Development of a Comprehensive Trauma Training Curriculum for the Resource-Limited Environment

Geoffrey A Anderson; Peter Kayima; Lenka Ilcisin; Noralis Portal Benitez; Katherine H Albutt; Susan M Briggs; Deepika Nehra

doi:10.1016/j.jsurg.2018.02.014

Development of a Comprehensive Trauma Training Curriculum for the Resource-Limited Environment

J Surg Educ. 2018 Sep-Oct;75(5):1317-1324. doi: 10.1016/j.jsurg.2018.02.014. Epub 2018 Mar 17.

Authors

Geoffrey A Anderson¹, Peter Kayima², Lenka Ilcisin³, Noralis Portal Benitez², Katherine H Albutt¹, Susan M Briggs⁴, Deepika Nehra⁵

Affiliations

¹ Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts.
² Department of Surgery, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda.
³ Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
⁴ Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
⁵ Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: dnehra@bwh.harvard.edu.

PMID: 29555307
DOI: 10.1016/j.jsurg.2018.02.014

Abstract

Objective: The goal of this project was to create a multitiered trauma training curriculum that was designed specifically for the low-resource setting.

Design: We developed 2 courses designed to teach principles and skills necessary for trauma care. The first course, "Emergency Ward Management of Trauma (EWMT)," is designed to teach interns the initial assessment and stabilization of trauma patients in the emergency ward. The second course for mid-level surgical residents, "Surgical Techniques and Repairs in Trauma for the Low-resource Environment" (STaRTLE), is a cadaver-based operative trauma course designed to teach surgical exposures and techniques. The courses were rolled out at Mbarara Regional Referral Hospital in the low-income country of Uganda. Precourse and postcourse tests and surveys were administered.

Setting: This study took place at Mbarara Regional Referral Hospital (MRRH). This is a hospital in southwest Uganda with a subspecialty care, a medical school, nursing school, and multiple residency programs.

Participants: Students in the EWMT course were interns at MRRH. After 1 year of training, most of these interns will become medical officers as the only provider at a district hospital in Uganda. The students in the STARTLE course were second-year residents in the general surgery program at MRRH.

Results: Scores on knowledge based tests improved significantly with both courses. Survey results from the EWMT course suggest that participants feel better prepared to care for the injured patient (median Likert [IQR]: 5.0 [5.0-5.0]) and that their practice improved (5.0 [5.0-5.0]). Similarly, following the STaRTLE course we found participants felt significantly more comfortable with performing 20 of the 22 operative procedures taught.

Conclusions: These courses represent a feasible, cost-effective, and resource appropriate trauma education curriculum that if standardized and implemented may improve trauma care and outcomes in the resource-limited setting.

Keywords: Patient Care; Uganda; curriculum development; low and middle-income country (LMIC); low-resource setting; trauma.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Clinical Competence*
Cost-Benefit Analysis
Curriculum
Developing Countries
Education, Medical, Graduate / economics*
Education, Medical, Graduate / methods
Emergencies
Female
Health Resources / economics*
Humans
Male
Medically Underserved Area*
Poverty
Risk Assessment
Statistics, Nonparametric
Traumatology / education*
Uganda