"A short trauma course for physicians in a resource-limited setting: Is low-cost simulation effective?". Issue 9 (September 2015)

• Record Type: Journal Article
• Authors: Pringle, K.; Mackey, J.M.; Modi, P.; Janeway, H.; Romero, T.; Meynard, F.; Perez, H.; Herrera, R.; Bendana, M.; Labora, A.; Ruskis, J.; Foggle, J.; Partridge, R.; Levine, A.C.
• Is Part Of: Injury. Volume 46:Issue 9(2015)
• Page Start: 1796
• Page End: 1800
• Publication Date: 2015-09
• Subjects: Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2015.05.021
• Languages: English
• ISSNs: 0020-1383

Abstract

<abstract abstract-type="author" id="abs0005"> <title id="sect0005">Abstract</title> <sec> <title id="sect0010">Introduction</title> <p id="spar0005">Morbidity and mortality from intentional and unintentional injury accounts for a high burden of disease in low- and middle-income countries. In addition to prevention measures, interventions that increase healthcare capacity to manage injuries may be an effective way to decrease morbidity and mortality. A trauma curriculum tailored to low-resource settings was implemented in Managua, Nicaragua utilising traditional didactic methods and novel low-cost simulation methods. Knowledge gain in attending and senior residents was subsequently assessed by using pre- and post-written tests, and by scoring pre- and post-simulation scenarios.</p> </sec> <sec> <title id="sect0015">Materials and methods</title> <p id="spar0010">A 5-day trauma course was designed for Nicaraguan attending and senior resident physicians who practice at six hospitals in Managua, Nicaragua. On days 1 and 5, participants underwent pre- and post-training evaluations consisting of a 26-question written exam and 2 simulation cases. The written exam questions and simulations were randomly assigned so that no questions or cases were repeated. The Wilcoxon signed-rank test was used to compare pre- and post-training differences in the written exam, and the percentage of critical actions completed in simulations. Time to critical actions was also analyzed using descriptive statistics.</p> </sec> <sec> <title id="sect0020">Results</title> <p id="spar0015">A total of 33 participants attended the course, including 18 (55%) attending and 15 (45%) resident physicians, with a 97% completion rate. After the course, overall written examination scores improved 26.3% with positive mean increase of 15.4% (<italic>p</italic> < 0.001). Overall, simulation scores based on the number of critical actions completed improved by 91.4% with a positive mean increase of 33.67 (<italic>p</italic> < 0.001). The time to critical action for completion of the primary survey and cervical spine immobilisation was reduced by 55.9% and 46.6% respectively.</p> </sec> <sec> <title id="sect0025">Conclusions</title> <p id="spar0020">A considerable improvement in participants' knowledge of trauma concepts was demonstrated by statistically significant differences in both pre- and post-course written assessments and simulation exercises. The participants showed greatest improvement in trauma simulation scenarios, in which they learned, and subsequently demonstrated, a standardised approach to assessing and managing trauma patients. Low-cost simulation can be a valuable and effective education tool in low- and middle-income countries.</p> </sec> </abstract>