Operative Trauma Courses: A Scoping Review to Inform the Development of a Trauma Surgery Course for Low-Resource Settings

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2023 Mar 29

PMID 36988651

Authors

Hannah Wild

Chris Marfo

Charles Mock

Tina Gaarder

Adam Gyedu

Lee Wallis

Emmanuel Makasa

Lars Hagander

Teri Reynolds

Timothy Hardcastle

Teresa Jewell

Barclay Stewart

Affiliations

Soon will be listed here.

Abstract

Background: A multitude of operative trauma courses exist, most of which are designed for and conducted in high-resource settings. There are numerous barriers to adapting such courses to low- and low-middle-income countries (LMICs), including resource constraints and contextual variations in trauma care. Approaches to implementing operative trauma courses in LMICs have not been evaluated in a structured manner.

Methods: We conducted a scoping review of the literature including databases (e.g., PubMed, Web of Science, EMBASE), grey literature repositories, and structured queries of publicly available course materials to identify records that described operative trauma courses offered since 2000.

Results: The search identified 3,518 non-duplicative records, of which 48 relevant reports were included in analysis. These reports represented 23 named and 11 unnamed operative trauma courses offered in 12 countries. Variability existed in course format and resource requirements, ranging from USD 40 to 3,000 per participant. Courses incorporated didactic and laboratory components, which utilized simulations, cadavers, or live animals. Course content overlapped significantly but was not standardized. Data were lacking on course implementation and promulgation, credentialing of instructors, and standardized evaluation metrics.

Conclusions: While many operative trauma courses have been described, most are not directly relatable to LMICs. Barriers include cost-prohibitive fees, lack of resources, limited data collection, and contextual variability that renders certain surgical care inappropriate in LMICs. Gaps exist in standardization of course content as well as transparency of credentialing and course implementation strategies. These issues can be addressed through developing an open-access operative trauma course for low-resource settings.

References

Wong E, Gupta S, Deckelbaum D, Razek T, Kushner A . Prioritizing injury care: a review of trauma capacity in low and middle-income countries. J Surg Res. 2014; 193(1):217-22. DOI: 10.1016/j.jss.2014.08.055. View

Wild H, Mock C, Lim A . Implementation of the WHO Trauma Care Checklist: A qualitative analysis of facilitators and barriers to use. Int J Surg. 2020; 83:15-23. DOI: 10.1016/j.ijsu.2020.08.050. View

Ullrich S, Kilyewala C, Lipnick M, Cheung M, Namugga M, Muwanguzi P . Design, implementation and long-term follow-up of a context specific trauma training course in Uganda: Lessons learned and future directions. Am J Surg. 2019; 219(2):263-268. DOI: 10.1016/j.amjsurg.2019.10.048. View

Ullrich S, DeWane M, Cheung M, Fleming M, Namugga M, Fu W . Development of an Operative Trauma Course in Uganda-A Report of a Three-Year Experience. J Surg Res. 2020; 256:520-527. DOI: 10.1016/j.jss.2020.07.024. View

Anderson G, Kayima P, Ilcisin L, Benitez N, Albutt K, Briggs S . Development of a Comprehensive Trauma Training Curriculum for the Resource-Limited Environment. J Surg Educ. 2018; 75(5):1317-1324. DOI: 10.1016/j.jsurg.2018.02.014. View

Mohammad A, Branicki F, Abu-Zidan F . Educational and clinical impact of Advanced Trauma Life Support (ATLS) courses: a systematic review. World J Surg. 2013; 38(2):322-9. DOI: 10.1007/s00268-013-2294-0. View

Navarro S, Montmany S, Rebasa P, Colilles C, Pallisera A . Impact of ATLS training on preventable and potentially preventable deaths. World J Surg. 2014; 38(9):2273-8. DOI: 10.1007/s00268-014-2587-y. View

Livergant R, Demetrick S, Cravetchi X, Kung J, Joos E, Hawes H . Trauma Training Courses and Programs in Low- and Lower Middle-Income Countries: A Scoping Review. World J Surg. 2021; 45(12):3543-3557. PMC: 8572832. DOI: 10.1007/s00268-021-06283-1. View

Mackenzie C, Tisherman S, Shackelford S, Sevdalis N, Elster E, Bowyer M . Efficacy of Trauma Surgery Technical Skills Training Courses. J Surg Educ. 2019; 76(3):832-843. DOI: 10.1016/j.jsurg.2018.10.004. View

10.

Peters M, Marnie C, Tricco A, Pollock D, Munn Z, Alexander L . Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020; 18(10):2119-2126. DOI: 10.11124/JBIES-20-00167. View

11.

Page M, Shamseer L, Tricco A . Registration of systematic reviews in PROSPERO: 30,000 records and counting. Syst Rev. 2018; 7(1):32. PMC: 5819709. DOI: 10.1186/s13643-018-0699-4. View

12.

Tricco A, Lillie E, Zarin W, OBrien K, Colquhoun H, Levac D . PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018; 169(7):467-473. DOI: 10.7326/M18-0850. View

13.

Jacobs L, Burns K, Luk S, Cornwell 3rd E, Adebonojo S . Advanced Trauma Operative Management course introduced to surgeons in West Africa. Bull Am Coll Surg. 2008; 90(6):8-14. View

14.

Mock C, Quansah R, Addae-Mensah L, Donkor P . The development of continuing education for trauma care in an African nation. Injury. 2005; 36(6):725-32. DOI: 10.1016/j.injury.2004.12.044. View

15.

Jacobs Jr L, Luk S, Burns K . Advanced Trauma Operative Management course: site and instructor selection and evaluation. J Am Coll Surg. 2006; 203(5):772-9. DOI: 10.1016/j.jamcollsurg.2006.07.033. View

16.

Wild H, Stewart B, LeBoa C, Stave C, Wren S . Epidemiology of Injuries Sustained by Civilians and Local Combatants in Contemporary Armed Conflict: An Appeal for a Shared Trauma Registry Among Humanitarian Actors. World J Surg. 2020; 44(6):1863-1873. PMC: 7223167. DOI: 10.1007/s00268-020-05428-y. View

17.

Wong E, Dominguez L, Trelles M, Ayobi S, Hazraty K, Kasonga C . Operative trauma in low-resource settings: The experience of Médecins Sans Frontières in environments of conflict, postconflict, and disaster. Surgery. 2015; 157(5):850-6. DOI: 10.1016/j.surg.2014.12.021. View

18.

Wild H, Stewart B, LeBoa C, Stave C, Wren S . Pediatric casualties in contemporary armed conflict: A systematic review to inform standardized reporting. Injury. 2021; 52(7):1748-1756. DOI: 10.1016/j.injury.2021.04.055. View

19.

Elder G, Murphy R, Herard P, Dilworth K, Olson D, Heinzelmann A . Challenging the barriers to accessing surgery in low-resource settings: Lessons learned from burns. Surgery. 2015; 158(1):33-6. DOI: 10.1016/j.surg.2015.04.006. View

20.

Boissin C, Wallis L, Kleintjes W, Laflamme L . Admission factors associated with the in-hospital mortality of burns patients in resource-constrained settings: A two-year retrospective investigation in a South African adult burns centre. Burns. 2019; 45(6):1462-1470. DOI: 10.1016/j.burns.2019.03.005. View