Stroever Stephanie, Lanning Colten, Buhavac Miloš, Mecham Cameran, Weitz Andrea, Frankovsky Frank, Rios Andres, Morris James
Department of Medical Education, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, USA.
Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, USA.
Adv Med Educ Pract. 2024 Nov 2;15:1059-1067. doi: 10.2147/AMEP.S475489. eCollection 2024.
Care of the acutely injured trauma patient is integral to the practice of emergency medicine. It is currently unknown how most emergency medicine residencies structure their residents' trauma experience and little guidance for competency assessment is provided by the Residency Review Committee. Our study aimed to determine current emergency medicine residency practices in trauma resuscitation.
We conducted a cross-sectional survey of members of the Council of Residency Directors in Emergency Medicine (CORD) listserv in April 2023. Frequency with percentage of item responses is reported and differences across trauma levels assessed via Fisher's exact test (α = 0.05).
Fifty-seven program directors responded to the survey (21.9%), the majority of whom operate at Level I facilities. Significantly more Level II/ III centers send residents to other sites for trauma experience compared to Level I (p = 0.000). Residents participate in all key procedures (eg, airway management, central venous access) when managing traumas except thoracotomy where participation was notably lower and statistically different across levels (p = 0.000). Lastly, program directors were very confident their residents can lead traumas independently and few acknowledged citations for deficiency in trauma training.
Trauma training and confirmation of competency is critical among EM residents who may serve as the sole lead in rural emergency departments. This study demonstrates that there is considerable variability in how residency programs structure trauma education, particularly with regards to the exposure to invasive procedures and the opportunity to lead trauma resuscitations. As the American Board of Emergency Medicine has introduced requirements for program directors to attest specifically to the competence of residents to lead trauma resuscitations, standardized and validated tools should be adopted to support this attestation and ensure competence regardless of the program hospital's trauma level.
急性创伤患者的护理是急诊医学实践的重要组成部分。目前尚不清楚大多数急诊医学住院医师培训项目如何构建其住院医师的创伤经历，住院医师评审委员会也几乎没有提供能力评估的指导。我们的研究旨在确定目前急诊医学住院医师培训项目在创伤复苏方面的实践情况。
我们于2023年4月对急诊医学住院医师培训主任委员会（CORD）邮件列表中的成员进行了横断面调查。报告了项目反应的频率及百分比，并通过Fisher精确检验评估不同创伤水平之间的差异（α = 0.05）。
57名项目主任回复了调查（21.9%），其中大多数在一级医疗机构工作。与一级中心相比，二级/三级中心将住院医师送到其他地点获取创伤经历的比例显著更高（p = 0.000）。在处理创伤时，住院医师参与所有关键操作（如气道管理、中心静脉置管），但开胸手术的参与度明显较低，且不同级别之间存在统计学差异（p = 0.000）。最后，项目主任非常确信他们的住院医师能够独立领导创伤救治工作，很少有人承认在创伤培训方面存在缺陷。
对于可能在农村急诊科担任唯一负责人的急诊医学住院医师来说，创伤培训和能力确认至关重要。本研究表明，住院医师培训项目构建创伤教育的方式存在很大差异，特别是在侵入性操作的接触机会和领导创伤复苏的机会方面。由于美国急诊医学委员会已对项目主任提出要求，需专门证明住院医师领导创伤复苏的能力，因此应采用标准化和经过验证的工具来支持这一证明，并确保无论项目医院的创伤级别如何，住院医师都具备相应能力。
