Longitudinal Retention of Anatomical Landmark Knowledge for the Performance of Lower Extremity Fasciotomy

Abstract

Due to Various factors including shorter training hours and changes in trauma prevalence and management, acquiring trauma surgical skills on‐the‐job is challenging for civilian and military surgeons. Surgical skills programs are used to supplement gaps in training opportunities. While these courses improve surgical knowledge, it is vital to understand retention of these skills and variables associated with successful procedures. While the Advanced Surgical Skills for Exposure in Trauma (ASSET) course, which includes training in lower extremity fasciotomy (FAS), improves knowledge of surgical landmarks and anatomical structures, we hypothesize knowledge retention will reduce with time. Specifically, a reduction of knowledge in critical landmarks and anatomy correlate with reduced success with four compartment decompression.Surgical residents (n=38) were tested with validated metrics performing a 2 incision 4 compartment FAS on a cadaver before and after the ASSET course. Retention assessments were performed 12–18 months later (χ̄=14 months). Surgeons who had taken ASSET within 2–4 years were similarly assessed (n=38; χ̄=30 months) for longer‐term retention. Residents were assessed for knowledge of technical anatomical knowledge, surgical procedure steps, and successful compartment decompression. Longitudinal change in knowledge and success was compared using Pearson Correlation and 3‐dimension (3D) regression analysis.After training, residents improved in anatomical knowledge and successful 4 compartment decompression where correct landmarks and incisions correlated with successful decompression (r=0.42–0.5; p<0.001). Retention of landmark and anatomical knowledge correlated significantly with retained decompression success (r=0.38; p<0.001). While all scores diminished with time, knowledge of anatomy and technical applications decreased by 25% and 38%, respectively, but the percent of successful decompression of four compartments (25%) did not exhibit significant deterioration. Surgeons assessed 2–4 years after ASSET exhibited a slightly diminished success rate (20.5%). For both groups, the deep posterior compartment was most commonly not decompressed. Three‐dimension regressions indicate component scores for both technical anatomical knowledge and expert discriminating variables (e.g. tissue manipulation) of 0.8 indicates a high probability of success.Knowledge and skills acquired for lower extremity fasciotomy were generally retained for 18 months after training with slight decreases thereafter. Retention of anatomical knowledge is critical for continued success in surgical performance. Specific training and deliberate practice can help acquire and retain fasciotomy skills to compensate for reduced on‐the‐job training opportunities.Support or Funding InformationU.S. Army Medical Research & Materiel Command: W81XWH‐13‐2‐0028This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.