EXPOSURE AND EXPERIENCE: A SURVEY OF COMPLEX TRAUMA CASELOAD AND ORTHOPAEDIC TRAINING IN THE UNITED KINGDOM

Abstract

Aim: To investigate the training of civilian Orthopaedic Trainee’s in complex trauma management.

Methods: A web-based survey of orthopaedic trainees utilising three scenarios for investigating complex trauma management. 225 responses obtained, achieving a < 0.05 error rate with 90% confidence.

Results:

Pelvic packing in exanguinating pelvic trauma:

• 2.2% fully confidentto manage such a case. A positive correlation exists between increasing training and confidence. 58.9% have never seen such a case. No correlation exists between time in training and exposure. 62.8% report training in this case inadequate. A positive correlation exists between time in training and perceived inadequacy of ability to manage such a case.

Junctional traum with non-compressible groin haemorrhage:

• 0.4% fully confident. A positive correlation exists between time in training and confidence. 73.0% have never seen such a case. 67.9% report training in this case inadequate. No correlation was found between time spent in training and perceived training adequacy.

Blood product resuscitation in trauma:

• 11.6% were fully confident. 18.8% have never seen such a case. No correlation exists between time in training and confidence or exposure. 45.0% report training as inadequate in this case. No correlation seen between time in training and perceived training adequacy.

Conclusion: Current training provides limited opportunities for exposure to significant trauma.

The quality of care afforded to service personnel and civilians in recent conflict is unsurpassed and it is essential that the lessons learnt by deployed surgeons form a continuum to their successors.

For military orthopaedic trainees this reinforces the need for closely supervised secondments on deployment; attendance at established military surgical training courses and appropriate fellowships to maximise exposure prior to first consultant deployment.