Canadian Trauma Training Needs Assessment and Development of a Trauma Laparotomy Operative Assessment Tool
Creators: Ryan, Joanna F
Publisher: name: University of Alberta Library
Year: 2022

<p>Background: Canadian general surgery trainees are required to achieve competence in multiple domains of trauma care such as the operative and non-operative management of injuries, performance of the role of trauma team leader, trauma-specific knowledge, teamwork, and communication. A gap between clinical exposure and the required operative competencies in trauma education has been identified. Additionally, there are no procedure-specific competency- based operative assessment tools available for general surgery trauma procedures.<br>
Objectives: This work aims to: (1) Conduct a national needs assessment for Canadian general surgery trauma training; and (2) develop a novel competency-based formative operative assessment tool for the trauma laparotomy procedure.<br>
Methods: A national needs assessment was conducted through a survey of general surgery educators and trainees. The survey encompassed a wide range of components of the trauma training experience and included questions on clinical exposure, completion of formal trauma courses, physical and human resources available for education, perceived deficits in training, and support for curriculum initiatives. A modified Delphi study was then conducted with an international panel of trauma surgeons and educators to identify a set of items to be included in a novel trauma laparotomy operative assessment tool. Strict consensus criteria were applied throughout the three rounds of the study. Items were modified based on Delphi panel comments.<br>
Results: Perceived deficiencies in trauma training were identified including operative management for many injury patterns, trauma epidemiology, evidence-based practice, and community advocacy. There was strong support for a wide array of curriculum initiatives to improve trauma education among both educators and trainees. Competency-based curriculum objectives and assessment tools for both technical and non-technical skills were strongly supported by participants. The modified Delphi study was conducted over three rounds. Items were categorized into four sections within the tool: pre-operative, intra-operative, post-operative, and global rating. At the end of the Delphi study, 17 items were included in the operative assessment tool.<br>
Conclusions: At this time, both educators and trainees perceive the existing Canadian trauma training curriculum to be insufficient to meet the educational needs of general surgery residents. Competency-based approaches to education and assessment were strongly supported by both educators and trainees in the national needs assessment. A competency-based formative operative assessment tool for the trauma laparotomy procedure has been developed for use in general surgery trauma training. Future work should focus on developing a national competency- based trauma training curriculum and evaluation of the assessment tool for utility, feasibility, and additional supporting validity evidence. Furthermore, the assessment tool development process and validity studies may be replicated to develop a full suite of assessment tools for trauma operations.</p>