Trauma Education Research Articles

The impact of flipped learning in surgical education: A mixed-method study

This study aims to investigate the effectiveness of flipped learning in surgical education in trauma. The participants were 15 first-year general surgery residents in Shiraz medical school. After completing a pre-test, the participants received the learning content in interactive multimedia, podcasts, movies, and books. One month later, they had a face-to-face class based on case-based discussions. An early post-test was performed immediately after the class, and a late post-test was performed one month later. In these tests, the residents' problem-solving abilities were assessed using multiple-choice questions. A semi-structured phone interview was used to measure their attitude towards the learning program. The results showed a significant difference between pre-test and early post-test scores and between pre-test and late post-test scores. However, there was no significant difference between early and late post-test scores. The residents were satisfied with the program's overall usefulness for junior residents. The participants tended to use podcasts more than other materials. They mentioned that the videos and books helped more to foster theoretical knowledge. The case-based discussion makes them more confident in dealing with patients in daily encounters.

Developing an Online Psychological Trauma Education Course for College Students

Introduction Individuals in various career fields will interact with people who have experienced trauma while engaging in their work responsibilities, and many have limited, if any, trauma training. Therefore, there is a need to provide trauma training within undergraduate degree programs. Statement of Problem Online learning is a viable method of meeting the need for psychological trauma education for undergraduate students. Literature Review Education in the United States has steadily moved toward more online formats, with many students preferring the flexibility of an online course. We discuss the literature on teaching about trauma and considerations for teaching the course online. Teaching Implications We outline components of an online undergraduate trauma education course focused on teaching students about psychological trauma. This includes presenting the course objectives, describing course assignments, and discussing considerations for the course which instructors can use in teaching about trauma. Conclusion Instructors of higher education can use the activities and considerations discussed in this article as a guide in the development of an online trauma education course.

The experience of domestic violence survivors in the US family courts: gender bias in the court

There is a significant body of research on gender bias against women in the family courts. During the Covid-19 pandemic, battered women's vulnerability to domestic violence increased on a global level as women experienced a significant increase in the severity of abuse. The problems of gender bias and the treatment of battered women and their children have a long history of human rights' abuses. In particular, battered mothers have been the focus of gender-biased theories of parental alienation, used as a defence against claims of abuse and child maltreatment, despite a lack of empirical validity and acceptance. Additionally, the family courts in the United States are closed to the public and as a result there is a lack of transparency and accountability. A large-scale national study revealed that many supporting mental health professionals who provide custody evaluations lack a formal graduate education in domestic violence and child maltreatment. Furthermore, legislative presumptions that favour joint legal custody in custody decisions and requirements of co-parenting, fail to take into consideration the long-term public health risks of such chronic traumatic exposure. Finally, this article will address needed systemic reforms that include increased transparency, longterm court-monitoring, and supporting mental health professionals with formal graduate education in trauma, child development, and abuse, to promote resilience in vulnerable families.

Editorial introductions.

Editorial introductions.

Trauma Takeaways: Reception and Utilization of a Postsimulation Newsletter.

Simulation is incorporated into medical education to reinforce practical skills. Instructor methodologies allow for reflective practice through debriefing; however, this is limited to real-time audiences. Few studies have described education via supplemental materials. This educational initiative demonstrates the reception and use of a postsimulation newsletter for both participating and nonparticipating trauma team members. After each case, the Trauma Takeaways newsletter was distributed to all trauma team members at our Level I pediatric trauma center. The newsletter included a brief case summary, objectives, and debrief highlights regarding communication, medical management, and practical logistics. A survey was conducted to assess its utility 6 months after its introduction. Of 69 interdisciplinary respondents, 46 reviewed the newsletter. The majority (69%) reported their trauma education is directly from simulation sessions. Thirty-nine percent of respondents found the newsletter most useful as a review when unable to attend, and 35% found it equally useful as compared with being an active participant. The majority of respondents found the newsletter either very helpful or extremely helpful. Medical simulation cases traditionally capture a select audience during educational debriefing sessions. However, because the majority of our respondents receive their trauma education from simulation sessions, the need for supplementation is paramount. Our team members found the Takeaways similarly useful both as a direct participant or as an indirect participant as a helpful reference for communication, management, and practical logistics in pediatric trauma care.

Prevention of Shaken Baby Syndrome Among High-Risk Neonates: Program Implementation and Evaluation

Background: Studies suggest that the implementation of high-quality education and support services for caregivers may reduce the incidence of unplanned harm to infants and young children under high-stress circumstances. Purpose: This pilot study evaluates the usefulness of the Period of PURPLE Crying program in a high-acuity NICU at The University of Chicago Comer Children’s Hospital based on six measurable objectives. Methods: The pilot study utilized a Likert-style pretest-posttest survey design to evaluate how NICU nurses perceived the Period of PURPLE Crying program. Nurses were educated on the program content during an in-service to teach participants how to utilize the Period of PURPLE Crying program materials to support and educate families about Shaken Baby Syndrome (SBS). Results: The intervention effectively increased nursing confidence in delivering the SBS and Abusive Head Trauma (AHT) education and increased accessibility to available resources pertaining to SBS and AHT. Questions pertaining specifically to the Period of PURPLE Crying presented exclusively on the post-test were met with an overwhelmingly positive response, with the majority (n=33, 97%) of respondents agreeing that the intervention was useful in standardizing SBS education, providing meaningful, effective information on this topic area, and delivering SBS and AHT information promptly.

A needs assessment of Canadian general surgery postgraduate trauma training

BackgroundClinical exposure to operative trauma cases for general surgery residents has decreased over recent decades. However, trainees are still expected to demonstrate competency in trauma care and injury management. MethodsA prospective survey based on preliminary qualitative analysis and a trauma education conceptual framework was distributed to general surgery educators, trauma surgeons, and general surgery residents across the country. Participants were asked to describe their trauma training experience, the educational resources available at their training programs, and their level of support for potential curriculum components. Results45% (31/69) of educators and 14% (58/405) of trainees responded to the survey. Perceived deficiencies were identified in the operative management of thoracic (educators 13%, trainees 28%), mediastinal (3%, 14%), neck (16%, 33%), and vascular (26%, 47%) injuries. Additional educational deficiencies were also identified in the domains of trauma systems and epidemiology, research and quality improvement, and injury prevention. Educators identified more inadequacies in training than trainees. Both groups supported participation in radiology (77%, 85%) and guideline (74%, 90%) reviews, journal clubs (84%, 81%), education rounds (90%, 88%), leading trauma resuscitations (94%, 98%), and trauma resuscitation simulations (90%, 95%) as valuable educational initiatives. ConclusionsTrauma training in Canada is currently perceived to be inadequate to support resident education. The development and implementation of competency-based curricular components will be essential to address the identified deficiencies. This data will be used to inform the development of a national trauma training curriculum and initiatives to enhance resident education.

Impact of coronavirus disease 2019 (COVID-19) on trauma surgical education at a level I trauma center

BackgroundDuring the coronavirus disease 2019 pandemic, trauma presentations to the emergency room decreased across the country. The goal of this study is to analyze the educational impact of coronavirus disease 2019 on trauma education and training at a level I trauma center. MethodsTrauma patient presentations were analyzed 6 months before a Tennessee executive stay-at-home order and 6 months after the state executive order. To control for the seasonal trauma volumes, an additional 6 months before the executive order was then analyzed comparing month to month. Total number of presentations, demographics, procedures, airway management, and coronavirus disease 2019 status of patients and residents were analyzed. ResultsThe number of trauma presentations were sustained after executive orders at our level I trauma center. There was no significant difference in intubations, central line placements, and chest tube placements before and during the pandemic. Blunt trauma decreased after stay-at-home orders. Of the 36 residents, no residents tested positive during the study period. ConclusionTrauma-focused surgical education was not affected at an academic level I trauma center. Understanding that it is region, city, and hospital specific, this study shows that quality trauma education can continue throughout the coronavirus disease 2019 pandemic while keeping trainees safe. Proper airway management, personal protective equipment, social distancing, and coronavirus disease 2019-preventative protocols seem to protect residents from potential harm while allowing them to participate and continue in quality trauma education and training.

Effectiveness of surgical residents compared to surgical faculty in teaching trauma evaluation and management

Introduction Senior medical students learn trauma principles in a 90-min interactive teaching session based on the trauma evaluation and management module designed by the American College of Surgeons. However, the number of surgical faculty available to conduct these interactive small group sessions is limited. The goal of this study is to compare the effectiveness of surgical residents to that of surgical faculty in teaching trauma principles. Methods 53 senior medical students received trauma teaching from trauma faculty ( n = 22), trauma residents ( n = 21), or no teaching ( n = 10). Students were tested on cognitive trauma knowledge (20 multiple choice questions) and clinical trauma simulation (using objective structured clinical performance score). All students completed a 5-point subjective questionnaire. Results Students receiving trauma teaching outperformed students receiving no teaching in the knowledge test (mean 13.0 ± 3.6 standard deviation (SD) vs. 8.4 ± 2.4 SD, p < 0.05), while faculty and resident teaching outcomes were similar (mean 12.6 ± 3.0 SD vs. 13.4 ± 4.1, p = 0.45). Similarly, in the clinical trauma simulation, students receiving trauma teaching scored better (objective score mean 78% vs. 56%, p < 0.05), while there was no difference between faculty and resident teaching outcomes (objective score mean 77% vs. 80%, p = 0.52). In the subjective questionnaire, students who received trauma teaching rated themselves higher on a scale of 10 in trauma knowledge and skills than those who did not have formal teaching (mean 5.2 vs. 2.1, p < 0.05) as resident and attending teaching group ratings were similar. Conclusions Although small group discussions and increased simulation enhance undergraduate surgical trauma education, the number of faculty surgeons needed to fully incorporate these activities is limited. Objective and perceived effectiveness of teaching trauma management by surgical residents compared to trauma attendings is equivalent. This highlights the opportunity to incorporate residents into teaching roles to bridge the gap in undergraduate trauma education.

A Survey of Trauma Education in Social Work Programs in the United States and Canada

ABSTRACT In the past 2 decades, social work education has increasingly advocated for inclusion of trauma-related content in educational programming. Yet, to date, little is known about the current state of trauma education and training in social work programs. The aim of this study is to describe trauma education and training in accredited, North American social work programs. The data are from an online survey of 192 social work educators from 165 universities with accredited social work programs in the United States (n=151) and Canada (n=14). Participants were asked whether trauma-specific education is offered, and if so, to provide the formats used to deliver the content, the type of curriculum used, and evaluation efforts. Most programs (67.9%) reported integrating trauma education into existing courses, with 61.4% of BSW programs and 65.4% of MSW programs offering some form of trauma education. Results suggest that social work educators are recognizing the importance of including trauma education in their programming. However, more evaluation is needed to identify specific trauma content being presented.

Proposing the inclusion of dental anatomy and trauma in the general medical curriculum.

Many medical doctors are not confident in managing traumatic dental injuries (TDI). This is probably due to a lack of education and training in dental trauma. The existence of inadequate TDI knowledge by doctors should provide the catalyst to establish a dental anatomy and trauma course within the medical curriculum.

Psychological outcomes after pediatric hospitalization: the role of trauma type

ABSTRACT Physical injury and illness are common potentially traumatic events during childhood and adolescence. Many children experience psychosocial difficulties after medical events. The sample consisted of 399 children aged 4 to 15 who had been hospitalized for physical illness or injury. Elevated psychological symptomatology (PTSS, depression, anxiety) was more frequent after multiple (type II) compared to single (type I) medical events, but only a few differences were statistically significant. The strongest risk factor of child PTSS was parental stress. Type II trauma and low parental education were significant risk factors only for parent report of child PTSS (not for child report). The analyzed risk factors did not differ for type I versus II trauma. We recommend standardized screening and monitoring for mental health in the standard pediatric health care. Furthermore, pediatricians should be trained in signaling stress signs of parents.

Mental health workers' experiences of support and help-seeking following workplace violence: A qualitative study.

The consequences of workplace trauma among mental health staff can include physical injuries and somatic disorders, professional exhaustion and burnout, depression, anxiety, and other occupational stress injuries. For the well-being of staff and patients, there is a need to understand mental health workers' experiences following exposure to workplace trauma, any subsequent mental health problems, and the process of help-seeking. The nuances of these experiences can best be captured through qualitative exploration. In this study, we explored inpatient mental health workers' experiences of support and help-seeking following workplace violence. Four overall themes emerged from interviews with 12 participants: (i) validation as motivation for help-seeking; (ii) stigma as a barrier to help-seeking; (iii) gaps in services provided; and (iv) desire for accessible and effective trauma support and education. This study demonstrates the need for supportive management responses and peer support, access to specialized and confidential trauma-informed mental health services, and reductions in stigma, victim blaming, and other barriers to help-seeking among mental health workers.

Trauma, Critical Care, and Medical Education in the Face of COVID-19

Article has no abstract

Dr. James Styner and the development of Advanced Trauma Life Support

The Advanced Trauma Life Support program, or ATLS, is a trauma education system that has become the standard of care for initial management in emergent settings. Trauma is responsible for 10% of the world’s mortality, and comes at extensive cost, often with significant morbidity and rehabilitation1. ATLS provides an organized language and approach to the trauma patient that can be communicated globally and has been shown to significantly decrease mortality in the first hour post-admission2. It was originally designed for use in low resource settings after a devastating accident involving an orthopaedic surgeon’s family. The shortcomings in care that his family received spurred him to create an educational system that could be applied at any site.

A cross-sectional evaluation of knowledge among Chinese dentists regarding the treatment of traumatic injuries in primary teeth.

Injuries to the primary dentition affect children's esthetics, function, and mental health. They may also affect the development of the permanent teeth. The knowledge of dentists about deciduous tooth trauma is rarely evaluated. The aim of this study was to evaluate the knowledge and attitude of dentists in China regarding traumatic dental injuries to primary teeth. A self-administered online questionnaire containing questions on demographic data and knowledge based on a clinical scenario was given to a purposive sample of dentists, recruited by a non-probability convenience sampling method. The chi-square test was used for statistical analysis, with the significance level set at P <.05. A total of 394 out of 409 dentists provided valid data. There was no significant difference in demographic data. Questions about the treatment of hard dental tissue injuries in primary teeth presented a correct-response rate of 66.4%, with the highest correct-response rate for enamel fracture (n=368, 93.4%) and lowest for complicated crown-root fracture with pulp exposure (n=104, 26.4%). Questions about treatment of luxation injuries in primary teeth presented a correct-response rate of 66.6%, with subluxation presenting the highest correct-response rate (n=391, 99.2%). Factors associated with higher correct-response rates were specialist disciplines, educational qualifications, workplaces, experience of injured teeth treated, and educational experience about primary tooth trauma. No significant differences were found in the correct-response rates of dentists with different years of work experience. Lack of cooperation from children was considered a major obstacle for treatment. Special lectures and Internet courses were the most preferred methods of obtaining knowledge. The results suggest that it is necessary to enhance dental trauma education for dentists in China. More attention needs to be paid to trauma in primary dentition to ensure adequate treatment for traumatized primary teeth.

Link for Injured Kids and Trauma Education: A Comparative Effectiveness Study of Two Parent-Based Interventions to Support Children After Traumatic Injury

Background: A comparative effectiveness trial tested two parent-based interventions in improving the psychosocial recovery of hospitalized injured children: 1) Link for Injured Kids (Link), a program of psychological first aid that teaches parents motivational interviewing and stress screening skills, and 2) Trauma Education, based on an informational booklet about trauma, its impacts and resources. Methods: A randomized controlled trial was conducted in four children’s hospitals in the Midwestern United States. 10-17 year old children admitted for an unintentional injury and a parent were recruited and randomly assigned to Link or Trauma Education between 1/2015-7/2017. Link parents were trained in motivational interviewing based communication and screening skills; Trauma Education parents received an educational booklet. Parents and children completed questionnaires at baseline, six weeks, three months, and six months post-hospitalization. Using an intent to treat analysis, changes in child-reported symptoms of posttraumatic stress (PTSS), depression, quality of life and child behaviors were compared between intervention groups. This study is registered at ClinicalTrials.gov (ID: NCT02323204, Unique Protocol ID: 201111728). The trial is currently closed. Findings: Of 795 injured children, 314 children and their parents were enrolled into the study (40%). Link and Trauma Education improved PTSS, depression and pediatric quality of life at similar rates over time. However, unlike those in Trauma Education, children in the Link group had notable improvement of child emotional behaviors, and mild improvement of conduct and peer behaviors. Link was also slightly more effective than Trauma Education in improving conduct behaviors in rural compared to urban children. Interpretation: Although both programs improved post-trauma symptoms, Link, which interacted with parents to teach communication and referral skills, was more effective in reducing problem behaviors. Trial Registration: This study is registered at ClinicalTrials.gov (ID: NCT02323204, Unique Protocol ID: 201111728). Funding Statement: The Patient-Centered Outcomes Research Institute (PCORI) funded this research. Declaration of Interests: All authors have no reported conflicts of interest. Ethics Approval Statement: Study procedures conducted at the University of Iowa Stead Family Children’s Hospital and Children’s Mercy Hospital Kansas City were approved by the University of Iowa Institutional Review Board (IRB ID# 201111728, reliance IRB#: 14110518). Study procedures conducted at Blank Children’s Hospital and Children’s Minnesota were approved by their respective Institutional Review Boards (ID number IM2014-029, IRB number 1602-010).

Developing sustainable prehospital trauma education in Rwanda.

IntroductionEvery year, >5 million people worldwide die from trauma. In Kigali, Rwanda, 50% of prehospital care provided by SAMU, the public prehospital system, is for trauma. Our collaboration developed and implemented a context-specific, prehospital Emergency Trauma Care Course (ETCC) and train-the-trainers program for SAMU, based on established international best practices.MethodsA context-appropriate two-day ETCC was developed using established best practices consisting of traditional 30-minute lectures followed by 20-minute practical scenario-based team-driven simulation sessions. Also, hands-on skill sessions covered intravenous access, needle thoracostomy and endotracheal intubation among others. Two cohorts participated — SAMU staff who would form an instructor core and emergency staff from ten district, provincial and referral hospitals who are likely to respond to local emergencies in the community. The instructor core completed ETCC 1 and a one-day educator course and then taught the second cohort (ETCC2). Pre and post course assessments were conducted and analyzed using Student's t-test and matched paired t-tests.ResultsETCC 1 had 17 SAMU staff and ETCC 2 had 19 hospital staff. ETCC 1 mean scores increased from 40% to 63% and ETCC 2 increased from 41% to 78% after the course (p < 0.001 using matched pair analysis). A one-way ANOVA mean square analysis showed that regardless of the baseline level of training for each participant, all trainees reached similar post-course assessment scores, F (1) = 15.18, p = 0.0004.DiscussionThis study demonstrates effective implementation of a context-appropriate prehospital trauma training program for prehospital staff in Kigali, Rwanda. The course resulted in improved knowledge for an instructor core and for staff from district and provincial hospitals confirming the effectiveness of a train-the-trainers model. This program may be effective to support capacity development for prehospital trauma care in the country using a qualified local source of instructors.

Fractures around the hip: inducing life-like fractures as a basis for enhanced surgical training.

In this study we investigated if realistic fracture patterns around the hip can be produced on human cadaveric specimens with intact soft tissue envelope. Possible applications of such fractured specimens would be in surgical training. 7 cadaveric specimens (2 male, 5 female, 2 formalin-fixed, 5 fresh-frozen) were fractured. 2 specimens were fractured on both femurs, 5 only on one side, resulting in 9 fractures total. 5 fractures were set in our custom-made drop-test bench, 2 fractures by inducing axial force using a hammer, and the remaining 2 fractures by a direct dorsal approach and a chisel. AO/OTA and Pauwels classification were used to classify the fractures on the specimens by two independent trauma surgeons. In our drop-test bench, axial load with the femur adducted by 10° resulted in an intertrochanteric fracture (AO type A1.3), adducted by 20° resulted in a femoral neck fracture (Pauwels type III). Fracture induction using a hammer resulted in two intertrochanteric fractures (AO type A2.2 right, A3.3 left). The use of a chisel resulted in both cases in a femoral neck fracture. The acetabulum could be fractured multifragmentarily through use of a hemiprosthesis as a stamp. A high energetic impulse induced by a custom-made drop-test bench can successfully simulate realistic proximal femur and acetabular fractures in cadaveric specimens with intact soft tissue. Furthermore, axial load using a hammer as well as using a chisel through a direct dorsal approach represent additional methods for fracture induction. These pre-fractured specimens can be utilized in surgical education to provide a realistic teaching experience for specialized trauma education courses.

Residency program under scrutiny (part 2)-How do residents prepare for emergency operations?

Postgraduate medical education in trauma and orthopedic surgery residents largely relates to learning and teaching surgery. During this crucial stage of surgical development some of the didactic challenges are caused by heterogeneous and contradictory expectations of trainees and trainers alike. So how do residents prepare for emergency surgery? To date there is neither an expert consensus nor scientific investigations in the clinical context on this topic. Between February and April 2015 questionnaires were issued to all physicians active in the field of trauma and orthopedic surgery within the Trauma Network East Bavaria (27clinics, 255 physicians). The participants were asked to rate the importance of certain elements functioning in the preparation of two emergency operations using a Likert scale. The intensity with which residents generally realize these elements of preparation was also documented. The aim was to objectify if and to what extent the presumed normal practices diverge from clinical reality. Atotal of 150 questionnaires were analyzed (return rate 59%). Discussion with the consultant (85.3%, n = 128), examination of the patient (80.0%, n = 120), surgical approach (76.0%, n = 114) and study of patient files (68.0%, n = 102) were considered to be the most important elements; however, many of the participants admitted that these elements of preparation are not sufficiently performed. The personal preparation of residents for an emergency operation should be classified as extremely important; however, the requirements and reality do not seem to hold true in the clinical environment. This seems to be most likely due to structural and organizational issues.