Initial evaluation of the "Trauma surgery course"
World Journal of Emergency Surgery
Initial evaluation of the "Trauma surgery course"
Gregorio Tugnoli 2
Sergio Ribaldi 1
Marco Casali 2
Stefano M Calderale 1
Massimo Coletti 1
Marco Alifano 0
Sergio N Forti Parri 0
Silvia Villani 2
Andrea Biscardi 2
M Chiara Giordano 2
Franco Baldoni 2
0 Chirurgia Toracica (Head: Dr. Maurizio Boaron) , Ospedale Maggiore, L.go Nigrisoli 2, 40133 Bologna , Italy
1 Gruppo Aperto per lo Studio del Trauma (GAST), Clinica Chirurgica d'Urgenza e di Pronto Soccorso, Universita La Sapienza , Roma, viale del Policlinico 2, 00100 Roma , Italy
2 Chirurgia d'Urgenza e del Trauma (Head: Dr. Franco Baldoni) , Dipartimento Emergenza, Ospedale Maggiore, L.go Nigrisoli 2, 40133 Bologna , Italy
Background: The consequence of the low rate of penetrating injuries in Europe and the increase in non-operative management of blunt trauma is a decrease in surgeons' confidence in managing traumatic injuries has led to the need for new didactic tools. The aim of this retrospective study was to present the Corso di Chirurgia del Politrauma (Trauma Surgery Course), developed as a model for teaching operative trauma techniques, and assess its efficacy. Method: the two-day course consisted of theoretical lectures and practical experience on largesized swine. Data of the first 126 participants were collected and analyzed. Results: All of the 126 general surgeons who had participated in the course judged it to be an efficient model to improve knowledge about the surgical treatment of trauma. Conclusion: A two-day course, focusing on trauma surgery, with lectures and life-like operation situations, represents a model for simulated training and can be useful to improve surgeons' confidence in managing trauma patients. Cooperation between organizers of similar initiatives would be beneficial and could lead to standardizing and improving such courses.
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Background
The treatment of the thoraco-abdominal trauma has
always represented a surgical challenge, owing to the
peculiarity of these injuries. The need for specific training
for surgeons involved in the care of these patients is
justified by the difficulties in obtaining an exhaustive
preoperative assessment, the need for prompt
decision-making, and the often limited available resources.
Furthermore, the number of surgically treated trauma
patients has markedly decreased in recent years, owing to
many factors, such as the low rate of penetrating trauma,
the improved safety system of vehicles, innovations in
diagnostic tools, and the discovery of alternative
treatments [1-4]. Thus, all these factors have prompted a
discussion about the future of trauma surgeon training [5,6].
A variety of didactic methods, based on "simulated
training", have been suggested [7,8] and computer simulation
or computer-controlled dummies have been employed.
Another proposed training method involves practice on
cadavers or animal models. The use of in vivo animal
models, generally large-sized swine, which simulate human
thorax and abdomen quite well, enables extremely
realistic situations to be recreated, even to the point of putting
the participants under stress [7,9,10].
In Italy the general surgeon is trained by six-year residency
in General Surgery or in General and Emergency Surgery.
However, there are no specific residency or university
courses for Trauma Surgery. Managing trauma differs
greatly from region to region; in most regions there is a
lack of reference centers for thoracic and abdominal
traumas, which are treated by the general surgeon of the
nearest hospital, whereas specific traumas, such as
neurosurgical, orthopedic and burns, are treated by
specialized surgeons.
Instead, in our region (Emilia-Romagna) there are three
reference trauma center (Parma, Bologna, Cesena). These
centers are equipped with all the necessary resources to
treat all kinds of trauma.
Since November 2002, a multi-trauma surgery-training
course has been running in Bologna, Italy, which is
mainly aimed at general surgeons, who, owing to their
work, more frequently run into trauma injuries and
residents who currently have less chance to gain experience in
trauma surgery.
The aim of this study was to present this course and
discuss its purposes and educational effectiveness compared
with similar courses. We also wanted to assess whether
our model could be used as a qualified updating course.
We present herein the results obtained in the first seven
editions of the course.
Materials and methods
Our project is based on the experience acquired in
thoracic and abdominal injuries at Maggiore Hospital of
Bologna, Italy, over the last 16 years. This hospital has
been a reference centre for trauma management for
several years, with over 400 cases of major (ISS>25) traumas
per year. Cooperation has been set up between our
multidisciplinary team of Emergency Surgery and Trauma and
the Open Group for the Study of Trauma (Gruppo Aperto
per lo Studio del Trauma GAST) belonging to the Clinical (...truncated)