Efficacy of Trauma Surgery Technical Skills Training Courses

Mackenzie, Colin F.; Tisherman, Samuel A.; Shackelford, Stacy; Sevdalis, Nick; Elster, Eric A.; Bowyer, Mark W.

doi:10.1016/j.jsurg.2018.10.004

Cited by 33 publications

(25 citation statements)

References 50 publications

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“…This is a speculation and requires further investigation. In Mackenzie's review of trauma skills courses in 2018 one major conclusion was that, while all the trauma training improved subjective measures of trauma resuscitation performance, there were very few objective measures studied or available 30 . A recent review of the literature found similar improvements in trauma team performance but few linked to better outcomes 28 .…”

Section: Discussionmentioning

confidence: 99%

Trauma bay virtual reality—A game changer for ATLS instruction and assessment

Colonna

Robbins

Stefanucci

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:Medical educational research highlights the need for high-fidelity, multidisciplinary simulation training to teach complex decisionmaking skills, such as those taught in Advanced Trauma Life Support (ATLS). This approach is, however, expensive and timeintensive. Virtual reality (VR) education simulation may improve skill acquisition in a cost-effective and time-sensitive manner.We developed a novel trauma VR simulator (TVRSim) for providers to apply ATLS principles. We hypothesized in this pilot study that TVRSim could differentiate practitioner competency with increasing experience and would be well accepted. METHODS:Providers at a Level I trauma center (acute care surgeons, novice (MS4 & PGY1), junior (PGY2 & 3), senior (PGY4-6) residents) ran a blunt, polytrauma VR code. Ten critical decision points were assessed: intubation, cricothyroidotomy, chest tube, intravenous access, focused abdominal sonography for trauma examination, pelvic binder, activation of massive transfusion protocol, administration of hypertonic saline, hyperventilation and decision to go to the operating room (OR). Learner assessment was based on frequency and time to correct decisions. Participant satisfaction was measured using validated surveys. RESULTS:All 31 providers intubated and obtained intravenous access. Novices and juniors frequently failed at hypertonic saline and hyperventilation decisions. Juniors often failed at cricothyroidotomy (60%) and OR (100%) decisions. Mean time to all decisions except going to the OR was longer for all groups compared to acute care surgeons. Mean number of decisions/min was significantly higher for surgeons and seniors compared to juniors and novices. Mortality was 92.3% for novices, 80% for juniors, 25% for seniors and 0% for the attendings. Participants found TVRSim comfortable, easy to use/interact with/performance enhancing, and helped develop skills and learning. CONCLUSIONS:In this pilot study using a sample of convenience, TVRSim was able to discern decision-making abilities among trainees with increasing experience. All trainees felt that the platform enhanced their performance and facilitated skill acquisition and learning.TVRSim could be a useful adjunct to teach and assess ATLS skills.

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Section: Discussionmentioning

confidence: 99%

Trauma bay virtual reality—A game changer for ATLS instruction and assessment

Colonna

Robbins

Stefanucci

et al. 2022

J Trauma Acute Care Surg

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“…The difficulty in evaluation of trauma courses is not unique to LMICs. A review by Mackenzie et al [14] identified 21 trauma skills courses, the majority delivered in high-income countries, and concluded that these programmes are variable in their design, content, duration, cost and resource requirements. In addition, the lack of universal performance metrics and outcomes makes determining the success of these courses difficult.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, further research in the form of prospective controlled trials is required to better answer our research question. Currently, there are limited published studies reporting patient outcomes following simulated trauma training courses [14]. A trial by Bellanova et al [42] identified that individual surgeon and team training was associated with reduced mortality; however, multiple confounding variables greatly limits the strength of this finding.…”

Section: Discussionmentioning

confidence: 99%

“…There remains a deficiency in LMICs of high-quality operative courses for trauma surgeons, which is alarming considering the importance of definitive surgical treatment in reducing the morbidity and mortality of trauma patients. Whilst high-income countries are able to run surgical trauma courses such as the American College of Surgeons Advanced Surgical Skills for Exposure in Trauma costing up to $2000 per student [14], LMICs do not have the same luxury. Thus, there is a clear need for a sustainability assessment of trauma surgery courses in LMICs, to establish recommendations for their improvement and widespread implementation.…”

Section: Introductionmentioning

confidence: 99%

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Are Trauma Surgery Simulation Courses Beneficial in Low- and Middle-Income Countries—A Systematic Review and Meta-Analysis

et al. 2021

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Despite trauma-related injuries being a leading cause of death worldwide, low- and middle-income countries (LMICs) lack the infrastructure and resources required to offer immediate surgical care, further perpetuating the risk of morbidity and mortality. In high-income countries, trauma surgery simulation courses are routinely delivered to surgeons, teaching the fundamental skills of operative trauma. This study aimed to assess whether similar courses are beneficial in LMICs and how they can be improved. We performed a systematic review and meta-analysis using MEDLINE, Embase and Google Scholar, analysing studies evaluating trauma surgery simulation in LMICs. The outcomes measured included clinical knowledge improvement, participant confidence and general course-feedback. The review was carried out in-line with PRISMA guidelines. Five studies were included, summating a population of 172 participants. In three studies, meta-analysis showed an overall significant weighted mean improvement of knowledge post-course by 22.91% (95%CI 19.53, 26.29; p < 0.00001; I2 = 0%). One study reported a significant increase in participant confidence for 20/22 of operative skills taught (p < 0.04). We conclude that these courses are beneficial in LMICs; however, further research is necessary to establish the optimum course design, and whether patient outcomes are improved following their implementation. Collaboration between international trauma institutions is essential for closing the educational resource inequality gap between higher- and lower-income countries.

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“…Notwithstanding this, simulators for emergency open skill procedures are poorly represented in surgical skills curricula. For trauma procedures either part-task trainers of limb structures, (such as a bone or a tendon) or human tissue or animal labs are necessary for simulation in this area [ 17 , 18 ]. Management of extremity injuries often involves a multidisciplinary team such as plastic surgeons, orthopaedic surgeons and vascular surgeons.…”

Section: Introductionmentioning

confidence: 99%

Designing a synthetic simulator to teach open surgical skills for limb exploration in trauma: a qualitative study exploring the experiences and perspectives of educators and surgical trainees

et al. 2021

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Background Simulation is an important adjunct to aid in the acquisition of surgical skills of surgical trainees. The simulators used to adequately enable trainees to learn, practice and be assessed in surgical skills need to be of the highest standards. This study investigates the perceived requirements of simulation and simulators used to acquire skills in limb exploratory procedures in trauma. Methods Semi-structured interviews were conducted with an international group of 11 surgical educators and 11 surgical trainees who had experience with surgical simulation. The interviews focused on the perceptions of simulation, the integration of simulators within a curriculum and the features of a simulator itself. Interviews were recorded, transcribed and underwent thematic analysis. Results Analysis of the perspectives of surgical educators and surgical trainees on simulated training in limb trauma surgery yielded three main themes: (1) Attitudes to simulation. (2) Implementing simulation. (3) Features of an open skills simulator. The majority felt simulation was relevant, intuitive and a good way for procedure warmup and the supplementation of surgical logbooks. They felt simulation could be improved with increased accessibility and variety of simulator options tailored to the learner. Suggested simulator features included greater fidelity, haptic feedback and more complex inbuilt scenarios. On a practical level, there was a desire for cost effectiveness, easy set up and storage. The responses of the educators and the trainees were similar and reflected similar concerns and suggestions for improvement. Conclusion There is a clear positive appetite for the incorporation of simulation into limb trauma training. The findings of this will inform the optimal requirements for high quality implementation of simulation into a surgical trauma curriculum and a reference to optimal features desired in simulator or task trainer design.

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Efficacy of Trauma Surgery Technical Skills Training Courses

Cited by 33 publications

References 50 publications

Trauma bay virtual reality—A game changer for ATLS instruction and assessment

Trauma bay virtual reality—A game changer for ATLS instruction and assessment

Are Trauma Surgery Simulation Courses Beneficial in Low- and Middle-Income Countries—A Systematic Review and Meta-Analysis

Designing a synthetic simulator to teach open surgical skills for limb exploration in trauma: a qualitative study exploring the experiences and perspectives of educators and surgical trainees

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