The Resident Experience on Trauma: Declining Surgical Opportunities and Career Incentives? Analysis of Data from a Large Multi-institutional Study

• Published in: The journal of trauma Vol. 54; no. 1; pp. 1 - 8
• Main Authors: Fakhry, Samir M., Watts, Dorraine D., Michetti, Christopher, Hunt, John P.
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins, Inc 01-01-2003
• Subjects: Attitude of Health Personnel; Career Choice; Case-Control Studies; Clinical Competence - standards; Clinical Competence - statistics & numerical data; Education, Medical, Graduate - standards; Education, Medical, Graduate - statistics & numerical data; Humans; Internship and Residency - standards; Internship and Residency - statistics & numerical data; Laparotomy - education; Laparotomy - statistics & numerical data; Motivation; Patient Admission - statistics & numerical data; Peritoneal Lavage - statistics & numerical data; Surveys and Questionnaires; Trauma Centers - statistics & numerical data; Traumatology - education; Ultrasonography - statistics & numerical data; United States; Workforce; Wounds and Injuries - diagnosis; Wounds and Injuries - epidemiology; Wounds and Injuries - surgery
• ISSN: 0022-5282; 1529-8809
• DOI: 10.1097/00005373-200301000-00001

PURPOSE The surgical resident experience with trauma has changed. Many residents are exposed to predominantly nonoperative patient care experiences while on trauma rotations. Data from a large multicenter study were analyzed to estimate surgical resident exposure to trauma laparotomy, diagnostic peritoneal lavage (DPL), and focused abdominal sonography for trauma (U/S).
METHODS Centers completed a self-report questionnaire on their institutional demographics, admissions, and procedure for a 2-year period (1998–1999).
RESULTS A total of 82 trauma centers that provide resident teaching were included. The included centers represent over 247,000 trauma admissions. The majority of trauma centers (65.9%) had > 80% blunt injury. Although all centers performed laparotomies, other results were more variable. For U/S, 24.2% performed none at all and 47.0% performed fewer than two U/S examinations per month. For DPLs, 3.8% performed none and 66.7% performed fewer than two per month. Assuming 1 night of 4 on call, the average surgical resident training at a trauma center performing > 80% blunt trauma has the potential to participate in only 15 trauma laparotomies, 6 diagnostic peritoneal lavages, and 45 ultrasound examinations per year. In addition, the resident will care for an average of 500 blunt trauma patients before performing a splenectomy or liver repair.
CONCLUSION Surgical resident experience on most trauma services is heavily weighted to nonoperative management, with a relatively low number of procedures, little experience with DPL, and highly variable experience with ultrasound. These data have serious implications for resident training and recruitment into the specialty.