Gunst Mark, O'Keeffe Terence, Hollett Lisa, Hamill Mark, Gentilello Larry M, Frankel Heidi, Shafi Shahid
Department of Surgery, Division of Burns, Trauma, and Critical Care, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9158, USA.
J Trauma. 2009 Nov;67(5):1091-6. doi: 10.1097/TA.0b013e3181bc77ba.
Declining trauma operative experience adversely impacts learning and retention of operative skills. Current solutions, such as acute care surgery, may not provide relevant operative experience. We hypothesized that a structured skills curriculum using fresh cadavers would improve participants' self-confidence in surgical exposure of human anatomic structures for trauma.
The trauma exposure course, a single-day, 8-hour course with two trainees and one instructor per fresh cadaver, was designed by the faculty of a high-volume, urban, level I trauma center. Trainees included all trauma fellows (n = 6) and surgical chief residents (n = 12) in academic year 2007 to 2008. Using a structured, pretested curriculum, participants were trained by trauma faculty in operative exposure of 48 structures in the neck, chest, abdomen, pelvis, and extremities. For each exposure, participants' self-reported levels of operative confidence were measured using the operating score (OR score, 1 = not confident and 5 = highly confident) before the course (pre), immediately afterward (post), and at long-term follow-up (median, 6 months).
Participation in the trauma exposure course resulted in a significant increase in OR scores for 44 of the 48 exposures (median scores, pre 3 vs. post 5, p < 0.0001), with no decline at long-term follow-up. Participants with less previous operative experience were most likely to benefit from the course.
A structured skills curriculum using fresh cadavers improved participants' self-confidence in operative skills required for surgical exposure of human anatomic structures for trauma. This model of training may be beneficial for surgical residents and fellows, as well as practicing trauma surgeons.
创伤手术经验的减少会对手术技能的学习和掌握产生不利影响。目前的解决方案，如急性护理手术，可能无法提供相关的手术经验。我们假设，使用新鲜尸体的结构化技能课程将提高参与者在创伤手术中暴露人体解剖结构的自信心。
创伤暴露课程为期一天，共8小时，每具新鲜尸体配备两名学员和一名教员，由一家高容量的城市一级创伤中心的教员设计。学员包括2007至2008学年的所有创伤专科住院医师（n = 6）和外科总住院医师（n = 12）。使用经过预先测试的结构化课程，参与者接受创伤科教员的培训，学习颈部、胸部、腹部、骨盆和四肢48个结构的手术暴露。对于每次暴露，在课程开始前（术前）、课程结束后立即（术后）以及长期随访（中位数为6个月）时，使用手术评分（OR评分，1 = 不自信，5 = 非常自信）测量参与者自我报告的手术信心水平。
参加创伤暴露课程后，48次暴露中有44次的OR评分显著提高（中位数评分，术前3分对术后5分，p < 0.0001），长期随访时没有下降。以前手术经验较少的参与者最有可能从该课程中受益。
使用新鲜尸体的结构化技能课程提高了参与者在创伤手术中暴露人体解剖结构所需手术技能的自信心。这种培训模式可能对外科住院医师和专科住院医师以及执业创伤外科医生有益。
