Cadaver-Based Trauma Procedural Skills Training: Skills Retention 30 Months after Training among Practicing Surgeons in Comparison to Experts or More Recently Trained Residents

Mackenzie, Colin F.; Bowyer, Mark W.; Henry, Sharon M.; Tisherman, Samuel A.; Puché, Adam C.; Chen, Hegang; Shalin, Valerie L.; Pugh, Kristy; Garofalo, Evan; Shackelford, Stacy; Anazodo, Antoinette; Bonds, Brandon W.; Granite, Guinevere; Hagegeorge, George; Holmes, Megan E.; Hu, Peter; Jessie, Elliot; Longinaker, Nyaradzo; Monoson, Alexys; Narayan, Mayur; Pasley, Jason; Pielago, Joseph; Robinson, Eric; Romagnoli, Anna; Sarani, Babak; Squyres, Nicole; Teeter, William; Yang, Shiming

doi:10.1016/j.jamcollsurg.2018.04.028

Cited by 18 publications

(31 citation statements)

References 30 publications

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“…Ali et al have shown progressive attrition of trauma knowledge in physicians with less ongoing trauma exposure,16 whereas Fisher et al demonstrated degradation of unused complex clinical skills among medical students over time 17. A recent study by Mackenzie et al 18 compared long-term retention of trauma procedural competency after the Advanced Surgical Skills for Exposure in Trauma course, finding that practicing surgeons with infrequent interval opportunities to use the learnt skills made more errors on follow-up testing than either in-training residents or subject matter experts. They concluded that skill degradation was more strongly associated with lack of interval practice than time since training.…”

Section: Discussionmentioning

confidence: 99%

The TEAM (Trauma Evaluation and Management) course: medical student knowledge gains and retention in the USA versus Ghana

Berndtson

Morna

Debrah

et al. 2019

Trauma Surg Acute Care Open

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IntroductionTrauma and injury are significant contributors to the global burden of disease, with 5 million deaths and 250 million disability-adjusted life years lost in 2015. This burden is disproportionally borne by low- and middle-income countries (LMICs). Solutions are complex, but one area for improvement is basic trauma education. The American College of Surgeons has developed the Trauma Evaluation and Management (TEAM) course as an introduction to trauma care for medical students. We hypothesized that the TEAM course would be an effective educational program in LMICs and result in increased knowledge gains and retention similar to students in high-income countries (HICs).MethodsThe TEAM course was taught and students evaluated at two sites, one LMIC (Ghana) and one HIC (USA), after obtaining approval from the HIC Institutional Review Board and medical schools at both sites. Participation was optional for all students and results were de-identified. The course was administered by a single educator for all sessions. Multiple-choice exams were given before and after the course, and again 6 months later.ResultsA total of 62 LMIC and 64 HIC students participated in the course and completed initial testing. Demographics for the two groups were similar, as was participant attrition over time. LMIC students started with a relative knowledge deficit, scoring lower on both pre-course and post-course tests than HIC students, but gained more knowledge during the initial teaching session. After 6 months, the LMIC students continued to improve, whereas the HIC students’ knowledge had regressed. Most students recommended course expansion.ConclusionThe TEAM course is a useful tool to provide the basic principles of trauma care to students in LMICs, and should be expanded. Further study is needed to determine the impact of TEAM education on patient care in LMICs.Level of evidenceLevel III; Care Management

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Section: Discussionmentioning

confidence: 99%

The TEAM (Trauma Evaluation and Management) course: medical student knowledge gains and retention in the USA versus Ghana

Berndtson

Morna

Debrah

et al. 2019

Trauma Surg Acute Care Open

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“…In the two-incision four-compartment leg fasciotomy, the lateral compartment is commonly decompressed, but the anterior compartment is frequently missed. 5 The need to correctly identify the intermuscular septum between the anterior and lateral compartments is critical to adequate decompression of these compartments. We hypothesized that a contributing factor to the error rate in anterior compartment decompression may be a surgeon misidentifying the septum between the lateral and posterior superficial compartments as the septum between anterior and lateral compartments.…”

Section: Discussionmentioning

confidence: 99%

“…Our previous study of ASSET-trained surgeons performing procedures on cadavers demonstrated that compartments, particularly anterior and deep posterior, were frequently missed. 5 We hypothesized that anterior compartment error rate may be due to incision position relative to intermuscular septum position between the anterior and lateral compartments. Previous studies looking at variability in the leg only assessed compartment pressures 6 and not positioning of leg compartments.…”

Section: Introductionmentioning

confidence: 99%

Quantitative analysis of intermuscular septa in the leg: implications for trauma surgery

Agandi¹,

Fuller²,

Sonderman

et al. 2021

Trauma Surg Acute Care Open

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BackgroundCompartment syndrome is the excess swelling within an inelastic compartment leading to excessive compartment pressure. Lower limb trauma has a high risk of compartment syndrome, which is typically mitigated using a two-incision fasciotomy. Our previous findings showed surgeons sometimes perform incomplete fasciotomies due to misidentifying the septum between the lateral and superficial posterior compartments as the septum between the anterior and lateral compartments. We conjectured this may be due to variability in the septal position between individuals leading to misinterpretation of the septal identity.MethodsA retrospective analysis was performed using CT angiograms to analyze septal position between the anterior and lateral compartments of the leg of 100 patients randomly selected from the University of Maryland Shock Trauma Center database.ResultsAnalysis of septal position showed that (1) as the septum progresses distally down the leg, the relative septum position shifts anteriorly; and that (2) there was considerable variability in the intermuscular septum position between individuals even when accounting for the anterior to posterior progression of septal position.DiscussionThis variability could lead to erroneous septal identification in individuals with a very anteriorly located septum during a leg fasciotomy with the classic initial incision being insufficiently anterior. We propose making the lateral initial incision ‘two finger breadths posterior the tibia’ rather than the traditional ‘one finger breadth anterior’ to the fibula. This moves the initial incision slightly anteriorly, uses the more readily palpable tibia, and makes the medial and lateral incisions symmetrical at ‘two finger breadths’ from the tibia, simplifying the procedure.Level of evidenceLevel 3.

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“…Mackenzie et al [8] evaluated extremity vascular exposure and FLE procedures in fresh cadavers for 38 surgical residents of average 14 months after taking the cadaver ASSET course and 10 experts practicing traumatologists of average 16 months after. They further evaluated the same procedures for 38 PGY 3-6 residents of average 14 months after taking the cadaver ASSET course, 35 practicing surgeons of average 30 months after, and 10 experts practicing traumatologists of average 46 months after [9]. They concluded that, in both studies, skill decreases were associated with interval procedure performance, and not time since taking the seminar [8,9].…”

Section: Discussionmentioning

confidence: 99%

Repeated participation in the cadaver-based educational seminar for trauma surgery (C-BEST) could maintain training effects: skill retention at a 2-year follow-up

Homma¹,

Oda²,

Sano³

et al. 2021

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Although the effectiveness of cadaver surgical training has been clarified, the decline in training effects over time has become a problem. This study examined whether repeated participation in cadaver-based educational seminar for trauma surgery (C-BEST) could suppress the decline in training effects. Basic and advanced C-BEST have pelvic package (PP) and fasciotomy of the lower extremity (FLE) as common training skills. For participants of these skills twice each, we examined the changes in a 10-point self-assessment of confidence levels (SACL) at six time points: (1) before the seminar of basic C-BEST, (2) immediately after basic C-BEST, (3) half a year after basic C-BEST, (4) before advanced C-BEST, (5) immediately after advanced C-BEST, and (6) half a year after advanced C-BEST. Data were collected from 28 basic C-BESTs and 5 advanced C-BESTs conducted from January 2013 to January 2020. Statistical analysis was performed by comparing SACL results from seminar evaluations at the six points, with significance at P < 0.05. A total of 60 participants were enrolled (postgraduate year, 16.5 ± 5.7). The interval between basic and advanced C-BEST was 27.1 ± 6.9 months. In PP, the SACL did not decrease at all six points. In FLE, SACL did not decrease at all six points, had a greater increase before versus immediately after advanced C-BEST, and did not decrease thereafter (P < 0.05). After participants retook the seminar, FLE-like procedures, which are unfamiliar to nonorthopedic surgeons, had increased and maintained self-evaluation values, whereas PP-like procedures, which are familiar to abdominal surgeons, had maintained high self-evaluation values. Therefore, repeated seminar participation could maintain the effects of cadaver training.

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Cadaver-Based Trauma Procedural Skills Training: Skills Retention 30 Months after Training among Practicing Surgeons in Comparison to Experts or More Recently Trained Residents

Cited by 18 publications

References 30 publications

The TEAM (Trauma Evaluation and Management) course: medical student knowledge gains and retention in the USA versus Ghana

The TEAM (Trauma Evaluation and Management) course: medical student knowledge gains and retention in the USA versus Ghana

Quantitative analysis of intermuscular septa in the leg: implications for trauma surgery

Repeated participation in the cadaver-based educational seminar for trauma surgery (C-BEST) could maintain training effects: skill retention at a 2-year follow-up

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