Colin F Mackenzie1, Mark W Bowyer2, Sharon Henry3, Samuel A Tisherman4, Adam Puche5, Hegang Chen5, Valerie Shalin6, Kristy Pugh5, Evan Garofalo7, Stacy A Shackelford8. 1. Shock Trauma Anesthesiology Research Center, Baltimore, MD; University of Maryland, School of Medicine, Baltimore, MD. Electronic address: cmack003@gmail.com. 2. Department of Surgery, Uniformed Services University of Health Sciences, and the Walter Reed National Military Medical Center, Bethesda, MD. 3. University of Maryland, School of Medicine, Baltimore, MD; Department of Surgery and Shock Trauma Center of the University of Maryland School of Medicine and Medical Center, Baltimore, MD. 4. Shock Trauma Anesthesiology Research Center, Baltimore, MD; University of Maryland, School of Medicine, Baltimore, MD; Department of Surgery and Shock Trauma Center of the University of Maryland School of Medicine and Medical Center, Baltimore, MD. 5. University of Maryland, School of Medicine, Baltimore, MD. 6. Department of Psychology, Wright State University, Dayton, OH. 7. Department of Anatomy, University of Arizona School of Medicine, Phoenix, AZ. 8. Institute of Surgical Research, San Antonio, TX.
Abstract
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.
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.
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