Establishing proficiency in specific trauma procedures during surgical residency has been limited to annual courses with limited data on its effect on the delivery of health care and patient outcomes. There is a wide variety of training on content and complexity with recent studies looking at time to imaging or secondary survey. In this study, we implement monthly case-based simulation after initial training on a variety of bedside trauma procedures. The overall goal is to evaluate the effect of simulation on time to specific interventions.
This is a prospective, observational study between July 2018 and February 2019 at a single-institution, Level I trauma center with a large surgical residency program. A trauma simulation program was implemented in November 2018 to train and evaluate surgical residents from post-graduate year 1 through 5. All rotating residents participated in an initial course on basic trauma procedures, such as percutaneous sheath placement, tube thoracostomy, and resuscitative thoracotomy followed by an end-of-month simulation. All Level I activations from preintervention starting in July to October 2018 (preintervention) and October 2018 through February 2019 (postintervention) were reviewed; monitored variables included age, sex, mechanism of injury, blunt or penetrating, and time to intervention in the trauma bay. Median times to intervention were recorded with interquartile ranges (IQR). Pearson's coefficient was used to measure the strength of the relationship between simulation and time to patient intervention.
Median time to most interventions improved over time but with more consistent improvement after the implementation of formal simulation and procedural training in November 2018. Median pretraining time for resuscitative thoracotomy was 14 minutes (IQR, 8–32 minutes); posttraining median time was 3 minutes (IQR, 2.7–8 minutes, p = 0.02). Median pretraining time to tube thoracostomy was 13 minutes (IQR, 5.5–19 minutes); posttraining time was 6 minutes (IQR, 4–31 minutes, p = 0.04). Pearson's coefficient (r2) measured strength of correlation and was highest for tube thoracostomy followed by resuscitative thoracotomy and percutaneous sheath access with r2 values of 0.46, 0.35, and 0.24, respectively.
High-complexity, routine procedural training, and trauma simulation are associated with decreased time to interventions within a short period of time. Routine implementation of a training program emphasizing efficient, effective approaches to bedside procedures is necessary to train our residents in these high-acuity, low-frequency situations. Future investigations are warranted in the effect of simulation on short-term and long-term patient outcomes.
LEVEL OF EVIDENCE
Therapeutic, level III.