TY - JOUR
T1 - Cadaver-Based Trauma Procedural Skills Training
T2 - Skills Retention 30 Months after Training among Practicing Surgeons in Comparison to Experts or More Recently Trained Residents
AU - Retention and Assessment of Surgical Performance Group of Investigators
AU - Mackenzie, Colin F.
AU - Bowyer, Mark W.
AU - Henry, Sharon
AU - Tisherman, Samuel A.
AU - Puche, Adam
AU - Chen, Hegang
AU - Shalin, Valerie
AU - Pugh, Kristy
AU - Garofalo, Evan
AU - Shackelford, Stacy A.
AU - Anazodo, Amechi
AU - Bonds, Brandon
AU - Granite, Guinevere
AU - Hagegeorge, George
AU - Holmes, Megan
AU - Hu, Peter
AU - Jessie, Elliot
AU - Longinaker, Nyaradzo
AU - Monoson, Alexys
AU - Narayan, Mayur
AU - Pasley, Jason
AU - Pielago, Joseph
AU - Robinson, Eric
AU - Romagnoli, Anna
AU - Sarani, Babak
AU - Squyres, Nicole
AU - Teeter, William
AU - Yang, Shiming
N1 - Publisher Copyright:
© 2018 American College of Surgeons
PY - 2018/8
Y1 - 2018/8
N2 - Background: Long-term retention of trauma procedural core-competency skills and need for re-training after a 1-day cadaver-based course remains unknown. We measured and compared technical skills for trauma core competencies at mean 14 months (38 residents), 30 months (35 practicing surgeons), and 46 months (10 experts) after training to determine if skill degradation occurs with time. Technical performance during extremity vascular exposures and lower-extremity fasciotomy in fresh cadavers measured by validated individual procedure score (IPS) was the primary outcome. Study Design: We performed a prospective study between May 2013 and September 2016. Results: Practicing surgeons had lower IPS and IPS component scores (p = 0.02 to 0.001) than residents (p < 0.05) and experts (p < 0.002) for vascular procedures. Frequencies of errors were no different among residents and experts. Practicing surgeons made more critical errors (p < 0.05) than experts or residents. Experts had shortest time to proximal vascular control. Fasciotomy procedural errors occurred in all participants. Cluster analysis of anatomy vs procedural steps identified tertiles of performance and wide variance (32.5% practicing surgeons, 26.5% residents vs 13% experts) for vascular procedures. Vascular control duration > 20 minutes (n = 21) and failure to decompress fasciotomy compartments were correlated with incorrect landmarks and skin incisions. Modeling found interval trauma skills experience, not time since training, was associated with lower IPS. Conclusions: Practicing surgeons with low trauma skills experience since training had lower IPS and component scores (p = 0.02 to 0.001) and more errors compared with experts and residents (p < 0.05). Surgeons, including experts with low interval experience performing trauma procedures, may benefit from refreshing of correct landmarks and skin incision placement identification.
AB - Background: Long-term retention of trauma procedural core-competency skills and need for re-training after a 1-day cadaver-based course remains unknown. We measured and compared technical skills for trauma core competencies at mean 14 months (38 residents), 30 months (35 practicing surgeons), and 46 months (10 experts) after training to determine if skill degradation occurs with time. Technical performance during extremity vascular exposures and lower-extremity fasciotomy in fresh cadavers measured by validated individual procedure score (IPS) was the primary outcome. Study Design: We performed a prospective study between May 2013 and September 2016. Results: Practicing surgeons had lower IPS and IPS component scores (p = 0.02 to 0.001) than residents (p < 0.05) and experts (p < 0.002) for vascular procedures. Frequencies of errors were no different among residents and experts. Practicing surgeons made more critical errors (p < 0.05) than experts or residents. Experts had shortest time to proximal vascular control. Fasciotomy procedural errors occurred in all participants. Cluster analysis of anatomy vs procedural steps identified tertiles of performance and wide variance (32.5% practicing surgeons, 26.5% residents vs 13% experts) for vascular procedures. Vascular control duration > 20 minutes (n = 21) and failure to decompress fasciotomy compartments were correlated with incorrect landmarks and skin incisions. Modeling found interval trauma skills experience, not time since training, was associated with lower IPS. Conclusions: Practicing surgeons with low trauma skills experience since training had lower IPS and component scores (p = 0.02 to 0.001) and more errors compared with experts and residents (p < 0.05). Surgeons, including experts with low interval experience performing trauma procedures, may benefit from refreshing of correct landmarks and skin incision placement identification.
UR - http://www.scopus.com/inward/record.url?scp=85047756504&partnerID=8YFLogxK
U2 - 10.1016/j.jamcollsurg.2018.04.028
DO - 10.1016/j.jamcollsurg.2018.04.028
M3 - Article
C2 - 29733906
AN - SCOPUS:85047756504
SN - 1072-7515
VL - 227
SP - 270
EP - 279
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 2
ER -