Madani Amin, Gips Amanda, Razek Tarek, Deckelbaum Dan L, Mulder David S, Grushka Jeremy R
Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
J Surg Educ. 2018 Mar-Apr;75(2):358-369. doi: 10.1016/j.jsurg.2017.07.012. Epub 2017 Jul 26.
Effective management of trauma patients is heavily dependent on sound judgment and decision-making. Yet, current methods for training and assessing these advanced cognitive skills are subjective, lack standardization, and are prone to error. This qualitative study aims to define and characterize the cognitive and interpersonal competencies required to optimally manage injured patients.
Cognitive and hierarchical task analyses for managing unstable trauma patients were performed using qualitative methods to map the thoughts, behaviors, and practices that characterize expert performance. Trauma team leaders and board-certified trauma surgeons participated in semistructured interviews that were transcribed verbatim. Data were supplemented with content from published literature and prospectively collected field notes from observations of the trauma team during trauma activations. The data were coded and analyzed using grounded theory by 2 independent reviewers.
A framework was created based on 14 interviews with experts (lasting 1-2 hours each), 35 field observations (20 [57%] blunt; 15 [43%] penetrating; median Injury Severity Score 20 [13-25]), and 15 literary sources. Experts included 11 trauma surgeons and 3 emergency physicians from 7 Level 1 academic institutions in North America (median years in practice: 12 [8-17]). Twenty-nine competencies were identified, including 17 (59%) related to situation awareness, 6 (21%) involving decision-making, and 6 (21%) requiring interpersonal skills. Of 40 potential errors that were identified, root causes were mapped to errors in situation awareness (20 [50%]), decision-making (10 [25%]), or interpersonal skills (10 [25%]).
This study defines cognitive and interpersonal competencies that are essential for the management of trauma patients. This framework may serve as the basis for novel curricula to train and assess decision-making skills, and to develop quality-control metrics to improve team and individual performance.
创伤患者的有效管理在很大程度上依赖于合理的判断和决策。然而，目前用于培训和评估这些高级认知技能的方法主观、缺乏标准化且容易出错。这项定性研究旨在定义和描述最佳管理受伤患者所需的认知和人际能力。
采用定性方法对不稳定创伤患者的管理进行认知和层次任务分析，以描绘出专家表现的思维、行为和实践。创伤团队负责人和获得委员会认证的创伤外科医生参与了半结构化访谈，访谈内容逐字记录。数据补充了已发表文献中的内容以及在创伤激活期间对创伤团队观察的前瞻性收集的现场记录。数据由2名独立评审员使用扎根理论进行编码和分析。
基于对专家的14次访谈（每次持续1 - 2小时）、35次现场观察（20次[57%]钝器伤；15次[43%]穿透伤；损伤严重度评分中位数20[13 - 25]）以及15篇文献资料创建了一个框架。专家包括来自北美7家一级学术机构的11名创伤外科医生和3名急诊医生（实践年限中位数：12[8 - 17]）。确定了29项能力，包括17项（59%）与态势感知相关，6项（21%）涉及决策制定，6项（21%）需要人际技能。在识别出的40个潜在错误中，根本原因被归结为态势感知错误（20个[50%]）、决策制定错误（10个[25%]）或人际技能错误（10个[25%]）。
本研究定义了创伤患者管理所必需的认知和人际能力。该框架可作为新的课程基础，用于培训和评估决策技能，并制定质量控制指标以提高团队和个人绩效。
