Onufer Emily J, Andrade Erin G, DeClue Angelia, Bochicchio Grant, Wise Paul, Klingensmith Mary E, Eaton Stephen, Kirby John, Punch L J
J Grad Med Educ. 2021 Feb;13(1):95-102. doi: 10.4300/JGME-D-20-00278.1. Epub 2021 Jan 8.
While wound management is a common task for practicing surgeons, there is a paucity of dedicated education on soft tissue management during residency training.
The COVER (Causes of soft tissue injury, Obstacles to closure, Vacuums and stitches, Epithelialization, Rationale for wound care) curriculum was developed to engage junior surgery residents in the management of soft tissue injury and infection.
Junior surgery residents participated in the COVER lab during academic years 2018-2020. Residents applied appropriate surgical management and wound care to cadaveric models of soft tissue injury and infection. Assessments included a pre-/post-curriculum and pre-/post-lab multiple choice questionnaire and survey.
All eligible residents (n = 45, 27) participated in the COVER lab for both academic years. Postgraduate year (PGY)-1s, PGY-2s, and PGY-3s showed improvement in wound management knowledge with an average increase in score of 17%, 8%, and 18%, respectively. They also showed a change in their self-reported perceived ability to achieve primary soft tissue closure with confidence levels 22%, 20%, and 16%, respectively. This was again seen in perceived ability to manage soft tissue injuries and infections (28%, 28%, and 23%, respectively). There was a significant increase in performing new wound management skills (PGY-1 mean 51.3%, PGY-2 33.5%, PGY-3 20%; ANOVA, = .0001).
The COVER curriculum provides a systematic approach to soft tissue injury and infection. Residents showed a significant increase in both soft tissue knowledge as well as confidence in ability to perform wound management.
虽然伤口处理是外科医生的常见工作,但住院医师培训期间缺乏关于软组织处理的专门教育。
开发COVER(软组织损伤原因、闭合障碍、负压与缝线、上皮化、伤口护理原理)课程,以使初级外科住院医师参与软组织损伤和感染的管理。
初级外科住院医师在2018 - 2020学年参加COVER实验室。住院医师对软组织损伤和感染的尸体模型应用适当的手术管理和伤口护理。评估包括课程前后和实验室前后的多项选择题问卷及调查。
所有符合条件的住院医师(n = 45, 27)在两个学年都参加了COVER实验室。一年级住院医师、二年级住院医师和三年级住院医师在伤口处理知识方面均有提高,平均得分分别提高了17%、8%和18%。他们自我报告的实现一期软组织闭合的感知能力也有变化,信心水平分别为22%、20%和16%。在管理软组织损伤和感染的感知能力方面也有类似情况(分别为28%、28%和23%)。在执行新的伤口处理技能方面有显著提高(一年级住院医师平均为51.3%,二年级住院医师为33.5%,三年级住院医师为20%;方差分析,P = .0001)。
COVER课程为软组织损伤和感染提供了一种系统的处理方法。住院医师在软组织知识以及伤口处理能力的信心方面均有显著提高。