M. P. DeWane1, M. Cheung1, G. Kurigamba2, R. N. Kabuye2, J. Mabweijano2, M. Galukande2, D. E. Ozgediz1, K. Y. Pei1 1Yale University School Of Medicine,Department Of Surgery,New Haven, CT, USA 2Makerere University,Department Of Surgery,Kampala, KAMPALA, Uganda
Introduction: Trauma is the leading cause of death in low-income countries, outpacing HIV, malaria and TB combined. Exacerbating the problem is a lack of formalized context-specific operative trauma training. We surveyed needs and beliefs regarding collaborative training with high-income country groups and assessed the need for operative training. We then utilized these results to develop an Operative Trauma Course (OTR) and evaluate its impact on trainees.
Methods: Fourteen 2nd year residents of the Makerere University School of Medicine at Mulago Hospital in Kampala, Uganda participated in the anonymous needs assessment and inaugural course. Training was held over three days and consisted of didactics, practicals, and cadaveric dissection for a total of 20 hours of instruction. Major themes included initial assessment, emergent airway management, and ultrasound use in trauma. Based on the local needs assessment, cadaveric didactics focused on penetrating neck, thoracic, and abdominal trauma. Pretests and posttests were administered and trainees completed a validated course review. Study authors were blinded to participant performance and review.
Results: The needs survey was administered to 12 of 14 residents (86%) while all 14 completed the course. All agreed that international training was important to their career. The preferred setting of training differed: 64% would prefer to travel internationally to train while the remaining preferred to have outside faculty rotate at their home institution. None were able to identify internationally sponsored trauma courses currently operating in Uganda. A majority (93%) of participants reported that operative trauma training is lacking and additional training opportunities would be highly useful. Regarding course completion, all participants felt course goals were clear and that class time was used effectively. Participants stated that the quality of the course was excellent and that it increased their knowledge and motivation to learn operative trauma techniques. A total of 13 participants completed the pre- and post-tests. Pretest score average was 56% (range 49%-71%), and increased by 24% following course completion in the posttest (80%, range 69%-89%). The difference in mean performance was statistically significant (P<0.001).
Conclusion: This study outlines the development of the first international operative trauma course hosted in Uganda. Ugandan trainees reported that international training was important and that trauma operative skills were most urgently needed to improve in their practice. Participants approved of the course as measured by validated course review and demonstrated significant improvement in their knowledge of trauma. Future studies will include an intensive point of care ultrasound extension and further development of trauma curricula is indicated to reduce the high toll of trauma in low resource settings.