Advanced Trauma Operative Management Research Articles

A Role for Live-Animal Models in Undergraduate Surgical Education During the Cadaver Shortage.

A Role for Live-Animal Models in Undergraduate Surgical Education During the Cadaver Shortage.

Launching the Advanced Trauma Operative Management (ATOM), Course in Trinidad and Tobago

Background: The Advanced Trauma Operative Management (ATOM) course which is aimed at improving penetrating trauma management skills is very challenging to conduct. We assessed the feasibility and potential impact of ATOM training in Trinidad and Tobago through the University of Toronto Global surgery initiative and its potential for improving penetrating trauma care in this developing country. Methods: Senior General Surgical trainees were randomly assigned to participate. Other participants consisted of: an experienced international ATOM course Director, one experienced ATOM instructor, an ATOM instructor candidate, an experienced ATOM veterinary medicine technologist, 2 veterinary medicine trainees, 8 senior general surgical trainees who completed the course using the 2 student to one faculty training model. Pre and post course self efficacy scores (a measure of confidence in surgical approach) and scores on multiple choice question exams (MCQ) were compared by paired t tests. The trainees completed 5-point Likert scales to assess different components of the course. Results: The course was successfully completed locally. Mean and SD self efficacy scores improved from 55.4 ± 18.5 to 80.5 ± 9.1 and MCQ improved from 63.0 ± 8.8 to 82.5 ± 9.6 (p Conclusions: Based on trainee course performance and their evaluations, there was significant improvement in trauma skills, knowledge and attitude with enthusiastic support for continuing the program, to improve penetrating trauma care locally and extending this training to other parts of the Caribbean.

Nonoperative Management (NOM) of most liver injuries impairs the mastery of intraoperative hemostasis

BackgroundNonoperative management (NOM) of most liver injury (LI) compromises teaching of technical skills required for intraoperative LI hemostasis. This study assesses this void. MethodsThe records of patients (pts) admitted for LI during two years (1/1/16–12/31/17) were compared to pts treated during two-year intervals for the last six decades. Treatment included NOM, operation only (OR/only), suture (Sut), tractotomy (Tra), dearterialization (HAL), and resection (Res). ResultsDuring 2016/2017, 41 pts had penetrating (23) or blunt (18) LI. Treatment for penetrating LI was NOM (4), OR/only (12), and hemostasis (7) with Sut (3), HAL (1), Tra (1), and Res (2). Treatment for blunt LI was NOM (16) and OR/only (2). 14 residents performed an average of 0.5 procedures. During six decades, LI requiring hemostasis was 121, 114, 30, 48, 17, and 7 per decade. Concomitantly, the percent having NOM or OR/only was 46%, 47%, 62%, 59%, 72%, and 83%. ConclusionNOM precludes adequate training for hemostasis of LI. Technical proficiency for LI hemostasis requires training in Advanced Trauma Operative Management (ATOM), Advanced Surgical Skills for Exposure in Trauma (ASSET), and rotation through a liver transplant or hepatobiliary service.

Efficacy of Trauma Surgery Technical Skills Training Courses

Because open surgical skills training for trauma is limited in clinical practice, trauma skills training courses were developed to fill this gap, The aim of this report is to find supporting evidence for efficacy of these courses. The questions addressed are: What courses are available and is there robust evidence of benefit? We performed a systematic review of the training course literature on open trauma surgery procedural skills courses for surgeons using Kirkpatrick's framework for evaluating complex educational interventions. Courses were identified using Pubmed, Google Scholar and other databases. The review was carried out at the University of Maryland, Baltimore with input from civilian and military trauma surgeons, all of whom have taught and/or developed trauma skills courses. We found 32 course reports that met search criteria, including 21 trauma-skills training courses. Courses were of variable duration, content, cost and scope. There were no prospective randomized clinical trials of course impact. Efficacy for most courses was with Kirkpatrick level 1 and 2 evidence of benefit by self-evaluations, and reporting small numbers of respondents. Few courses assessed skill retention with longitudinal data before and after training. Three courses, namely: Advanced Trauma Life Support (ATLS), Advanced Surgical Skills for Exposure in Trauma (ASSET) and Advanced Trauma Operative Management (ATOM) have Kirkpatrick's level 2-3 evidence for efficacy. Components of these 3 courses are included in several other courses, but many skills courses have little published evidence of training efficacy or skills retention durability. Large variations in course content, duration, didactics, operative models, resource requirements and cost suggest that standardization of content, duration, and development of metrics for open surgery skills would be beneficial, as would translation into improved trauma patient outcomes. Surgeons at all levels of training and experience should participate in these trauma skills courses, because these procedures are rarely performed in routine clinical practice. Faculty running courses without evidence of training benefit should be encouraged to study outcomes to show their course improves technical skills and subsequently patient outcomes. Obtaining Kirkpatrick's level 3 and 4 evidence for benefits of ASSET, ATOM, ATLS and for other existing courses should be a high priority.

Trauma surgery simulation education in Japan: the Advanced Trauma Operative Management course.

Simulation has become an important teaching tool, in part because of changes mandated by restrictions in resident work hours. Simulation models include life‐like mannequins, ex vivo tissue, cadavers, and live animal models. The Advanced Trauma Operative Management (ATOM) course teaches a standard approach for the treatment of traumatic injuries. The 1‐day course includes six lectures in the morning and a live animal surgery laboratory in the afternoon. The animal laboratory includes five standard injury scenarios. Advanced Trauma Operative Management was brought to Japan in 2008 and has carried out 60 courses, training more than 250 surgeons and 70 instructors at six training sites throughout Japan. There have been a number of innovations initiated by ATOM Japan including Nurse Participation Certificates and a course for Trauma Nurses that runs concurrently with the ATOM course. There are other trauma courses given throughout the world, which are scenario‐based and include concurrent nurse training. It is difficult to quantitatively assess the benefits of trauma training to patients. There are a number of documented cases in Japan of surgeons who have had good operative outcomes in the care of traumatically injured patients who attribute the successful management of these patients to participation in the ATOM course. Training in trauma surgery using simulation models and the ATOM course have had a positive impact on surgical training and patient care in Japan. These courses will continue to be modified and refined, resulting in better education and clinical outcomes. Education research is essential to determine the optimum use of the available models.

Can specialized surgical simulation influence resident career choice?

ObjectiveOur institution began Advanced Trauma Operative Management (ATOM) simulation course in 2007 for senior residents with the aim of increasing opportunities for surgical trainees to gain operative trauma experience. The aim of our study was to evaluate the effect of the ATOM simulation course on residents' choice of trauma as a career as demonstrated by entrance into surgical critical care (SCC) fellowships. DesignRetrospective study of institutional data on graduating residents from 2002 to 2015. Residents were divided into pre-ATOM (2002–08) and post- (institution of) ATOM (2009–15) cohorts. The percentage of residents entering SCC fellowships was then compared among cohorts as well as to national trends. ResultsNationally the pre-ATOM group had 7057 graduating general surgery (GS) residents (847 SCC) and post-ATOM had 7581 graduating GS residents (1268 SCC). Locally the pre-ATOM group consisted of 40 graduating GS residents (1 SCC) and while the post-ATOM cohort had 51 graduating GS residents (9 SCC). The number of SCC fellows increased by 4.7% nationally and 15.7% institutionally between the two study groups. The increased interest in SCC was more than could be accounted for by national trends. ConclusionsInterest in a career in trauma was increased among residents graduating from this single institution after instituting ATOM as part of the educational curriculum.

Does Resident Trauma Exposure Affect Advanced Trauma Operative Management Course Experience?

The Advanced Trauma Operative Management (ATOM) course is a simulation course adopted by the American College of Surgeons to teach operative management of primarily penetrating, traumatic injuries. Although it is clear that overall operative trauma exposure is decreasing, the educational benefit of ATOM for residents with different amounts of trauma exposure remains unclear. Our aim was to determine whether residents from trauma centers experienced less benefit from the ATOM course when compared with residents from nontrauma centers. We compared two groups of residents who take ATOM through our institutional course, those from trauma centers and those from nontrauma centers. ATOM pre- and postcourse evaluations of knowledge and self-efficacy were collected from October 2007 to June 2013. Overall residents from three institutions, two trauma centers (100 residents) and one nontrauma center (34 residents), were included in the study. All resident groups had statistically significant improvement in knowledge and self-efficacy after taking the ATOM course (P < 0.0001). There was no statistically significant difference in improvement relative to each of the groups in the ATOM categories of knowledge and self-efficacy. Our data show that residents with different levels of trauma exposure had similar pre- and postcourse scores as well as improvement in the ATOM evaluations. As operative trauma continues to decrease the ATOM course shows benefit for all residents regardless of the depth of their clinical trauma exposure in surgical residency.

Model for Team Training Using the Advanced Trauma Operative Management Course: Pilot Study Analysis

Education and training of surgeons has traditionally focused on the development of individual knowledge, technical skills, and decision making. Team training with the surgeon's operating room staff has not been prioritized in existing educational paradigms, particularly in trauma surgery. We aimed to determine whether a pilot curriculum for surgical technicians and nurses, based on the American College of Surgeons' Advanced Trauma Operative Management (ATOM) course, would improve staff knowledge if conducted in a team-training environment. Between December 2012 and December 2014, 22 surgical technicians and nurses participated in a curriculum complementary to the ATOM course, consisting of 8 individual 8-hour training sessions designed by and conducted at our institution. Didactic and practical sessions included educational content, hands-on instruction, and alternating role play during 5 system-specific injury scenarios in a simulated operating room environment. A pre- and postcourse examination was administered to participants to assess for improvements in team members' didactic knowledge. Course participants displayed a significant improvement in didactic knowledge after working in a team setting with trauma surgeons during the ATOM course, with a 9-point improvement on the postcourse examination (83%-92%, p = 0.0008). Most participants (90.5%) completing postcourse surveys reported being "highly satisfied" with course content and quality after working in our simulated team-training setting. Team training is critical to improving the knowledge base of surgical technicians and nurses in the trauma operative setting. Improved communication, efficiency, appropriate equipment use, and staff awareness are the desired outcomes when shifting the paradigm from individual to surgical team training so that improved patient outcomes, decreased risk, and cost savings can be achieved. Determine whether a pilot curriculum for surgical technicians and nurses, based on the American College of Surgeons' ATOM course, improves staff knowledge if conducted in a team-training environment. Surgical technicians and nurses participated in a curriculum complementary to the ATOM course. In all, 8 individual 8-hour training sessions were conducted at our institution and contained both didactic and practical content, as well as alternating role play during 5 system-specific injury scenarios. A pre- and postcourse examination was administered to assess for improvements in didactic knowledge. The course was conducted in a simulated team-training setting at the Legacy Institute for Surgical Education and Innovation (Portland, OR), an American College of Surgeons Accredited Educational Institute. In all, 22 surgical technicians and operating room nurses participated in 8 separate ATOM(s) courses and had at least 1 year of surgical scrubbing experience in general surgery with little or no exposure to Level I trauma surgical care. Of these participants, 16 completed the postcourse examination. Participants displayed a significant improvement in didactic knowledge (83%-92%, p = 0.0008) after the ATOM(s) course. Of the 14 participants who completed postcourse surveys, 90.5% were "highly satisfied" with the course content and quality. Team training is critical to improving the knowledge base of surgical technicians and nurses in the trauma operative setting and may contribute to improved patient outcomes, decreased risk, and hospital cost savings.

Hemorrhage Control in Penetrating Cardiac Injury: A New Device Put to the Test in the Advanced Trauma Operative Management (ATOM) Course

Hemorrhage Control in Penetrating Cardiac Injury: A New Device Put to the Test in the Advanced Trauma Operative Management (ATOM) Course

Does resident depth of clinical trauma exposure affect Advanced Trauma Operative Management (ATOM) course experience?

Kaban, Jody M. MD, FACS; Stone, Melvin E. MD, FACS; Safadjou, Saman MD; Reddy, Srinivas H. MD; Simon, Ronald MD, FACS; Teperman, Sheldon H. MD, FACS Author Information

Permissive Hypotension in Bleeding Trauma Patients: Helpful or Not and When?

Severity of hemorrhage and rate of bleeding are fundamental factors in the outcomes of trauma. Intravenous administration of fluid is the basic treatment to maintain blood pressure until bleeding is controlled. The main guideline, used almost worldwide, Advanced Trauma Life Support, established by the American College of Surgeons in 1976, calls for aggressive administration of intravenous fluids, primarily crystalloid solutions. Several other guidelines, such as Prehospital Trauma Life Support, Trauma Evaluation and Management, and Advanced Trauma Operative Management, are applied according to a patient's current condition. However, the ideal strategy remains unclear. With permissive hypotension, also known as hypotensive resuscitation, fluid administration is less aggressive. The available models of permissive hypotension are based on hypotheses in hypovolemic physiology and restricted clinical trials in animals. Before these models can be used in patients, randomized, controlled clinical trials are necessary.

The Advanced Trauma Operative Management course—a two student to one faculty model

BackgroundThe internationally recognized Advanced Trauma Operative Management (ATOM) course uses a 1:1 student-to-faculty teaching model. This study examines a two student to one faculty ATOM teaching model. Materials and methodsWe randomly assigned 16 residents to four experienced ATOM faculty members. Half started with the one-student model and the other half with the two-student model and then switched using the same faculty. Students and faculty completed forms on the educational value of the two models (1 = very poor; 2 = poor; 3 = average; 4 = good; and 5 = excellent) and identified educational preferences and recommendations. ResultsWe assigned educational values for the 13 procedures as follows: All faculty rated the one-student model as excellent; six members rated the two-student model as excellent, and seven as good. Students rated 50%–75% as excellent and 12%–44% as good for the two-student model, and 56%–81% as excellent and 12%–44% as good for the one-student model. Given resource constraints, all faculty and 88% of students preferred the two-student model. With no resource constraints, 75% of students and 50% of faculty chose the two-student model. All faculty and students rated both models “acceptable.” Overall, 81% of students and 50% of faculty rated the two-student model better. All faculty members recommended that the models be optional; 94% of students recommended that they be either optional (50%) or a two-student model (44%). Performing or assisting on each procedure twice was considered an advantage of the two-student model. ConclusionsThe two-student teaching model was acceptable and generally preferred in this study. With appropriately trained faculty and students, the two-student model is feasible and should result in less animal usage and possibly wider promulgation.

Effectiveness of A 2:1-Student to Faculty Model for Teaching the Advanced Trauma Operative Management (ATOM) Course

Effectiveness of A 2:1-Student to Faculty Model for Teaching the Advanced Trauma Operative Management (ATOM) Course

Impact of trauma societies on the clinical care of polytrauma patients.

Trauma societies have an influence on the management and outcome of polytrauma. Its contributions include setting up standard definitions, trauma registries, evidence-based medicine guidelines, and the creation of educational tools such as specific courses of trauma care and decision-making. Literature and web-based search of definitions and available information. The history of and accomplishments of trauma societies in the above-mentioned domains are reviewed, including the major trauma registries (Major Trauma Outcome Study, National Trauma Data Bank, The American Pediatric Surgical Association, the American Burn Association trauma, and the German Trauma Society trauma registries). Several learned societies in the field of trauma have created recommendations and/or guidelines concerning polytrauma (the Eastern Association for the Surgery of Trauma, The Society of Critical Care Medicine, and the German Trauma Society, Brain Trauma Foundation, and the Essential Trauma Care (EsTC) Guidelines). Several practical, hands-on courses and scoring systems for improving the quality of management of polytrauma patients have been founded and implemented in the past 35years, including the Advanced Trauma Life Support (ATLS(®)) Course of the American College of Surgeons, the Definitive Surgical Trauma Care (DSTC(TM)) Course, the National Trauma Management Course (NTMC(TM) Course,) the Advanced Trauma Operative Management (ATOM) Course, and the European Trauma Course (ETC). Trauma and emergency care societies have made an elaborate, substantial contribution by developing trauma registries and creating specific guidelines courses on trauma care and decision-making.

(P1-59) Atom Course in Japan

IntroductionTrauma care is one of the key components of disaster medicine. However, it is difficult in Japan to gain extensive experience in trauma surgery, especially penetrating trauma. The Advanced Trauma Operative Management (ATOM) course was developed as a model for teaching operative trauma techniques to surgical residents, fellows, and attending surgeons as the number of these cases decreases in the US. In 2008, a new ATOM training site was established at Jichi Medical University in Japan, and as of December, 2010, five courses have been offered.MethodsThe ATOM course consists of lectures and a porcine operative experience. Comprehensive evaluation of ATOM was designed to assess participant learning in the cognitive, affective, and psychomotor domains. Data on the first 36 participants was retrospectively collected and analyzed.ResultsParticipants included: 20 expert trauma surgeons, and 16 general surgeons. All groups showed improvement in knowledge (pre-test score: 61.9 ± 16.4 (mean ± standard deviation), post-test score: 70.6 ± 16.5, p-value &lt; 0.001) with results in the expert and fellow groups reaching statistical significance. Self-confidence also improved (pre-evaluation score: 65.4 ± 17.6, post-evaluation score: 82.0 ± 9.4, p-value &lt; 0.001), with all groups reaching statistical significance.DiscussionThis course creates real operative situations in a standardized fashion that improves knowledge and operative confidence for trauma operations, which may be of great benefit in disaster medicine training.

Advanced Trauma Operative Management Course: Participant Survey

The Advanced Trauma Operative Management (ATOM) course uses standardized porcine simulation to teach the repair of penetrating trauma. It is offered in 26 sites in the United States, Canada, Africa, the Middle East, and Japan. The purpose of the present study was to query ATOM participants regarding their perceptions of the value and influence of the ATOM course on knowledge, confidence, and skill to repair penetrating injuries. An anonymous, voluntary survey was posted on the Internet at surveymonkey.com. E-mail notification was sent to all 1,001 ATOM participants through May 2008. Items requested agreement/disagreement on a 5-point Likert scale and space for comments. Agreement indicated positive perceptions of ATOM. A total of 962 surgeons received the request to complete the survey; 444 ATOM participants from 36 states and 17 countries participated, for a response rate of 46%. Range of agreement with all of the items was 75.4-99.0%. Results include the following: 78.9% (95% CI, 74.7-82.6%) can identify injuries more quickly; 80.7% (95% CI, 76.6-84.3%) have a more organized operative approach; 81.1% (95% CI, 77.0-84.6%) can control bleeding more quickly; 86.1% (95% CI, 82.4-89.2%) can control injuries more effectively; 86.4% (95% CI, 82.7-89.4%) are more competent trauma surgeons; 87.0% are more confident (95% CI, 83.4-89.9%), and 89.2% are more knowledgeable (95% CI, 85.8-91.8%) about repairing penetrating injuries; 99% (95% CI, 97.4-99.7%) said ATOM is worthwhile. Overall, 87.4% of the comments were positive. Participants worldwide perceive that ATOM is worthwhile and helps surgeons improve knowledge, confidence, and skill in repairing penetrating injuries.

Porcine anaesthesia for advanced trauma operative management (atom)

Anaesthesia has been provided for pigs for the Advanced Trauma Operative Management Course which was first held at the Korle Bu Teaching Hospital in February 2005. As of January 2006, 16 animals have been anaesthetized. Acepromazine (1mg/kg) and atropine (0.05mg/kg) were used for premedication. IM ketamine (30mg/kg) and isoflurane (in oxygen) were used for the anaesthesia and the animals were intubated and ventilated with positive pressure ventilation. No neuromuscular blocking agents were used. Morphine (average 3 doses of 10mg) was used for analgesia. Systolic blood pressure ranged between 80mmHg and 115mmHg and diastolic pressure ranged between 45mmHg and 80mmHg. Large amounts of IV fluids were given during the procedure. At the end of surgery, the animals were euthanized by increasing the concentration of isoflurane and administering potassium chloride. Out of the 14 cases reported on, 13 animals survived to the end of all the surgical procedures. 1 animal had a cardiac arrest during the last procedure (inflicting a laceration to the heart) and could not be resuscitated.

Advanced Trauma Operative Management: Surgical Strategies for Penetrating Trauma. Lenworth M. Jacobs, MD, Ronald I. Gross, MD, Stephen S. Luk, MD, eds. Published by Cineʼ-Med, Woodbury, Connecticut, 2004. 395 pp.

Advanced Trauma Operative Management: Surgical Strategies for Penetrating Trauma. Lenworth M. Jacobs, MD, Ronald I. Gross, MD, Stephen S. Luk, MD, eds. Published by Cineʼ-Med, Woodbury, Connecticut, 2004. 395 pp.

Advanced Trauma Operative Management: Surgical Strategies for Penetrating Trauma

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Advanced Trauma Operative Management Course: Site and Instructor Selection and Evaluation

t a p c o c t he work of surgeons involves the repair of penetrating rauma. Opportunities to practice management and reair of penetrating injuries need to be available to sureons so that they are ready to deal with any traumatic mergency. Others have documented that supplying resdents with sufficient operative experiences is a chalenge, and there is a need to increase the operative expeience for residents on the trauma rotation. Simulation ducation is being recognized as one way to offer resients and others real life-like learning experiences to romote acquisition or retention of skills. The Advanced rauma Operative Management (ATOM) course was eveloped to provide surgeons and surgeons-in-training ith operative experience in the management and repair f penetrating injuries. The 1-day ATOM course focuses n penetrating trauma and teaches the surgical proceures to manage and repair injuries in the chest and bdomen using simulation in a porcine laboratory xperience. To ensure educational integrity of any course, care ust be given to the selection of sites and the qualificaions and preparation of the instructors. Requisite criteia must be available and documented. This article reiews the processes in place to extend ATOM to new ites and to certify new instructors. Results of a survey of TOM instructors will be presented.