title: Attrition of cognitive and trauma management skills after the Advanced Trauma Life Support (ATLS) course.
abstract: OBJECTIVE
  To test the attrition of cognitive and trauma management skills among practising physicians after the Advanced Trauma Life Support (ATLS) course.
  
  
  METHODS
  Sixty practising physicians who completed the ATLS course had comparative assessment of cognitive skills (with multiple choice questions, MCQ) pre-ATLS, immediately post-ATLS, at 6 months (group A), 2 years (group B), 4 years (group C), and 6 years (group D) after the course. Trauma management skills were also compared using eight Objective Structured Clinical Examination (OSCE) trauma stations completed by the four groups of physicians.
  
  
  RESULTS
  Pre-ATLS MCQ scores (54.2 +/- 4.2 to 59.8 +/- 5.3%) and immediately post-ATLS MCQ scores (85.9 +/- 5.1 to 87.7 +/- 5.3%) were similar in all four groups. Follow-up MCQ scores were 77.8 +/- 3.6% at 6 months 70.6. +/- 1.9% at 2 years, 69.4 +/- 1.7% at 4 years, and 68.9 +/- 2.0% at 6 years. OSCE scores out of a maximum of 20 were 16.8 +/- 0.3 at 6 months, 13.9 +/- 0.1 at 2 years, 12.0 +/- 0.1 at 4 years, and 11.9 +/- 0.1 at 6 years. Adherence-to-priorities scores (maximum, 7) were 6.6 +/- 0.2 at 6 months, 6.8 +/- 0.1 at 2 years, 6.6 +/- 0.1 at 4 years, and 6.6 +/- 0.1 at 6 years. Organized-approach scores (maximum, 5) were 4.8 +/- 0.1 at 6 months, 4.6 +/- 0.2 at 2 years, 4.7 +/- 0.2 at 4 years, and 4.6 +/- 0.2 at 6 years. Using the MCQ 80% pass mark criterion, at least 50% of physicians fail by 6 months and all fail this cognitive test thereafter.
  
  
  CONCLUSIONS
  Whereas cognitive and trauma management skills decline after the ATLS, these skills are maintained at similar levels between 4 and 6 years after ATLS. A 50% failure rate occurs within 6 months and maximum attrition of cognitive skills occurs within 2 years of ATLS completion. Major principles of adherence to priorities and maintenance of an organized approach to trauma care are preserved for at least 6 years after ATLS.
authors.affiliation: Department of Surgery, University of Toronto, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Ali
authors.forename: R
authors.initials: R
authors.lastname: Cohen
authors.forename: R
authors.initials: R
authors.lastname: Adam
authors.forename: T J
authors.initials: TJ
authors.lastname: Gana
authors.forename: I
authors.initials: I
authors.lastname: Pierre
authors.forename: E
authors.initials: E
authors.lastname: Ali
authors.forename: H
authors.initials: H
authors.lastname: Bedaysie
authors.forename: U
authors.initials: U
authors.lastname: West
authors.forename: J
authors.initials: J
authors.lastname: Winn
mesh_terms: D000328:Adult; D003071:Cognition; D004496:Education, Continuing; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008020:Life Support Care; D008297:Male; D013997:Time Factors; D014947:Wounds and Injuries / Q000628:therapy*