Impact of Recent Trends of Noninvasive Trauma Evaluation and Nonoperative Management in Surgical Resident Education

Abstract

Noninvasive diagnostic tests have allowed more rapid trauma evaluation and fewer nontherapeutic laparotomies. As nonoperative experience grows, the opportunity for operative experience decreases. These trends may adversely affect the education of residents and suggest that novel approaches are needed to ensure adequate operative experience in trauma.

Nonoperative Management of Solid Organ Injury Diminishes Surgical Resident Operative Experience: Is It Time for Simulation Training?

“…Beginning in the early 1980s, trauma surgeons increasingly called for attention to general surgery resident training and competence in the field of trauma/ critical care surgery [14]. Dr. Trunkey stated in his presidential address to the Society of University Surgeons that applicants to the American Board of Surgery in 1980 reported only 22 (5%) operative trauma cases [21].…”

“…The authors expressed concern regarding the waning resident operative trauma experience combined with a greater need for community surgeons capable of caring for trauma patients. They surmised that integration of cadaver, computer, and virtualreality simulation might augment the technical and decision-making experience traditionally gained from operative trauma experience [14].…”

“…Tools and techniques, including ultrasound, computed tomography (CT), angiography, and percutaneous catheter-based interventions serve to decrease health care expenditures, hospital length of stay, and operative morbidity, as well as time to return to work and possibly infectious risk to the operating team [7][8][9][10][11]. However, NOM of traumatic spleen and liver injuries negatively affects surgeon reimbursement, resident operative trauma experience, and student and resident interest in the field of trauma surgery [4,[12][13][14][15][16][17].…”

“…With an increasing number of spleen and liver injuries treated nonoperatively, residency graduates garner less operative trauma experience with SAOI and may be faced with more complicated and technically challenging cases when operation is required [4,[14][15][16]. Additionally, trainees exposed to a high proportion of blunt compared with penetrating mechanisms of injury gain less operative trauma experience [4,15].…”

Post-Traumatic Rupture of the Ovarian Cyst - Case Report

“…Approximately 30% patients are still assigned to receive laparotomy (4). At the same time, it is estimated that the percentage of non-therapeustic laparotomy lies between 5-14% in different health centers (3,4,6,(8)(9)(10)(11). Alternative treatment for these patients is use of emergency diagnostic laparoscopy.…”