Training In Trauma Surgery Research Articles

Development of a simulator and training curriculum for liver trauma surgery training for general surgeons

Development of a simulator and training curriculum for liver trauma surgery training for general surgeons

Trauma surgery training at a South African level 1 trauma centre: challenges and opportunities

We look at two perspectives detailing the differences in open surgical training opportunities in the UK and South Africa.

The Association of Surgeons in Training (ASiT) Consensus Statement on Major Trauma Training in the UK.

Since the establishment of the Major Trauma Networks in 2012, it is estimated that an extra 1,600 lives have been saved across England. Although the delivery of trauma care has improved significantly, the provision of trauma training has not and remains fragmented. The Association of Surgeons in Training (ASiT), an independent organisation run by trainees, is dedicated to excellence in surgical training within the United Kingdom (UK) and Republic of Ireland (ROI). The aim of this study was to develop a consensus statement representing the views of the ASiT on the future of trauma surgery training. A modified nominal group technique was used in five stages: 1, scoping exercise; 2, virtual consultation; 3, nominal group consensus meeting; 4, virtual feedback from stakeholders; and 5, virtual confirmation by the ASiT Council. The design and reporting of the consensus followed best practice methodology for consensus research. Overall, 62 participants gave 90 statements across stages 1-3. Eleven key themes were identified, all of which met the consensus of the ASiT Council. The key findings were widespread support for increased exposure to trauma for medical students and early surgical trainees as well as an increased use of simulation methods and improved focus on non-technical skills within trauma surgery. This study sets out the position of the ASiT on the future of trauma surgery training and how training in major trauma surgery in the UK and ROI could be improved.

Training in trauma surgical techniques using cryopreserved porcine organs.

To develop a trauma surgery training program using porcine organs and evaluate its usefulness. This program allows participants to experience the tactile sensation of organs and bleeding, which are impossible in trauma surgery training using a cadaver. Resected organs (heart, lung, liver, spleen, kidney, small intestine, bladder, and external carotid artery) from slaughtered pigs for medical research were perfused with saline solution, flash-frozen in a deep freezer, and thawed naturally on the morning of training. The training program consisted of half-day practical training in suture repair of artificially created damage to the parenchymal organs and suture or anastomotic repair of damage to the luminal organs. We injected the parenchymal organs' arteries with porcine blood and the renal ureters with saline solution to create models of organ hemorrhage and urinary leakage. The training's usefulness was evaluated using a participant questionnaire that included an 11-point self-assessment of confidence level (SACL) form. Nine training seminars were conducted from September 2018 to February 2023, attended by 67 participants who were in their 1st to 20th post-graduate year. The mean SACL significantly increased immediately after the seminar but decreased half-year thereafter. However, it was maintained for those with surgical residency. It was also maintained for those with no surgical residency through seminar repetition. Training in trauma surgical techniques using porcine organs is beneficial regardless of whether the participant has prior surgical residency.

Velocity changes in femoral vessel ultrasound with Doppler in Porcine hemorrhagic shock

Physician-directed point-of-care ultrasound (PoCUS) is routinely used to identify the etiology of shock and guide therapy in the ICU. We performed a preclinical study to determine what changes are manifested in the femoral vessels during hemorrhagic shock on Duplex imaging and to generate a femoral vessel sonographic profile over the time course of shock. A preclinical study in swine was performed using a convenience sample of animals that were being used in a Trauma Surgery training lab. The animals developed progressive unregulated hemorrhage during the lab. Six anesthetized swine underwent Duplex studies of the femoral vessels prior to any hemorrhage and at two time points after the start of hemorrhage. N/A. Femoral vessel imaging was performed using a portable ultrasound (Sonosite and Clarius). Femoral arterial peak systolic velocity decreased in all animals with hemorrhage, from a mean (SD) of 77 (27) cm/s pre-hemorrhage to 42 (17) and 32 (16) cm/s at the two post-hemorrhage time points. There were also changes to the arterial waveform morphology. Mean venous velocities also decreased with hemorrhage (20, 11, 7cm/s). Animals with severe hemorrhage had a cessation of venous flow during positive pressure ventilation. In this preclinical study, both femoral peak systolic velocity and venous velocity decreased with hemorrhage. Femoral vessels represent an easily accessible target for non-invasive hemodynamic monitoring. Changes in femoral vessel Duplex waveforms and velocities should be studied both in a larger sample of animals with controlled hemorrhage and in human trauma patients to determine whether changes appear in early hemorrhage, before the onset of clinically evident hemorrhagic shock.

Soft skills and competences in continuing education and personal development : What we need them for

In addition to the content of orthopedic and trauma surgery training, which is recorded in the logbook in black and white, there seems to be more content for being agood physician. The so-called soft skills are currently discussed regularly but the perspective of the younger generation is rarely presented. Do soft skills and communication techniques support us in the continuing education and development to agood leader? Competence is defined as the combination of cognitive abilities and skills required to perform aspecific task or role. These are modifiable and, more importantly, learnable. Successful leadership competence consists of motivating members of the team to achieve common goals and giving them the space to evolve and develop themselves. This requires well thought out, respectful and structured teamwork. Agood error culture, open and appreciative communication within the team and in this respect the requirement to be informed about various social, societal and political issues are important. In addition, creativity and independence as well as critical questioning should already be trained during the medical studies through participatory teaching; however, intergenerational dialogue is particularly important in order to share perspectives and competencies and to jointly develop effective future perspectives and plans. The substantive values and competencies attributed to aleader are not static but dynamic and should therefore be redefined taking into account political, societal, social, infrastructural aspects and current developments.

Benefits of international trauma rotation in South Africa: comparison with a trauma center in Tokyo

Abstract International rotations have been an option for young surgeons who face difficulties in obtaining sufficient trauma training in their own countries. One of the authors attended training in trauma surgery in South Africa for 6 months, where there are many trauma caseloads, and could experience the number of emergency operations equivalent to approximately 5 years in Japan. The rotation allows trainees to expose clinical practices intensively and to learn principles and theories of care under experienced academic surgeons. On the other hand, they could contribute to the host hospital as part of the workforce and by assisting young surgical residents. the development of a more systematic and formalized framework for staff exchange between developed and developing countries will provide mutual benefits to both sides.

Knowledge survey regarding blast wound education of student doctors at a local academic medical university in Japan.

To improve knowledge about blast injury for medical student doctors or surgeons. In the modern uncertain era, education and training programs for blast injuries for medical student doctors or surgeons are recently necessary worldwide. To understand primary corresponding ability to treat blast injuries, leading to improvement of the trauma education curriculum, a retrospective study by a knowledge survey was performed between 2018 and 2019. The subject had the title of Student Doctor (SD) at university. The answers of 183 participants who answered the interview questionnaire with 16 questions were summarized. Although most SDs received basic lectures for trauma medicine and majority of SDs knew about mass casualty incidents and primary treatment, the existence of knowledge on soft targets is limited. One-fourth of the SDs knew the characteristics of blast wounds. Most SDs understood priority triage for a conscious person with massive bleeding from a limb with hemostasis to save lives. The 17% selected cardiopulmonary resuscitation first and 72% of SDs could explain hemorrhagic shock; however, only four could explain adequate hemostatic procedures. Most had no interest regarding necessity of their knowledge in the field of serious blast trauma wounds. Experience in trauma surgery training from stages in SDs and authorized education are important for raising students' knowledge of unexpected serious blast incidents.

Mentorship: A Millennia-Old Remedy for Learner Success Amidst the COVID-19 Pandemic

Mentorship: A Millennia-Old Remedy for Learner Success Amidst the COVID-19 Pandemic

Observed benefits of a major trauma centre in a tertiary hospital in Nigeria.

IntroductionA Trauma System or its components has been shown to improve trauma services and outcome of seriously injured patients. These organised services are non0existent or the components operate in isolation in most African countries.This study was done to identify the observed advances in trauma care service delivery, brought about by the beginning of operation of a trauma centre in the capital city of a West African country.MethodologyThe operation of the trauma centre was reviewed for progress in terms of organisation of care, in-hospital care, training, and referral system and injury prevention. In addition, the challenges facing the trauma centre were also reviewed and discussed.ResultsThe trauma centre has brought about better organisation of care and specialist availability, various training in trauma surgery, advances in referral and injury prevention. Funding is an identified threat to the function of the centre.DiscussionThe trauma centre provided the drive for specialist training in trauma and changes in the process of care. Funding is a threat to optimal function, as was poor inter-relatedness with other local hospitals, pre-hospital services and rescue providers.

Polytrauma: The European Paradigm

This review of the literature aims to describe the main advantages and disadvantages of the trauma systems in Europe. Moreover, the purpose of this article is to present the last concepts regarding the management of the polytrauma patients and the newest sets of measures to prevent car crashes in European Union. The articles published regarding the management of the polytrauma patient and trauma systems were identified using PubMed search. Optimal management of major polytrauma requires a national trauma system which should detail every level of organization from the trauma centers to the every member of the trauma team. European trauma systems varies a lot depending on the country and the specialized trauma surgery training programs are more advanced in countries with complex trauma systems. Introducing road safety performance indicators for trauma management decreased the rate of deaths by car crashes in Europe.

Impact of the COVID-19 pandemic on orthopaedic and trauma surgery training in Europe.

PurposeThis study aimed to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on orthopaedic and trauma surgery training in Europe by conducting an online survey among orthopaedic trainees.MethodsThe survey was conducted among members of the Federation of Orthopaedic and Trauma Trainees in Europe (FORTE). It consisted of 24 questions (single-answer, multiple-answer, Likert scales). Orthopaedic trainees’ demographic data (six questions), clinical role changes (four questions), institutional changes due to the COVID-19 pandemic (nine questions), and personal considerations (five questions) were examined.ResultsThree hundred and twenty-seven trainees from 23 European countries completed the survey. Most trainees retained their customary clinical role (59.8%), but a significant number was redeployed to COVID-19 units (20.9%). A drastic workload decrease during the pandemic was reported at most institutions. Only essential activities were performed at 57.1% of institutions and drastic disruptions were reported at 36.0%. Of the respondents, 52.1% stated that faculty-led education was restricted and 46.3% pursued self-guided learning, while 58.6% stated that surgical training was significantly impaired. Concerns about the achievement of annual training goals were expressed by 58.2% of the participants, while 25.0% anticipated the need for an additional year of training.ConclusionsThe SARS-CoV-2 pandemic significantly affected orthopaedic and trauma training in Europe. Most trainees felt the decrease in clinical, surgical, and educational activities would have a detrimental effect on their training. Many of them consulted remote learning options to compensate training impairment, stating that after the COVID-19 pandemic electronic educational approaches may become more relevant in future.Electronic supplementary materialThe online version of this article (10.1007/s00264-020-04742-3) contains supplementary material, which is available to authorized users.

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.

Trauma surgery training: the Dutch approach

Surgery is evolving rapidly and surgeons continue to specialize. The care for trauma patients will always need a physician with a broad base of knowledge and skills. In the Netherlands this care is well organized with a trauma center system and is mainly performed by specialized general surgeons, called trauma surgeons. These surgeons are trained in a well-defined education program and perform treatment for thoracic, visceral, and musculoskeletal injuries. In the near future collaboration with the orthopedic surgeons will be intensified, because currently they are less involved in trauma care. This will potentially develop to a common trauma unit and education program.

Effectiveness of cadaver-based educational seminar for trauma surgery: skills retention after half-year follow-up.

AimIn Japan, trauma surgery training remains insufficient, and on‐the‐job training has become increasingly difficult because of the decreasing number of severe trauma patients and the development of non‐operative management. Therefore, we assessed whether a 1‐day cadaver‐based seminar is effective for trauma surgery training.MethodsData were collected from 11 seminars carried out from January 2013 to March 2014, including a 10‐point self‐assessment of confidence levels (SACL) for 21 surgical skills and an evaluation of the contents before, just after, and a half‐year after the seminar. Statistical analysis was undertaken using the paired t‐test at P < 0.0167.ResultsA total of 135 participants were divided into three groups based on experience and clinical careers. The SACL improved in all skills between before and just after the seminar, however, they decreased between just after and a half‐year after the seminar. The SACL did not change significantly in all skills between just after and a half‐year after the seminar in highly experienced and experienced group members belonging to an emergency center.ConclusionsA cadaver‐based seminar provided more self‐confidence just after the seminar for participants at all experience levels. This effect was not maintained after a half‐year, except in participants who can practice the skills at an emergency center. Practicing and participating in the seminar repeatedly is suggested to be effective for skills retention in trauma surgery.

Training in trauma surgery in Wales: Are we fit for purpose?

Training in trauma surgery in Wales: Are we fit for purpose?

Die studentische Lehre im gemeinsamen Fach Orthopädie-Unfallchirurgie – eine deutschlandweite Statuserhebung

Musculoskeletal conditions consume enormous resources and costs, and their incidence is increasing worldwide. Therefore, an appropriate education of medical students about these conditions is required. This study examines the extent of medical education in orthopaedic and trauma surgery in Germany. A questionnaire comprising 7 topics (curriculum design, lecture, practical training, e-learning, examination, evaluation, resources) with a total of 44 items was sent to all assistant lecturers in orthopaedic and trauma surgery at the 37 medical schools in Germany. The survey attained a return rate of 76 % for orthopaedic surgery and 81 % for trauma surgery, respectively. Medical training in musculoskeletal conditions represents with an average of 38.4 hours of lectures and further 55.9 hours of practical training less than 6 % of the entire undergraduate medical education. This study demonstrates a high inhomogeneity regarding the curriculum design when comparing the different German medical schools not only in total training time but also regarding its contents. E-learning as additional teaching method is only offered in 39 % of orthopaedic training and in 47 % of the trauma surgery training. Practical examinations like the OSCE are offered at 8 medical schools for orthopaedic training and 15 schools for trauma surgical training, respectively. Medical training in musculoskeletal conditions is very inhomogeneous and requires further improvement and standardisation regarding quantity and implementation.

Which Future for Traumatology in Europe?

AbstractThe last decades have been characterized by rapid changes in society, medicine and surgery. There is a distinct evolution towards specialization and super-specialization. Trauma surgery also evolves towards a specialty, focused on the care of the injured. To optimize the quality of care and meet the needs of patients and care providers, a well-structured trauma surgery training program as well as the regionalization of trauma care with the implementation of Level I trauma centers are needed. The core competence of the European trauma surgeon is the coordination of the early management of the severely injured and the treatment of muskuloskeletal trauma, which represent the most common pathologies in our countries.

A Survey on Trauma Systems and Education in Europe.

To assess the current stage of trauma system development and trauma surgery training in Europe. Email-based survey from 53 physicians representing 25 European countries. On a scale of 0-10, the mean (SD) score for trauma system development was 5.4 (2.4) and for trauma surgery specialization 4.1 (2.9). There was a significant positive correlation between trauma system development and trauma surgery specialization (p = 0.018). Countries with ties to the Austro-German surgical tradition had higher scores both in trauma system development (p = 0.003) and in trauma surgery specialization (p = 0.000), whereas the size, economic performance or geographical location were not associated with either. Despite the great variation from country to country, three trends in developing trauma care and education can be identified: trauma system development based exclusively on major (life-threatening) trauma care (the old United States model), combining trauma and emergency surgery into a single regionalized system (the acute care surgery model), or maintaining the orthopedic surgery-orientated all-inclusive trauma care model as practiced in most central European countries today. Although each country and region might proceed along their own line depending on local circumstances, some kind of general guidelines and recommendations at least at the European Union level would be urgently needed.

Development of a hands-on training for undergraduates on cadavers and artificial bones in trauma surgery.

BACKGROUND: Education of students in trauma surgery is problematic with respect to a number of factors, e.g. work flow in the operating theater or patient safety. As a result, surgical education for students takes place mainly in the lecture hall favouring theory and neglecting procedural skills. AIMS: To better close the gap between watching operations and performing them on patients we established a hands-on training in trauma surgery. To achieve this, we developed a seminar for students to practice procedural skills as simulations on artificial bones and cryo-fixated corpses outside the operation theater. DESIGN: The first seminar was held five years ago with a group of 12 students, trained from one trauma surgeon employing one formaldehyde-fixed cadaver. Due to increasing experience and feedback from students, the curriculum was adapted in every consecutive course to better meet the students’ expectations and knowledge in psychology of learning. The final curriculum included a training seminar in osteosynthesis techniques on artificial bones using different implants. Additionally, students were allowed to perform a variety of surgical approaches and osteosynthesis using cryo-fixated corpses. CONCLUSION: Taken together, we developed a trauma surgery curriculum including simulations ranging from basic skills (suturing wound) to complex procedures (planning and performing orthopedic operations). Artificial bone training followed by a simulation employing cryo-fixated corpses seems to represent adequate and logical substitutes to obtain advanced surgical skills. Using this trauma surgery curriculum, we are able to offer students intensive hands-on training in trauma surgery in a very cost-efficient.