surgery and emergency medicine are procedure-oriented disciplines that often work side-by-side in the trauma bay. Mastery and knowledge of the skills taught in the ATLS course is essential for any surgeon or emergency room physician involved in the care of a trauma patient. In addition to the invasive procedures taught in ATLS, Focused Assessment with Sonography for Trauma (FAST)2 has become an essential diagnostic tool in the armamentarium of the trauma practitioner. Ultrasound examination of the traumatized abdomen has been shown to be rapid, noninvasive, reliable, and effectively administered by nonradiologists.3, 4 FAST is becoming a standard procedure in the assessment of trauma victims and has been deemed a necessary aspect of residency training by both the American College of Surgeons and the American College of Emergency Physicians.5
Recent Accreditation Council for Graduate Medical Education (ACGME)-mandated restrictions on resident work hours,6 limited availability of funds for residency training programs, and concerns about learning potentially harmful, invasive procedures for the first time on patients have prompted physician educators to seek venues for resident education outside of the traditional hospital setting. The Temple University Hospital Department of Surgery and Department of Emergency Medicine sought to determine whether combining interdepartmental educational and technical resources in a laboratory setting would benefit resident education. Specifically, our goal was to increase the knowledge and understanding of trauma procedures for surgery and emergency medicine residents and raise their confidence levels during performance of these skills. It was accomplished by means of an ultrasound course for surgery residents and an animate trauma skills course for emergency medicine residents. A resident survey assessed the effectiveness of this teaching model.
Section snippets
Study Population
The ultrasound course was offered to Temple University Hospital Department of Surgery residents of all PGY levels (1 to 5), and the animate trauma skills laboratory was offered to Temple University Hospital Department of Emergency Medicine residents of all PGY levels (1 to 3). For the 2004/2005 academic year, at the time of this course, the Department of Surgery employed 48 residents, and the Department of Emergency Medicine employed 27 residents. Thirty-five surgery residents (PGY 1 = 12, PGY
Results
For FAST as well as ultrasound-guided location of central venous neck anatomy, tracheostomy, peripheral venous cutdown, diagnostic peritoneal lavage, and thoracotomy, there were no differences by PGY level in the number of times a resident had performed the skill in the clinical setting before participating in the ultrasound and trauma skills laboratory. PGY 1 and 2 emergency medicine residents, however, placed significantly less (p < 0.05) chest tubes before the laboratory course than PGY 3
Discussion
The objective of our study was to combine the technical and educational resources of the Department of Surgery and Department of Emergency Medicine to increase knowledge, comfort, and understanding of trauma procedures by residents. These goals were accomplished by educating surgery and emergency medicine residents in the laboratory setting, using live human models for an ultrasound course, and an animate model for a trauma skills course. Resident surveys revealed that after taking the
Conclusions
Our study is limited by the lack of objective measures of the effectiveness of our teaching model. Although junior surgery and emergency medicine residents clearly reported a perceived benefit from learning the exercises in the laboratory, we did not observe performance or measure outcomes of the learned skills in the clinical setting. In the future we will need to add objective assessments to our model and prospectively evaluate transferability to the clinical setting. Ideally, patient
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