S. Rodriguez1, N. Lin1, M. L. Fabra2, J. A. Martinez2, M. DeMoya3, D. M. Valdés2, T. Zakrison1 2Hospital Universitario Calixto García, University Of Havana,Havana, HAVANA, Cuba 3Massachusetts General Hospital,Boston, MA, USA 1University Of Miami,Miami, FL, USA
Introduction: Trauma-related injuries are the leading cause of death of youth under the age of 44 globally, disproportionately affecting low-and- middle income countries (LMICs). Cuba has had a long tradition of medical internationalism and the largest medical school in the world for foreign trainees, most originating from other LMICs. Standardized, excellent trauma training and teaching is an important priority with significant global responsibility. Currently, there is no standardized method to teach trauma across Cuba, with local variability present. Our objective was to assess the feasibility of teaching the Trauma Evaluation and Management (TEAM) course to medical trainees in Havana, Cuba, as a potential model for other LMICs in to increase exposure to standardized trauma care.
Methods: The first TEAM course in Havana, Cuba was taught at a major tertiary hospital in 2016. The course focuses on trauma assessment and management for medical students during clinical years of training and serves as a brief version of the Advanced Trauma Life Support (ATLS). We employed 4 ATLS instructors, (2 Cuban and 2 US trauma surgeons). The course was taught in Spanish using curriculum provided by the American College of Surgeons (ACS). Course materials were donated from the ACS while instructors donated their time. Course instruction included slideshows, books, and exams. We used a mixed methods approach to measure pre-and post-test scores for comprehension combined with qualitative focus groups for feedback and evaluation for improvement. Parametric statistics were used after determining skewedness.
Results: 30 health professional students from 5 countries (Cuba, South Africa, Angola, Chad and Germany) participated in the trauma simulation course. In the pre-test period, 53% of students passed compared to 80% of students in the post-test period (p = 0.00001). When focus groups examined the ideal way of teaching the principles of trauma in Cuba and globally, thematic analysis demonstrated two salient themes: i) the need for more ‘hands-on’ training, using simulation models and ii) standardized trauma courses are urgently needed to ensure a level of competency, consistency and sustainability in trauma care and education.
Conclusion: Teaching TEAM in a low-income country, to a globally diverse group of medical students is feasible and needed. Promulgation of such courses that standardize trauma teaching and employ simulations should be a priority for the American College of Surgeons and other global surgical organizations. Bringing courses like TEAM to an international level can be a robust platform for global training in trauma that allow for sustainability and standardization of trauma care as well as reciprocal learning and collaboration.