Effective retention of primary survey skills by medical students after

participation in an expanded TEAM (eTEAM) course

Mona S. Li MD, Karen J. Brasel MD, MPH, David Schultz MD,

Mark E. Falimirski MD, Renae E. Stafford MD, Lewis B. Somberg MD, John A. Weigelt MD

Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226

Introduction

•Management of Life Threatening Injuries

–Advanced Trauma Life Support (ATLS)

•Organized sequence of interventions

–Trauma Evaluation and Management module (TEAM)

•Retention/attrition of skills

Introduction (con’t)

•eTEAM (Medical College of Wisconsin)

–3 day course for junior medical students

–Didactic lectures

–Group case discussions

–Videotape review of resuscitations

Introduction (con’t)

• eTEAM (con’t)

–“Hands-on” practice moulages/skill stations for primary survey, procedures & X-rays/ultrasound

Purpose

To assess whether medical studentscould retain trauma management skills introduced in eTEAM after a period of one year.

Methods

•Two groups of randomly selected senior medical students before and after eTEAM

•OSCE to assess performance of primary survey & initial resuscitation

–Faculty evaluators

–Clinical skills checklist of essential interventions

–Standardized Patients

–Each student tested individually

Methods (con’t)

•Scoring: – Total OSCE (35)

– Content/History (10)

– Primary survey exam (9)

– Physical exam (8)

– Sequence (0 or 1)

– Procedures/tests ordered (7)

•Same required junior trauma surgery lecture

•Same OSCE moulages/checklist

•Analysis: unpaired Student’s T and Chi-square tests with p<0.05 considered significant

Results

Fig.1 Mean OSCE score for understanding primary survey principles

Primary Survey Correct

0

2

4

6

8

Year

Mea

n O

SC

E s

core

Pre eTEAM

Post eTEAM

* *p<0.001

Results (con’t)

Fig.2 Mean OSCE Score for correct sequence performance

Primary Survey in Sequence

0

0.2

0.4

0.6

0.8

1

1.2

Year

Mea

n O

SC

E S

core

Pre eTEAM

Post eTEAM

* *p<0.001

Results (con’t)

0

5

10

15

20

25

Me

an

OS

CE

Sc

ore

Pre eTEAM

Post eTEAM

Pre eTEAM 14.96 4.31 4.27 1.75

Post eTEAM 16.35 3.58 4.08 2

Total OSCE ContentPhysical

ExamProcedures

Fig.3 Mean OSCE scores for total OSCE score, primary survey content, physical exam skills and procedures performed

Results (con’t)

•Only one student from both groups rotated on trauma surgery service

•Time between lecture or eTEAM and OSCE testing varied between 11-23 months

•Total number of students in each group

– Before eTEAM: 55

– After eTEAM: 26

•Avg. # of students/class MCW: 225

Discussion

•Main objectives of eTEAM:

–Apply principles of the primary survey

–Perform in an organized & proper sequence

– Institute initial resuscitation

–Recognize need for tertiary referral

•Retention/attrition of practicing MDs after ATLS:

–Adherence to primary survey

–Organized sequence

–Overall OSCE scores

Discussion (con’t)

•One year after eTEAM:

–Retention of primary survey principles

–Organized sequence

•Suggests that format & content of the course, “hands-on” teaching, exposure to trauma faculty may have had impact

•Retention important for students whose future environment may have limited exposure to trauma

Discussion (con’t)

•Other possible reasons for improved OSCE:

–Exposure to trauma patients on other clerkships

– Increased interest in surgery for post eTEAM class

•No significant difference in OSCE scores for total OSCE, obtaining a history, physical exam and procedures/tests ordered

–Emphasis on these skills during the junior/senior years

–Use of OSCEs at MCW

Discussion (con’t)

•Limitations:

–Difficult to test entire 4th year class

–Relatively small number of students in each group

–One year time frame limits generalizability

–Did not assess cognitive retention via a written examination

Conclusions

• Junior medical students retain important eTEAM principles

•eTEAM provides a consistent and interactive curriculum with long term benefit

•eTEAM currently taught in original format

–Popular and positively reviewed by junior students