M. W. Bowyer1, S. A. Shackelford1,2, E. Garofalo1,2, K. Pugh2, C. Mackenzie2 1Uniformed Services University Of The Health Sciences,Norman M. Rich Department Of Surgery,Bethesda, MD, USA 2University Of Maryland,Baltimore, MD, USA
Introduction: Experience with the management of vascular trauma by senior surgical residents is limited. When queried about their understanding of anatomy and ability to perform specific vascular exposures, residents express a moderately high level of confidence. We hypothesized that this perception does not equal reality.
Methods: 42 senior surgical residents participating in an ongoing validation study of the Advanced Surgical Skills for Exposures in Trauma (ASSET) course were asked to self-assess their baseline (pre-course) confidence of their understanding of the anatomy required to perform, and their ability to perform exposures of the Axillary (AA), Brachial (BA), and Femoral (FA) Arteries, as well as Lower Extremity Fasciotomy (LEF) using a 5 point Likert scale. The residents then performed the 4 procedures on a cadaver model and were scored in real time by pre-trained trauma experts using both a global assessment (5 point Likert scale) of "understanding of anatomy" and "resident is ready to perform", as well an overall numerical score (1-100) of the performance. Statistical analysis was performed using the student t-test with α set at p < 0.05.
Results: As seen in the table, residents consistently rated their understanding of anatomy and their ability to perform the 4 procedures higher than the expert evaluators ultimately scored them. This was especially pronounced for the lower extremity for both FA exposure and lower extremity fasciotomy. The average global numerical scores for the 4 procedures was between 57 and 66 out of 100 points.
Conclusion: The findings suggest that senior residents are ill-prepared to perform the studied exposures for vascular trauma, and that they have an unwarranted confidence in both their understanding of the anatomy and the ability to perform these procedures. Perception clearly does meet reality in preparing these trainees to perform as advertised, and future curricular offerings and evaluation should address this gap.
