Summary report on current clinical trauma care fellowship training programs.

BACKGROUND

Almost 10 years ago, the Careers in Trauma Committee of the Eastern Association for the Surgery of Trauma (EAST) identified four main problems with trauma fellowships: (1) lack of specified educational objectives, (2) undefined curricula, (3) inconsistent emphasis on research, and (4) inconsistent surgical exposure. These perceived problems still exist and may threaten the future of trauma surgery as a career. The objective of this study was to examine these issues in a profile of the current active clinical trauma care fellowship training programs.

METHODS

The database foundation was the Trauma Fellowships Listing at the EAST Web site (http://www.east.org). All active clinical trauma training programs on this list were identified, and descriptive information was updated and abstracted. A supplemental survey was sent to each program contact person with specific questions regarding program organization, educational material, fellow responsibilities, and scholarly opportunities. In 2003, the entire database was updated, and the survey process was repeated.

RESULTS

The number of active trauma care fellowship programs was 39 (1996), 43 (1999), and 50 (2003). From 1996 to 2003, 15 new programs came into existence, and 4 programs became inactive. Current programs are located in 23 states, Washington DC, Canada, and Australia. California has seven; Pennsylvania has four; and three states have three programs each. The annual trauma admissions for most programs (42 of 50, 84%) vary between 750 and 4,000, with six programs admitting more than 4,000. The most common program format (20 of 50, 40%) offers combined trauma and critical care training, whereas only three programs (6%) offer a choice of trauma only, critical care only, or combined trauma and critical care. A Residency Review Committee (RRC)-approved surgical critical care program was an integral component in 54% (1996), 76% (1999), and 78% (2003). The majority of programs (39 of 50, 78%) are of 1-year duration, with some (22 of 50, 44%) having an optional second year. Most programs (40 of 50, 80%) have one or two positions per year, with the largest program having eight fellows per year. The total number of positions available per year was 66 (1996), 89 (1999), and 95 (2003). Most fellows lead and direct a team of residents and medical students. More programs reported that fellows direct the initial resuscitation of all trauma patients admitted, and more programs are requiring in-house call requirements for fellows.

CONCLUSIONS

There is steady growth in trauma fellowship training, with an emphasis on direct clinical management. An RRC-approved surgical critical care program is an important link, but one not essential to the trauma fellowship. Expected radical changes in surgical and trauma training are on the horizon. It is imperative that leaders in trauma surgery continue to monitor these trends for successful integration of trauma care training into surgical residency redesign efforts, and for facilitation of programmatic improvement in trauma care as a career.