Teaching effectiveness of the trauma evaluation and management module for senior medical students.

BACKGROUND: The Trauma Evaluation and Management (TEAM) module was devised by the American College of Surgeons for teaching senior medical students trauma management principles. This article reports on the teaching effectiveness of this module. METHOD: Cognitive skills (by 20 item multiple-choice question examination on trauma topics) and clinical trauma management skills performance, using the Objective Structured Clinical Examination, were compared between two groups of 16 randomly selected final year medical students who had completed the standard curriculum including trauma topics. One group had the TEAM (TEAM group) and the other did not (no-TEAM group). Objective Structured Clinical Examination score (percentage), Priority score (range, 1-7), Organized Approach score (range, 1-5), and Global Pass status were assigned at each station. The students also completed a five-part questionnaire. RESULTS: Results of the questionnaire showed that on a scale of 1 to 5, with 5 being excellent, 96.8% assigned a score of 4 or greater, indicating the objectives were met, 83.8% that trauma knowledge was improved, 51.6% that clinical skills were improved, 90.3% that the module should be mandatory, and 83.9% overall satisfaction with the program. CONCLUSION: The TEAM module is very effective in teaching trauma management principles to senior medical students, by whom the program was very well received. Consideration should be given to adopting this program more widely in our medical undergraduate curriculum.

Comparison of performance of interns completing the old (1993) and new interactive (1997) Advanced Trauma Life Support courses

BACKGROUND: The 1997 edition of the Advanced Trauma Life Support (ATLS) course emphasized interactivity as its major change. The impact of this change is assessed in this study. METHODS: We compared two matched groups of 16 interns completing either the old (group I) or new (group II) ATLS course. Cognitive skills (40 standard ATLS questions plus 10 additional questions on airway and shock) and clinical trauma management skills (four trauma objective structured clinical examinations [OSCEs] on simulated trauma patients) were tested. OSCE station scores (standardized to a maximum of 20), priority scores (graded 1-7), organized approach global passing grades (graded 1-5), and initial assessment test station scores (graded 1-5) were compared. RESULTS: Using ATLS criteria, three interns failed in each group. Post-ATLS examination quesiton scores were similar (84.5 +/- 6.9 for group I, 85.9 +/- 7.1 for group II); scores for the airway and shock questions were higher but not different between the two groups. The four OSCE station mean scores varied between 13.9 +/- 2.0 and 15.4 +/- 2.1 for group I and were higher (P < 0.05) for group II (17.9 +/- 1.6 to 19.1 +/- 1.0). Priority scores were similar (group I, 6.3 +/- 1.1; group II, 6.4+/- 1.2), but approach scores (3.9 +/- 0.1 for group I and 4.9 +/- 0.8 for group II). There were 8 honors grades in group I and 40 (p < 0.05) in group II. Interactive teaching, adult education principles, opportunities for discussion, provision of feedback, and stimulation of self-learning were rated more highly in the new course. CONCLUSION: Using standard ATLS pass criteria, performance after the new and old ATLS courses was similar. Superior performances were measured using OSCE methodology for clinical trauma management skills after the new compared with the old ATLS course in this population of interns.(Au)

Effect of basic prehospital trauma life support program on cognitive and trauma management skills

We tested the effectiveness of a basic prehospital trauma life support (PHTLS) program by assessing cognitive performance and trauma management skills among prehospital trauma personnel. Fourteen subjects who completed a standard PHTLS course (group I) were compared to a matched group not completing a PHTLS program (group II). Cognitive performance was assessed on 50-item multiple choice examinations, and trauma skills management was assessed with four simulated trauma patients. Pre-PHTLS multiple choice questionnaire scores were similar (45 +/- 9.4 percent vs. 48.4 +/- 8.9 percent for groups I and II respectively), but the post-PHTLS scores were higher in group I (80.4 +/- 5.9 percent) than in group II (52.6 +/- 4.9 percent). Pre-PHTLS simulated trauma patient performance scores (standardized to a maximum total of 20 for each station) were similar at all four stations for both groups, ranging from 7.9 to 10.4. The post-PHTLS scores were statistically significantly higher at all four stations for group II (range 8.0 - 11.1). The overall mean pre-PHTLS score for all four stations was 8.3 +/- 2.1 for group I and 8.8 +/- 2.0 (NS) for group II; the group I post-PHTLS mean score for the four stations was 17.1 +/- 2.7 (p < 0.05) compared to 9.1 +/- 2.3 for group II. Pre-PHTLS Adherence to Priority scores on a scale of 1 to 7 were similar (1.1 +/- 0.9 for group I and 1.2 +/- 1.0 for group II). Post-PHTLS group I Priority scores increased to 5.9 +/- 1.1. Group II (1.1 +/- 1.0) did not improve their post-PHTLS scores. The pre-PHTLS Organized Approach scores in the simulated trauma patients on a scale of 1 to 5 were 2.1 +/- 1.0 for group I and 1.9 +/- 1.2 for group II (NS) compared to 4.2 +/- 0.9 (p < 0.05) in group I and 2.0 +/- 0.8 in group II after PHTLS. This study demonstrates improved cognitive and trauma management skills performance among prehospital paramedical personnel who complete the basic PHTLS program.(Au)

Impact of the prehospital trauma life support programme in Trinidad and Tobago

The impact of the Prehospital Trauma Life Support (PHTLS) programme, introduced in Trinidad and Tobago in 1992, was assessed by questionnaires completed by 26 medical personnel (MP); 71 ambulance personnel (AP); and 50 non ambulance paramedical personnel (NAP). Of the 23 MP, 45 AP and 38 NAP who were aware of the programme, 19 (82.6 percent) MP, 40(88.9 percent) AP and 25 (65.8 percent) NAP were able to differentiate personnel that had taken the PHTLS programme based on their performance. 32 (71.1 percent) of the AP were PHTLS trained. 24 (53.3 percent) and 4 (9 percent) of the AP identified poor equipment and poor supervision, respectively, as reasons for difficulty in applying PHTLS principles. Improvements observed among those completing the PHTLS programme were: improved resuscitation techniques by 20 (86.9 percent) MP, 38 (84.4 percent) AP and 27 (71.1 percent) NAP; better vital signs recording by 8 (34.8 percent) MP, 27 (60 percent) AP and 8 (21.1 percent) NAP; improved immobilization by 23 (100 percent) MP, 40 (88.9 percent) AP and 33 (86.8 percent) NAP: better haemorrhage control by 22 (95.6 percent) MP, 40 (88.9 percent) AP and 24 (63.2 percent) NAP; appropriate splinting of fractures by 23 (100 percent) MP, 40 (88.9 percent) AP and 32 (84.2 percent) NAP: and increased utilization of oxygen by 15 (65.2 percent) MP, 31 (68.9 percent) AP and 21 (55.3 percent) NAP. 32 (71.1 percent) AP with PHTLS training indicated improvement in their ability to resuscitate and transport trauma victims, with 42 (93.3 percent) reporting improvement in overall prehospital care. Medical, paramedical and ambulance personnel all perceive a significant positive impact of PHTLS training on prehospital trauma care. Although improvements in supervision, documentation and equipment are still required, improved trauma resuscitative techniques after PHTLS training should improve trauma patient outcome in Trinidad and Tobago. (AU)

The role of water-soluble contrast myelography implications for the Caribbean - abstract

Since 1985, water-soluble contrast medium has been used for myelography in Trinidad; it has distinct advantages over the traditional oily medium. It is rapidly excreted in the urine so that it does not need removal. A smaller (20-22 gauge) spinal needle is used; less trauma causes less CSF leakage and hence less post-spinal headache. The needle is removed after contrast injection, allowing easier patient manipulation. The low viscosity contrast also gives a better view of the thecal sac, spinal cord and nerve roots; further, it can traverse a lesion enabling both cephalad and caudal margin delineation. Fluoroscopy is not absolutely necessary as the 5-30 degree head up postero-anterior and obliques show a lumber lesion. Further, it can be used as an outpatient procedure and allows for enhanced CT scanning. There were 57 cases in the 3 years from 1985 to 1987 (7, 15, 35): 30 at San Fernando, 12 at Port-of-Spain and 15 in private clinics. The 36 males and 21 females were aged 23 to 62 years; 54 had low-back syndrome, 2 suspected thoracic and the other suspected cervical lesions. Metrizamide (Amipaque) was used in 44 cases and Iohexo (Omnipaque) in 13. Visualization was good to excellent in all cases. Complications were headaches in 3, vomiting in 1 and seizures in another. In the latter patient, the contrast passed intracranially during the Trendelenburg tilting for thoracic visualisation. Twice some contrast was injected epidurally without complication. However, this comprised visualisation. Extreme care was taken in proper patient hydration, gentle motion in the procedure and the 15-30 degree head up position for 24 hours post-myelogram. There is advantageous ease of performance, rarity of complications, outpatient performance and lack of necessity for fluoroscopy in areas where this is not available. It is advised for use in developing territories where the common problem of back pain and suspected lower spinal lesions can be more easily investigates (AU)