Advanced Surgical Skills for Exposure in Trauma (ASSET) course improves military surgeon confidence.

OBJECTIVE: Active duty military surgeons often have limited trauma surgery experience prior to deployment. Consequently, military-civilian training programs have been developed at high-volume trauma centers to evaluate and maintain proficiencies. Advanced Surgical Skills for Exposure in Trauma (ASSET) was incorporated into the predeployment curriculum at the Army Trauma Training Detachment in 2011. This is the first study to assess whether military surgeons demonstrated improved knowledge and increased confidence after taking ASSET. DESIGN: Retrospective cohort study. SETTING: Quaternary care hospital. PATIENTS AND PARTICIPANTS: Attending military surgeons who completed ASSET between July 2011 and October 2020. MAIN OUTCOME MEASURE(S): Pre- and post-course self-reported comfort level with procedures was converted from a five-point Likert scale to a percentage and compared using paired t-tests. RESULTS: In 188 military surgeons, the median time in practice was 3 (1-8) years, with specialties in general surgery (52 percent), orthopedic surgery (29 percent), trauma (7 percent), and other disciplines (12 percent). The completed self-evaluation response rate was 80 percent (n = 151). The self-reported comfort level for all body regions improved following course completion (p < 0.001): chest (27 percent), neck (23 percent), upper extremity (22 percent), lower extremity (21 percent), and abdomen/pelvis (19 percent). The overall score on the competency test improved after completion of ASSET, with averages increasing from 62 ± 18 percent pretest to 71 ± 13 percent post-test (p < 0.001). CONCLUSIONS: After taking the ASSET course, military surgeons demonstrated improved knowledge and increased confidence in the operative skills taught in the course. The ASSET course may provide sustainment of knowledge and confidence if used at regular intervals to maintain trauma skills and deployment readiness.

Bringing Trauma Education to the Frontier: Overcoming Distance Barriers Utilizing a Virtual Platform.

BACKGROUND: The American College of Surgeons and state regulations mandate that trauma facilities offer trauma-specific continuing education throughout the region they serve. These requirements come with unique challenges when serving a rural and sparsely populated state. A novel approach to providing education was necessitated by the coronavirus disease 2019 pandemic, travel distance, and limited local specialists. OBJECTIVE: The purpose of this article is to describe the development of a virtual educational program used to improve access to quality trauma education and decrease barriers to obtaining continuing education hours inherent in the region. METHODS: This article describes the development and implementation of the Virtual Trauma Education program, which provided one free continuing education hour per month from October 2020 to October 2021. The program reached more than 2,000 viewers and established a method to provide continuous monthly educational offerings throughout the region. RESULTS: After the Virtual Trauma Education program implementation, monthly educational attendance increased from an average of 55 to 190. Viewership data indicate that trauma education across our region is far more robust, available, and accessible using a virtual platform. With more than 2,000 views from October 2020 to October 2021, Virtual Trauma Education offerings have spread far beyond regional borders, reaching 25 states and 169 communities. CONCLUSION: Virtual Trauma Education delivers easily accessible trauma education and is a program that has proven its sustainability.

Disparities in trauma care education: An observational study of the ATLS course within a national trauma system.

BACKGROUND: Disparities in trauma systems, including gaps between trauma center levels, affect patient outcomes. Advanced Trauma Life Support (ATLS) is a standard method of care that improves the performance of lower-level trauma systems. We sought to study potential gaps in ATLS education within a national trauma system. METHODS: This prospective observational study examined the characteristics of 588 surgical board residents and fellows taking the ATLS course. The course is required for board certification in adult trauma specialties (general surgery, emergency medicine, and anesthesiology), pediatric trauma specialties (pediatric emergency medicine and pediatric surgery), and trauma consulting specialties (all other surgical board specialties). We compared the differences in course accessibility and success rates within a national trauma system which includes seven level 1 trauma centers (L1TC) and twenty-three non-level 1 hospitals (NL1H). RESULTS: Resident and fellow students were 53% male, 46% employed in L1TC, and 86% were in the final stages of their specialty program. Only 32% were enrolled in adult trauma specialty programs. Students from L1TC had a 10% higher ATLS course pass rate than NL1H (p = 0.003). Trauma center level was associated with higher odds to pass the ATLS course, even after adjustment to other variables (OR = 1.925 [95% CI = 1.151 to 3.219]). Compared to NL1H, the course was two-three times more accessible to students from L1TC and 9% more accessible to adult trauma specialty programs (p = 0.035). The course was more accessible to students at early levels of training in NL1H (p < 0.001). Female students and trauma consulting specialties enrolled in L1TC programs were more likely to pass the course (OR = 2.557 [95% CI = 1.242 to 5.264] and 2.578 [95% CI = 1.385 to 4.800], respectively). CONCLUSIONS: Passing the ATLS course is affected by trauma center level, independent of other student factors. Educational disparities between L1TC and NL1H include ATLS course access for core trauma residency programs at early training stages. Some gaps are more pronounced among consulting trauma specialties and female surgeons. Educational resources should be planned to favor lower-level trauma centers, specialties dealing in trauma care, and residents early in their postgraduate training.

Learning trauma surgery through cytoreductive surgery.

OBJECTIVES: Regarding war surgery (WS), the initial and continuing education of French military gastrointestinal surgeons (FMGIS) is considered flawed and inappropriate. This results from the low incidence of gastrointestinal (GI) trauma, its predominantly non-surgical management, and a daily surgical practice that strongly differs from WS. Conversely, cytoreductive surgery (CRS) of peritoneal metastases has similarities with WS which led us to assess its potential contribution to the initial and continuing education of FMGIS in WS. METHODS: We reported the activities of the GI surgery departments of the military teaching hospitals of Percy and Begin. The first one dedicated to traumatology and the second to CRS. We then specifically looked into the surgical procedures conducted by the FMGIS during deployment from January 2004 to December 2014. RESULTS: Amongst the 600 severe trauma patients admitted to the Percy trauma center between January 2019 and December 2020, 17 underwent abdominal surgery with a total of 25 procedures performed. During the same period, 61 patients undertook CRS in Begin with an average of 7 surgical processes per patient carried out and a total of 418 abdominal surgical procedures. Outside abdominal packing and nephrectomy (not performed in CRS), the numbers of splenectomy, gastrointestinal / gynecological resections (hysterectomy and/or adnexectomy), or liver resection were higher during CRS compared to abdominal trauma surgery with 10 times less patients (10 vs 1, 43 vs 9, 20 vs 0, 6 vs 0, respectively). CONCLUSION: CRS, through its similarities with WS, seemed to be an appropriate tool for the initial and continuing education of FMGIS in WS and, to an extent, of civilian trauma surgeons who could eventually treat terrorist attacks casualties on the national territory.

[Orthopedics and trauma surgery-Decathlon of medicine : Is a full education possible during resident education?] / Orthopädie und Unfallchirurgie ­ Zehnkampf der Medizin : Doch werden wir dem in der Weiterbildung noch gerecht?

BACKGROUND: When the specialties of orthopedics and trauma surgery were merged in 2006 in Germany, the learning content significantly increased while the training time remained the same. Less and less junior doctors learn the whole spectrum of orthopedics and trauma surgery for diagnosis, treatment and aftercare options. OBJECTIVE: How can continuing education concepts be designed to meet the wide range of theoretical and practical content required in residency training to become an orthopedic and trauma surgeon? RESULTS AND CONCLUSION: Orthopedics and trauma surgery is one of the most diverse specialties in terms of patients, clinical pictures and fields of activity. Accordingly, residency training must also be broadly based. This can be achieved through structured and well-planned training concepts. Furthermore, digital simulators could be used to prepare residents for working with patients. Rotation models in the outpatient area could also be beneficial in order to gain an insight into the outpatient care of musculoskeletal diseases. In addition to the active involvement of the resident in the training, the interest and participation of the trainers is also important in order to actively promote junior physicians and prepare them for their later work.

[Traumatology-an interdisciplinary task: exclusively for educational purposes?] / Traumatologie ­ eine interdisziplinäre Aufgabe: nur in der Lehre?

BACKGROUND: Traumatology of the head and neck region is not only a part of otorhinolaryngology, but also has a large overlap with neighboring disciplines of the head and neck region. In Freiburg, an interdisciplinary lecture on "ENT emergencies" was implemented in the 21/22 winter semester. The aim was to provide an even more realistic view on interdisciplinary patient care and to make evident the areas of intersection of four of the major head disciplines (otorhinolaryngology, neurosurgery, ophthalmology, and maxillofacial surgery). MATERIALS AND METHODS: A new, special lecture in otorhinolaryngology was implemented as part of the regular online lecture series accompanying the semester. With reference to the clinical care of ENT emergencies, possible overlaps with neighboring disciplines were identified and explained by the discipline representatives or discussed in front of and with the auditorium. At the end of the semester, all participating students (n = 173) were invited to evaluate the seminar using the survey tool "EvaSys" (EvaSys GmbH, Lüneburg, Germany). In total, 78 students participated in the evaluation process. RESULTS: The new lecture concept was very well accepted and immediately ranked top among the interdisciplinary lecture titles within the ENT lecture series. The clear communication of the term "interdisciplinarity" in the sense of a complementary clinical cooperation was also very successful and was appreciated accordingly by students during the evaluation process. CONCLUSION: Pragmatic presentation of ideal clinical patient care using an interdisciplinary approach is possible within the regular ENT lecture series. This realistic portrayal, beyond any technical and/or professional differences, is of great interest to students and is considered clinically relevant. Thus, interdisciplinary lectures provide a valuable tool to teach the fundamental values of clinical interdisciplinary management for the best possible patient care.

[With structure to successful further education : Presentation of curriculum, checklists and compendium for career entrants]. / Mit Struktur zur erfolgreichen Weiterbildung : Vorstellung von Curriculum, Checklisten und Berufseinsteigerheft.

The further training to a medical specialist in orthopedics and trauma surgery is in a state of continuous development. This is underlined by numerous amendments from previous and coming years, including recently the implementation of the eLogbook, which is presently being implemented nationwide by the individual State Chambers of Physicians; however, in addition to the legally regulated conditions of the further education regulations the focus on the quality of the content of further training should not be neglected. This could be achieved by a structural approach. As the Young Forum for Orthopedics and Trauma Surgery (JFOU) we would like to promote the exchange of ideas and policy engagement and directly contribute to the topic of further training in orthopedics and trauma surgery by facilitating a successful further training in numerous projects. This article presents the following projects on the topic of further training: checklists on diverse topics which are relevant for the clinical routine and further training, a comprehensive compendium for career entrants to facilitate the start of the career on the threshold from studying to routine daily work, a guide on further training for structured training even during the period of training for medical specialists and beyond, interactive spreadsheets for the progress in fulfilling the required benchmarks and a structured curriculum for further training in the medical specialist examination for orthopedics and trauma surgery in cooperation with Thieme eREF. Additionally, further projects on the topics of mentoring and specialization in orthopedics and trauma surgery can be found on our platform.

Mentorship in Medical Residency in Orthopedics: Evaluation of a Program by Mentors and Mentees / Mentoria na residência médica em Ortopedia: Avaliação de um programa por mentores e mentorados

Abstract Objective To demonstrate the degree of recommendation of mentors and mentees regarding a mentorship program, to assess the degree of satisfaction of the participants, and to describes the main characteristics of the meetings in pairs. Materials and Methods A primary, retrospective, analytical study based on answers to the annual evaluation questionnaires of the institutional mentorship program in pairs of the Orthopedics and Traumatology residency from December 2017 to February 2021. Results We compiled 52 responses from 26 mentorship preceptors and 26 mentored residents. The mentees and mentors had average ages of 27 (±1.5) years and 45 (±8.2) years respectively. A total of 96% of the participants recommend the program, and 89% of the mentees reported that the mentors contributed to their personal and professional decision-making process. Conclusion The mentorship program proved to be a highly recommended strategy in medical residency in Orthopedics. Data show that mentors contributed to the mentees' personal and professional decision-making process.

Resumo Objetivo Demonstrar o grau de recomendação de mentores e mentorados quanto à participação em um programa de mentoria, avaliar o grau de satisfação dos participantes, e descrever as principais características das reuniões em dupla. Materiais e Métodos Estudo primário, retrospectivo, analítico, com análise das respostas dos questionários de avaliação anual do programa de mentoria em dupla da residência de Ortopedia e Traumatologia da instituição de dezembro de 2017 a fevereiro de 2021. Resultados Foram obtidas 52 respostas de 26 preceptores mentores e 26 residentes mentorados. A média de idade dos mentorados foi de 27 anos (±1,5 ano), ao passo que a média de idade dos mentores foi de 45 anos (±8,2 anos). O grau de recomendação do programa pelos participantes foi de 96%, e 89% dos mentorados consideraram que os mentores contribuíram para a tomada de decisões pessoais e profissionais. Conclusão O programa de mentoria se mostrou uma estratégia com alto grau de recomendação na residência médica em Ortopedia. Os dados mostram que os mentores contribuíram para a tomada de decisões pessoais e profissionais dos mentorados.

Ha sido el 2020 un año perdido en la formación de cirugía ortopédica y traumatología? Percepción de los residentes / Has 2020 been a lost year in orthopedic surgery and trauma training? Residents’ perceptions

Objetivo: La pandemia de la COVID-19 ha afectado a la formación sanitaria especializada a todos los niveles. El aprendizaje en el ámbito quirúrgico se ha visto gravemente afectado y hasta ahora no se ha valorado el impacto en la formación de residentes de traumatología. Material y métodos: Se hizo llegar mediante enlace web y redes sociales una encuesta en línea de 17 preguntas a los residentes de cirugía ortopédica y traumatología de todo el territorio español entre el 10 de febrero y el 28 de febrero de 2021. Se analizaron los efectos de la pandemia de la COVID-19 en la actividad asistencial y formativa de los residentes. Resultados: Un total de 307 residentes de cirugía ortopédica y traumatología de toda España respondieron la encuesta. El 77,2% de los encuestados tuvo que suspender sus rotaciones. De estos, al 67,5% le gustaría retomar las rotaciones perdidas durante la pandemia. Un 69,7% de las cirugías programadas fueron suspendidas. La actividad quirúrgica estuvo completamente parada una media de 8 semanas. El 66,8% de los residentes considera que se ha visto afectada su formación quirúrgica y que esto repercutirá en su futuro laboral. El 49,5% considera insuficiente la oferta formativa en línea. Del total de encuestados, el 52,1% considera que el impacto de la situación de pandemia respecto a su situación formativa ha sido malo o muy malo. Conclusiones: La recogida de datos muestra un impacto negativo sobre la formación asistencial y teórica. Este estudio pone de manifiesto la necesidad de continuar ofreciendo una formación de calidad y maximizar las oportunidades de aprendizaje.(AU)

Objective: The COVID-19 pandemic has affected specialized healthcare training at all levels. Surgical learning has been severely affected, and the impact on orthopedic surgery residency training has so far not been assessed. Material and methods: An online survey of 17 questions was sent via web link to orthopedic surgery residents throughout Spain between February 10, 2021 and February 28, 2021. The effects of the COVID-19 pandemic on the care and training activities of residents were analyzed. Results: A total of 307 orthopedic surgery residents from all over Spain responded to the online survey. A total of 77.2% of the respondents had to suspend their rotations. Of these, 67.5% would like to resume the rotations they missed during the pandemic. A total of 69.7% of scheduled surgeries were suspended. Surgical activity was completely stopped for an average of 8 weeks. 66.8% of the residents consider that their surgical training has been affected and this will have repercussions on their future work. 49.5% considered the online training offered to be insufficient. Of the total number of respondents, 52.1% considered that the impact of the pandemic situation on their training situation was bad or very bad. Conclusions: The data collection shows a negative impact on both theoretical and clinical training. This study highlights the need to continue offering quality training by maximizing learning opportunities.(AU)

[Translated article] Has 2020 been a lost year in orthopaedic surgery and trauma training? Residents’ perceptions / Ha sido el 2020 un año perdido en la formación de cirugía ortopédica y traumatología? Percepción de los residentes

Objetivo: La pandemia de la COVID-19 ha afectado a la formación sanitaria especializada a todos los niveles. El aprendizaje en el ámbito quirúrgico se ha visto gravemente afectado y hasta ahora no se ha valorado el impacto en la formación de residentes de traumatología. Material y métodos: Se hizo llegar mediante enlace web y redes sociales una encuesta en línea de 17 preguntas a los residentes de cirugía ortopédica y traumatología de todo el territorio español entre el 10 de febrero y el 28 de febrero de 2021. Se analizaron los efectos de la pandemia de la COVID-19 en la actividad asistencial y formativa de los residentes. Resultados: Un total de 307 residentes de cirugía ortopédica y traumatología de toda España respondieron la encuesta. El 77,2% de los encuestados tuvo que suspender sus rotaciones. De estos, al 67,5% le gustaría retomar las rotaciones perdidas durante la pandemia. Un 69,7% de las cirugías programadas fueron suspendidas. La actividad quirúrgica estuvo completamente parada una media de 8 semanas. El 66,8% de los residentes considera que se ha visto afectada su formación quirúrgica y que esto repercutirá en su futuro laboral. El 49,5% considera insuficiente la oferta formativa en línea. Del total de encuestados, el 52,1% considera que el impacto de la situación de pandemia respecto a su situación formativa ha sido malo o muy malo. Conclusiones: La recogida de datos muestra un impacto negativo sobre la formación asistencial y teórica. Este estudio pone de manifiesto la necesidad de continuar ofreciendo una formación de calidad y maximizar las oportunidades de aprendizaje.(AU)

Objective: The COVID-19 pandemic has affected specialized healthcare training at all levels. Surgical learning has been severely affected, and the impact on orthopedic surgery residency training has so far not been assessed. Material and methods: An online survey of 17 questions was sent via web link to orthopedic surgery residents throughout Spain between February 10, 2021 and February 28, 2021. The effects of the COVID-19 pandemic on the care and training activities of residents were analyzed. Results: A total of 307 orthopedic surgery residents from all over Spain responded to the online survey. A total of 77.2% of the respondents had to suspend their rotations. Of these, 67.5% would like to resume the rotations they missed during the pandemic. A total of 69.7% of scheduled surgeries were suspended. Surgical activity was completely stopped for an average of 8 weeks. 66.8% of the residents consider that their surgical training has been affected and this will have repercussions on their future work. 49.5% considered the online training offered to be insufficient. Of the total number of respondents, 52.1% considered that the impact of the pandemic situation on their training situation was bad or very bad. Conclusions: The data collection shows a negative impact on both theoretical and clinical training. This study highlights the need to continue offering quality training by maximizing learning opportunities.(AU)

Effects of the SARS-CoV­2 pandemic on residency training in orthopedics and traumatology in Germany : A nationwide survey.

BACKGROUND: The spread of the coronavirus disease has impacted healthcare systems worldwide; however, restrictions due to the SARS-CoV­2 (severe acute respiratory syndrome coronavirus 2) pandemic are particularly drastic for physicians in residency training. Imposed restrictions interrupt the standard educational curricula, and consequently limited residents to meet mandatory requirements. AIM: The aim of this study was to evaluate the effects of the SARS-CoV­2 pandemic on residency training in orthopedics and trauma surgery in Germany. METHODOLOGY: An online-based, voluntary, and anonymous survey of physicians in residency training for orthopedics and trauma surgery was conducted. Through email lists of junior physician organizations the survey was sent to 789 physicians. Participation was possible between October and November 2021. RESULTS: A total of 95 participants (female 41.1%) with a mean age of 31.3 ± 2.8 years were analyzed. In the everyday clinical practice and care 80% of participants thought that they were set back in time of their general training due to the pandemic. There was an average reduction of 25.0% in time spent in the OR and 88.4% agreed that their surgical training was delayed due to the pandemic. Of the respondents 33.6% were able to attend external continuing education courses. Only 4.2% were able to invest more time in research and 55.8% of participants agreed that their residency training will be extended due to the pandemic. CONCLUSION: The COVID pandemic has had a significant impact on the residency training in orthopedics and trauma surgery in Germany. In almost all areas of training, residents had to accept restrictions due to the imposed restrictions, which potentially negatively affected their training.

Procedural simulation training in orthopaedics and traumatology: Nationwide survey among surgeon educators and residents in France.

BACKGROUND: Simulation is among the tools used in France to train residents specialising in orthopaedic and trauma surgery (OTS). However, implementing simulation-based training (SBT) is complex and poorly reported. The objective of this study was to describe the use of simulation for OTS training in France. HYPOTHESIS: Nationwide, SBT is not used to its full capacity for teaching OTS in France, and differences in opinions about SBT may exist between surgeon educators and residents. STUDY DESIGN: Nationwide questionnaire survey in France. MATERIALS AND METHODS: We built two specific self-questionnaires then e-mailed them between December 2020 and February 2021 to the surgeon educators who were members of the national university council and to the residents specialising in OTS during the current academic year. The questions were about the 2018-2019 academic year, before the COVID-19 pandemic. Two classes of residents who were still medical students during this period were not included, leaving three classes for the analysis. RESULTS: The participation rates were 57% (67/117) for the educators and 24% (87/369) for the three classes of residents. Of the 67 educators, 47 (70%) reported being involved in SBT and identified the university (70%) and industry (53%) as the main funders of this teaching modality. The educators indicated that the mean number of SBT laboratories in their region was 1.4±0.9 (range, 0-4). The main types of simulators were saw bones (77%); cadavers (85%); and commercial simulators (74%), notably for the knee (87%) and shoulder (78%). The educators estimated that they had achieved a mean of 33%±23% (range, 0%-100%) of the teaching objectives set out in the OTS curriculum and that the main obstacles were insufficient funding (81%) and lack of time (67%). Only 21% of educators reported conducting SBT research. The residents reported that they accessed SBT via the OTS teaching module (28/87, 32%), local university degrees (23/87, 26%), their hospital department (17/87, 18%), or the industry (15/87, 17%); 25/87 (29%) had never received SBT. On a 0-10 scale (0, completely disagrees; 10, completely agrees), the mean score for SBT effectiveness was 8.6±2.1 for residents and 7.1±3.0 for educators (p<0.001); the corresponding values for the quality of SBT integration in the region were 1.5±1.8 and 3.8±2.6, respectively (p<0.001). CONCLUSION: SBT is not yet used to its full potential for teaching OTS in France. Insufficient funding and lack of time were identified by the educators as the main obstacles to greater use of SBT. Both the residents and the educators felt that SBT mightbe beneficial for training. LEVEL OF EVIDENCE: IV, nationwide survey.

Reasons for resident resignations from Orthopedic Residency Programs in Turkey: A cross-sectional survey from residents' perspectives.

OBJECTIVE: The aim of this study was to analyse the factors that led to resignations from Orthopaedics and Traumatology Residency pro- grammes in Turkey, and to determine the overall rate of resignation among residents from Orthopaedics and Traumatology programmes. METHODS: In this cross-sectional survey,120 residents who either resigned or transferred to other OT clinics between autumn of 2013 and spring of 2020 were included. They were asked to complete a questionnare which was sent via Whatssapp application or e-mail. The ques- tionnare was comprised of 2 sections; Section A, which adressed resignation, consisted of 15 questions and Section B, which adressed transfer to another OT programme, consisted of 12 questions. Both sections had open ended and multiple choice questions. RESULTS: Of 120 residents, 96 (6.6%) resigned and then transferred to another specialty, and 24 (1.6%) transferred to another orthopedics and traumatology clinic based on our review. The overall resignation rate as per the total quotas for orthopedics and traumatology residency from 2013 to 2020 was 8.2%. Of the 120 orthopedics and traumatology residents who were eligible for the survey, 83 (70%) completed the questionnaire. Sixty-one (60 males, 1 female; median age = 26 years; age range = 25-35) of 96 residents who resigned from the orthopedics and traumatology residency completed section A (the response rate was 63.5%); 22 (22 males; median age=27.6 years; age range=25-34) out of 24 residents who transferred to another orthopedics and traumatology clinic completed section B (the response rate was 91.6%). In section A, 40 out of 61 individuals (65.5%) preferred orthopedics and traumatology specialty as the first choice in TUS, and 34 residents (55.7%) reported not to have had enough information regarding the residency program before starting their clinics. In section B, out of the 22 residents, 13 (59%) stated that orthopedics and traumatology residency was not their first choice in TUS, and 18 (81.8%) reported not to have had sufficient knowledge about the preferred clinic. The most common reason for resignation or transfer to another specialty was heavy workload (n=46, 74.19%), followed by excessive hours of work (n=45, 72.58%). The most common reason for transfer to another orthopedics and traumatology clinic was drudgery (n=10, 45.5%), followed by problems with the hierarchy in orthopedics and traumatology residency (n = 9, 40.9%). CONCLUSION: The results of this survey have shown us, with an overall resignation rate of 8.2% as per the total quotas for OT residency from 2013 to 2020, that resignation from OT residency represents an important problem in Turkey. Workload and excessive hours of work were the most common reasons for resignation from orthopaedic residency programmes. Furthermore, extra work that diverted residents from their actual job responsibilities, as well as academic and educational concerns, were the main factors leading to transfer to another OT residency programme.

Factores influyentes en el desarrollo de competencias en Ortopedia y Traumatología durante el internado médico / Influential Factors in The Development of Competencies in Orthopedics and Traumatology During the Medical Internship

RESUMEN Introducción: Actualmente la salud es concebida como un derecho fundamental y para garantizarlo se debe propender por una adecuada formación de los profesionales de la salud. El internado rotatorio es la última etapa y la más importante del pregrado en Medicina. Objetivo: Explorar los factores desde la perspectiva de estudiantes y docentes, que influyen en el desarrollo de competencias en la rotación de Ortopedia y Traumatología durante el internado médico. Métodos: Estudio cualitativo con enfoque en teoría fundamentada. Para la recolección de datos se realizó un cuestionario semiestructurado a una muestra aleatoria de 14 participantes, 7 estudiantes y 7 docentes, que cumplían los criterios de inclusión. El análisis se basó en la codificación y categorización de los datos que posteriormente fueron sometidos a un proceso de triangulación para lograr la teorización final. Resultados: Los factores que favorecen el desarrollo de competencias están relacionados con la motivación intrínseca del estudiante, la flexibilidad y disponibilidad de recursos académicos, las características del programa de la rotación y el ambiente de práctica. Se identificaron como factores limitantes aquellos asociados a una formación deficiente en ciencias básicas médicas, la priorización del componente asistencial sobre el académico, la disponibilidad limitada de espacios y recursos de aprendizaje y los métodos de enseñanza tradicionales. Conclusiones: Es de vital importancia la identificación de los factores que favorecen y limitan el desarrollo de las competencias de los estudiantes de medicina en su última etapa de formación en ortopedia.

ABSTRACT Introduction: Few areas of orthopedic surgery have had such important technical changes in recent decades as in corrective spinal surgery. Fundamental changes have come with the new spinal instrumentation systems, which have been substantially modified and improved to facilitate three-dimensional correction of the deformity and provide secure spinal fixation, correction and stability. Objective: To evaluate the results achieved with the spinal instrumentation systems used in the correction of thoracolumbar kyphosis due to ankylosing spondylitis. Methods: A descriptive, retrospective and longitudinal study was carried out on 16 patients with thoracolumbar kyphosis due to ankylosing spondylitis operated on with the pedicle subtraction osteotomy technique and instrumented with Luque-type pedicle and sublaminar systems, in the Orthopedics service at Hermanos Ameijeiras Surgical Clinical Hospital, from March 2001 to March 2021. Results: All the patients were male, white skin color and average age of 39 years. More than 80% correction was achieved in the sagittal profile and an average of 34.3° per osteotomy, without major neurological complications. Good functional results were obtained, with high degree of patient satisfaction and improvement in their quality of life. Conclusions: The use of both spinal instrumentation systems is effective in maintaining the correction of thoracolumbar kyphosis due to ankylosing spondylitis.

Adequacy of spine surgery fellowship training in Turkey: Results of a survey.

OBJECTIVE: The aim of this study was to determine the adequacy of spine surgery fellowship training (SSFT) in Turkey and what is needed for further development by interviewing current fellows. METHODS: Forty male orthopaedics and traumatology or neurosurgery specialists who had completed SSFT in three different spine centers in Turkey between 2010 and 2018 were asked to complete a survey with 29 questions about SSFT in Turkey. Thirty specialists responded, and the collected data were analyzed. RESULTS: Twenty-seven (90%) participants were orthopaedic and traumatology specialists and three (10%) were neurosurgery specialists, with a mean age of 39 (range = 35-53) years. Most participants received their residency training in the provinces where their fellowship training took place (11 (37%) in Istanbul and 7 (23%) in Ankara). The mean duration between residency training and the start of SSFT was 4 (range = 0-14) years, and the mean SSFT duration was 8 (range = 1-18) months. Seventy percent of participants had participated in spine surgery cases during their residency. Twenty-three (77%) participants reported that spine surgery training in their hospital during their residency was inadequate. Seventeen (57%) participants felt that they could not independently perform spine surgery cases before SSFT. All three centers (100%) participating in the study that offered SSFT were non-public institutions such as private hospitals and private university hospitals of medicine managed by a dedicated mentor with personal commitment, without any accreditation for SSFT. While 25 (83%) participants indicated that they felt competent enough to perform a standard spinal deformity surgery case independently at the end of SSFT, 5 (17%) indicated the opposite. This proportion, which was 43% at the end of residency, increased to 83% after SSFT. CONCLUSION: The results of this study have demonstrated the importance of SSFT in spine surgery as a specialty with a potentially high risk of complications that require prolonged case observation, challenging work-up, and adequate equipment. In this regard, there is a need for regulations on accreditation in government health facilities that provide ideal conditions. We propose to offer SSFT to all surgeons interested in spine surgery in Turkey by conducting further studies supported by an optimal health sector that ensures the appropriate requirements, in accordance with the declaration of TOTEK (The Turkish Orthopaedics and Traumatology Education Council), training workshops, and an accredited master's degree program in spine surgery or subspecialty.

Visualization of complicated fractures by 3D-printed models for teaching and surgery: hands-on transitional fractures of the ankle.

AIMS: Understanding the orientation of fracture lines and mechanisms is the essential key to sufficient surgical therapy, but there is still a lack of visualization and teaching methods in traumatology and fracture theory. 3D-printed models offer easy approach to those fractures. This paper explains the use of the teaching possibility with 3-dimensional models of transitional fractures of the ankle. METHODS AND RESULTS: For generating 3D printable models, already obtained CT data were used and segmented into its different tissues, especially parts concerning the fracture. After the segmentation process, the models were produced with FFF (fused filament fabrication) printing technology. The fracture models then were used for hands-on teaching courses in AO course (Arbeitsgemeinschaft für Osteosynthesefragen) of pediatric traumatology in 2020 in Frankfurt. In the course fracture anatomy with typical fracture lines, approaches, and screw placement could be shown, discussed and practiced. CONCLUSION: The study shows the use of 3D-printed teaching models and helps to understand complicated fractures, in this case, transitional fractures of the ankle. The teaching method can be adapted to numerous other use cases.

Succeeding in Continuing Trauma Education During a Pandemic.

BACKGROUND: Corona virus disease 2019 (Covid-19) impacted continuing medical education programs such as the Advanced Trauma Life Support (ATLS) course. Modifications made to medical training like teleconferencing could affect students' learning success. We sought to evaluate the effects of the American College of Surgeons modifications on success rates in passing the ATLS course. METHODS: This study evaluated 28 ATLS 10th edition courses educating 898 students at our region before and after Covid-19 modifications. Traditional two-day courses were performed in-person while modified courses were conducted with a one-day teleconference followed by a second in-person practical day. We compared the characteristics and course pass rates between the traditional and modified ATLS courses. RESULTS: Modified ATLS courses had significantly lower pass rates (81.0%; 95% confidence interval = [74.8-87.3]) compared to traditional ATLS courses (94.3%; [92.2-96.3]). CONCLUSIONS: Modifications to the ATLS course are associated with lower student pass. This is possibly due to ineffective knowledge consolidation. Better modifications to the course are required such as use of electronic learning tools with modification to course schedule or returning to the traditional course but with the use of Covid-19 vaccines and other protective measures. These suggestions should be considered and evaluated further by ATLS program leaders.

Mixed methods approach to understanding the influence of changes in successive versions of the advanced trauma life support training program on student performance.

BACKGROUND: The Advanced Trauma Life Support course is the American College of Surgeons' standard of care for physicians who provide initial care to trauma victims. In addition to content updates, Advanced Trauma Life Support version 10 adopted contemporary learning theory and practice into the format and conduct of the training. METHODS: The study used a mixed-methods approach wherein a one-group post-test-only study of student and student refresher exam score differences was followed up with a faculty survey to qualitatively explore the quantitative findings. Mann-Whitney U tests were used to test the null hypotheses that student and student refresher test scores on version 9 (2018) and version 10 (2019) were the same. χ2 tests of independence were conducted to test the null hypotheses that student and student refresher initial assessment pass rates under versions 9 and 10 were the same. Faculty survey responses were analyzed descriptively. RESULTS: For the student written tests, the null hypothesis was retained. For the student refresher written tests the null hypothesis was rejected; the 2019 cohort performed worse than the 2018 cohort. Student initial assessment and student refresher initial assessment pass rates in 2018 and 2019 were statistically the same. The majority of faculty reported less motivation for teaching version 10. CONCLUSION: Although a quadrennial review of the format and conduct of Advanced Trauma Life Support courses above and beyond content updates is appropriate, it may be prudent to require strong evidence of improved student performance and value before implementing changes to the training.