4 - Training Paradigms for Vascular Trauma

Abstract

Over the past 30 years, the practice of surgery has undergone a revolution as minimally invasive techniques have to a great degree supplanted, or at least compete as acceptable alternatives to, open techniques in many fields of surgery. Significant changes in residency programs, decreased exposure to vascular trauma during training and professional careers, as well as new approaches to the management of vascular injury, including the development of endovascular techniques, mandate a reappraisal of how both vascular specialists and general surgeons are prepared to manage vascular trauma. Although specialist vascular surgeons will deliver some of this care, there are many situations where this is not practical, so some nonvascular specialists must also have a skill set to deal with a patient with a vascular injury. The skill set required is somewhat of a moving target as experience, technology, and techniques continue to advance at a rapid pace. Understandably, the ideal curriculum, with unambiguous goals and testable competencies, is yet to be defined. Graduate Medical Education (GME), as it currently exists, is not well suited to adequately train general surgeons in the care of traumatic vascular injuries. Even graduates of vascular GME programs have limited exposure to trauma patients, and they must apply knowledge, skills, and abilities (KSAs) developed in the care of nontraumatic disease processes to the management of traumatic injuries. To overcome these deficiencies, supplemental educational programs are being developed to deliver vascular trauma training that uses a synthesis of techniques, including animal-model training, human cadaveric training, and simulation-based training. It has been recognized that crew resource management (CRM), as utilized in other safety critical industries such as aviation, is an important component in minimization of errors and requires team-based training. This chapter explores the current training paradigms, both GME and post-GME, and looks to how new strategies, perhaps a complete reappraisal of training paradigms, in delivering both technical and nontechnical skills training are required to deliver quality care to the patient with a vascular injury.