Trauma surgery training: the Dutch approach

Übersichten Trauma Berufskrankh 2017 · [Suppl 1]: 19:S52–S54 DOI 10.1007/s10039-016-0184-z Published online: 18 August 2016 © The Author(s) 2016. This article is an open access publication. H. P. A. M. Poos Introduction Sports selected 11 hospitals as level 1 trauma centre. These 11 trauma centers have the responsibility to organize the trauma care in their region. They focus in particular on care for polytraumatized and tertiary referred patients, classification of the regional hospitals in level 2 and 3 trauma centers (. Table 1), and registration of hospitalized trauma patients in a national database (Landelijke Trauma Registratie). The following trauma centers are having a helicopter team with a surgeon or anesthesiologist and nurse for prehospital care: Amsterdam, Groningen, Nijmegen, and Rotterdam. In contrast to Germany, there is no so-called ‘Notartzt’ system. The ambulance service personnel are trained to stabilize patients and to start CPR. They In the last few decades, general surgery is getting more and more divided into subspecialties in the Netherlands. Until now, in most hospitals there is one general surgery department in which visceral, oncologic, vascular and trauma surgeons are working together. The development of specialization increases the quality of the treatment of selected diseases or injuries. However, the overview of the whole patient can become endangered. It is important to train specialists, but every surgeon has to have a wide knowledge of patient care. This is eminently important in the treatment of polytraumatized patients. Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands Trauma surgery training: the Dutch approach are also allowed to give selected medical treatment [1]. In the hospital the trauma surgeon is in the lead during whole treatment of a trauma patient, from the emergency department to discharge. A trauma surgeon is a general surgeon who is trained to treat thoracic, abdominal, and musculoskeletal injuries. When necessary, other disciplines are consulted. Polytraumatized patients are always treated by the trauma surgeon. Depending on local agreement, isolated fracture care can also be done by the orthopedic surgeon. Nowadays, approximately 75 % of fracture care is done by trauma surgeons and 25 % by orthopedic surgeons. Trauma care in the Netherlands The Netherlands is a small but densely country with approximately 17 million inhabitants. Most accidents are related to traffic, work, and sports. Violencerelated injuries are less common. Since 1998 the Ministry of Health, Welfare and 2y Common Trunk 1,5 y Common Trunk 2y General Surgery 4,5 y General Orthopedics 2y Differentiation phase: Overview of trauma centers - Trauma surgery Level 1 Trauma surgeon 24/7 on call trauma Primary and definitive care for center polytraumatized patients All medical specialists - Visceral surgery Level 2 Trauma surgeon 24/7 on call trauma Primary care for polytraumatized center patients Mainly monotrauma care (fracture treatment) No neurosurgery or plastic surgery - Pediatric surgery Table 1 Level 3 General surgeon 24/7 on call trauma In day time, a fracture care specenter cialist is always present (trauma surgeon or orthopedic surgeon) Monotrauma care (fracture treatment) S52 Trauma und Berufskrankheit · Suppl 1 · 2017 Orthopedic Surgeon - Oncologic surgery - Vascular surgery - Lung surgery General Surgeon with a subspecialty a b Fig. 1 8 Training overview in general surgery (a) and orthopedic surgery (b) Abstract · Zusammenfassung Infobox 1 Mandatory courses during trauma surgery training Trauma Berufskrankh 2017 · [Suppl 1]: 19:S52–S54 DOI 10.1007/s10039-016-0184-z © The Author(s) 2016. This article is an open access publication. 4 Advanced AO/OTC course 4 AO/OTC Pediatric course 4 Definitive Surgical Trauma Care (DSTC) H. P. A. M. Poos Course 4 Emergency Management of Severe Burns (EMSB) 4 Hand and wrist course (Dutch course) 4 Dutch Traumasurgery Days 4 1 International Trauma congress Surgical training in the Netherlands The training to become a trauma surgeon and orthopedic surgeon is separate [2]. When the basic medical training is completed, young physicians start working as resident not in training or they start a research project to write a PhD thesis. The organization of surgical training is divided into 8 regions and all regions are part of a university hospital with one main responsible trainer. Every region has several regional hospitals with local responsible trainers. To become a surgical resident in training, someone has to apply for a residency and has to do a job interview with all local trainers. The training is competent based and every resident has a digital portfolio and has to get a mandatory amount of clinical and operative reviews from the teaching surgeons in this portfolio. Every year, the resident has to do an exam adopted from the American Board of Surgeons. The education program takes 6 years and 2 or 4 of these 6 years are respectively spent in a university hospital or in a peripheral clinic. The first 2 years is called the Common Trunk and consists of rotations in emergency department, intensive care unit, vascular, visceral, and trauma surgery. The second 2 years are aimed at advanced surgical training in vascular, visceral and trauma surgery. The resident reaches a level of independent clinical and operative skills in these first 4 years. The last 2 years are called the ‘differentiation phase’. The resident specializes in one of the subareas of general surgery: trauma surgery, visceral surgery, oncologic surgery, vascular surgery, lung surgery, or pediatric surgery. After 6 years the resident fin- Trauma surgery training: the Dutch approach Abstract Surgery is evolving rapidly and surgeons continue to specialize. The care for trauma patients will always need a physician with a broad base of knowledge and skills. In the Netherlands this care is well organized with a trauma center system and is mainly performed by specialized general surgeons, called trauma surgeons. These surgeons are trained in a well-defined education program and perform treatment for thoracic, visceral, and musculoskeletal injuries. In the near future collaboration with the orthopedic surgeons will be intensified, because currently they are less involved in trauma care. This will potentially develop to a common trauma unit and education program. Keywords Trauma surgery · Education · Trauma unit · Trauma care · Netherlands Ausbildung in der Unfallchirurgie: niederländischer Ansatz Zusammenfassung Die Chirurgie entwickelt sich rasant, und die Chirurgen spezialisieren sich immer weiter. In der Versorgung von Unfallpatienten wird immer ein Arzt mit einer breit angelegten Basis an Wissen und Fertigkeiten erforderlich sein. In den Niederlanden erfolgt diese Versorgung gut organisiert innerhalb eines Systems von Traumazentren und wird hauptsächlich durch spezialisierte Allgemeinchi (...truncated)