Anderson Geoffrey A, Kayima Peter, Ilcisin Lenka, Benitez Noralis Portal, Albutt Katherine H, Briggs Susan M, Nehra Deepika
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts.
Department of Surgery, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda.
J Surg Educ. 2018 Sep-Oct;75(5):1317-1324. doi: 10.1016/j.jsurg.2018.02.014. Epub 2018 Mar 17.
The goal of this project was to create a multitiered trauma training curriculum that was designed specifically for the low-resource setting.
We developed 2 courses designed to teach principles and skills necessary for trauma care. The first course, "Emergency Ward Management of Trauma (EWMT)," is designed to teach interns the initial assessment and stabilization of trauma patients in the emergency ward. The second course for mid-level surgical residents, "Surgical Techniques and Repairs in Trauma for the Low-resource Environment" (STaRTLE), is a cadaver-based operative trauma course designed to teach surgical exposures and techniques. The courses were rolled out at Mbarara Regional Referral Hospital in the low-income country of Uganda. Precourse and postcourse tests and surveys were administered.
This study took place at Mbarara Regional Referral Hospital (MRRH). This is a hospital in southwest Uganda with a subspecialty care, a medical school, nursing school, and multiple residency programs.
Students in the EWMT course were interns at MRRH. After 1 year of training, most of these interns will become medical officers as the only provider at a district hospital in Uganda. The students in the STARTLE course were second-year residents in the general surgery program at MRRH.
Scores on knowledge based tests improved significantly with both courses. Survey results from the EWMT course suggest that participants feel better prepared to care for the injured patient (median Likert [IQR]: 5.0 [5.0-5.0]) and that their practice improved (5.0 [5.0-5.0]). Similarly, following the STaRTLE course we found participants felt significantly more comfortable with performing 20 of the 22 operative procedures taught.
These courses represent a feasible, cost-effective, and resource appropriate trauma education curriculum that if standardized and implemented may improve trauma care and outcomes in the resource-limited setting.
本项目的目标是创建一个专门为资源匮乏地区设计的多层次创伤培训课程。
我们开发了两门课程，旨在教授创伤护理所需的原则和技能。第一门课程“创伤急诊病房管理（EWMT）”，旨在教授实习生在急诊病房对创伤患者进行初始评估和稳定病情的方法。第二门课程面向中级外科住院医师，即“资源匮乏环境下的创伤手术技术与修复（STaRTLE）”，是一门基于尸体的创伤手术课程，旨在教授手术暴露和技术。这些课程在乌干达这个低收入国家的姆巴拉拉地区转诊医院推出。进行了课前和课后测试及调查。
本研究在姆巴拉拉地区转诊医院（MRRH）进行。这是乌干达西南部的一家医院，提供专科护理、医学院、护理学院以及多个住院医师培训项目。
EWMT课程的学生是MRRH的实习生。经过1年的培训，这些实习生中的大多数将成为医疗官员，成为乌干达地区医院的唯一医疗服务提供者。STaRTLE课程的学生是MRRH普通外科项目的二年级住院医师。
两门课程的知识测试成绩均有显著提高。EWMT课程的调查结果表明，参与者感觉自己在照顾受伤患者方面准备得更好（中位数李克特量表[四分位间距]：5.0[5.0 - 5.0]），并且他们的实践能力有所提高（5.0[5.0 - 5.0]）。同样，在STaRTLE课程之后，我们发现参与者对所教授的22项手术操作中的20项操作感觉明显更得心应手。
这些课程代表了一种可行、具有成本效益且资源适配的创伤教育课程，如果进行标准化并实施，可能会改善资源有限环境下的创伤护理及治疗效果。
