Colin F Mackenzie1, Evan Garofalo2, Stacy Shackelford3, Valerie Shalin4, Kristy Pugh5, Hegang Chen6, Adam Puche7, Jason Pasley3, Babak Sarani8, Sharon Henry9, Mark Bowyer10. 1. Shock, Trauma and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland; Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland. Electronic address: cmack003@gmail.com. 2. Shock, Trauma and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland; Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, Maryland. 3. US Airforce Center for the Sustainment of Trauma and Readiness Skills, Baltimore, Maryland. 4. Department of Psychology, Wright State University, Dayton, Ohio. 5. Shock, Trauma and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland. 6. Department of Epidemiology, University of Maryland School of Medicine, Baltimore, Maryland. 7. Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, Maryland. 8. Department of Surgery, George Washington University School of Medicine, Washington, District of Columbia. 9. Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland. 10. Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Abstract
OBJECTIVE: Test with an individual procedure score (IPS) to assess whether an unpreserved cadaver trauma training course, including upper and lower limb vascular exposure, improves correct identification of surgical landmarks, underlying anatomy, and shortens time to vascular control. DESIGN: Prospective study of performance of 3 vascular exposure and control procedures (axillary, brachial, and femoral arteries) using IPS metrics by 2 colocated and trained evaluators before and after training with the Advanced Surgical Skills Exposure for Trauma (ASSET) course. IPS, including identification of anatomical landmarks, incisions, underlying structures, and time to completion of each procedure was compared before and after training using repeated measurement models. SETTING: Audio-video instrumented cadaver laboratory at University of Maryland School of Medicine. PARTICIPANTS: A total of 41 second to sixth year surgical residents from surgical programs throughout Mid-Atlantic States who had not previously taken the ASSET course were enrolled, 40 completed the pre- and post-ASSET performance evaluations. RESULTS: After ASSET training, all components of IPS increased and time shortened for each of the 3 artery exposures. Procedure steps performed correctly increased 57%, anatomical knowledge increased 43% and skin incision to passage of a vessel loop twice around the correct vessel decreased by a mean of 2.5 minutes. An overall vascular trauma readiness index, a comprehensive IPS score for 3 procedures increased 28% with ASSET Training. CONCLUSIONS: Improved knowledge of surface landmarks and underlying anatomy is associated with increased IPS, faster procedures, more accurate incision placement, and successful vascular control. Structural recognition during specific procedural steps and anatomical knowledge were key points learned during the ASSET course. Such training may accelerate acquisition of specific trauma surgery skills to compensate for shortened training hours, infrequent exposure to major vascular injuries, or when just-in-time training is necessary. IPS is a benchmark for competence in extremity vascular control.
OBJECTIVE: Test with an individual procedure score (IPS) to assess whether an unpreserved cadaver trauma training course, including upper and lower limb vascular exposure, improves correct identification of surgical landmarks, underlying anatomy, and shortens time to vascular control. DESIGN: Prospective study of performance of 3 vascular exposure and control procedures (axillary, brachial, and femoral arteries) using IPS metrics by 2 colocated and trained evaluators before and after training with the Advanced Surgical Skills Exposure for Trauma (ASSET) course. IPS, including identification of anatomical landmarks, incisions, underlying structures, and time to completion of each procedure was compared before and after training using repeated measurement models. SETTING: Audio-video instrumented cadaver laboratory at University of Maryland School of Medicine. PARTICIPANTS: A total of 41 second to sixth year surgical residents from surgical programs throughout Mid-Atlantic States who had not previously taken the ASSET course were enrolled, 40 completed the pre- and post-ASSET performance evaluations. RESULTS: After ASSET training, all components of IPS increased and time shortened for each of the 3 artery exposures. Procedure steps performed correctly increased 57%, anatomical knowledge increased 43% and skin incision to passage of a vessel loop twice around the correct vessel decreased by a mean of 2.5 minutes. An overall vascular trauma readiness index, a comprehensive IPS score for 3 procedures increased 28% with ASSET Training. CONCLUSIONS: Improved knowledge of surface landmarks and underlying anatomy is associated with increased IPS, faster procedures, more accurate incision placement, and successful vascular control. Structural recognition during specific procedural steps and anatomical knowledge were key points learned during the ASSET course. Such training may accelerate acquisition of specific trauma surgery skills to compensate for shortened training hours, infrequent exposure to major vascular injuries, or when just-in-time training is necessary. IPS is a benchmark for competence in extremity vascular control.
Authors: Colin F Mackenzie; Evan Garofalo; Adam Puche; Hegang Chen; Kristy Pugh; Stacy Shackelford; Samuel Tisherman; Sharon Henry; Mark W Bowyer Journal: JAMA Surg Date: 2017-06-01 Impact factor: 14.766
Authors: Christina M Theodorou; Jamie E Anderson; Megan Brenner; Thomas M Scalea; Kenji Inaba; Jeremy Cannon; Mark Seamon; M Chance Spalding; Charles J Fox; Ernest E Moore; Joseph J DuBose; Joseph M Galante Journal: J Surg Res Date: 2020-04-17 Impact factor: 2.192
Authors: Colin F Mackenzie; Shiming Yang; Evan Garofalo; Peter Fu-Ming Hu; Darcy Watts; Rajan Patel; Adam Puche; George Hagegeorge; Valerie Shalin; Kristy Pugh; Guinevere Granite; Lynn G Stansbury; Stacy Shackelford; Samuel Tisherman Journal: World J Surg Date: 2021-01-03 Impact factor: 3.352