title: Is attrition of advanced trauma life support acquired skills affected by trauma patient volume?
abstract: BACKGROUND
  We assessed the effect of trauma volume on skills attrition among physicians completing the advance trauma life support (ATLS) course.
  
  
  METHODS
  Cognitive (40 item multiple choice question [MCQ] examination) and clinical (4 objective structured clinical examinations [OSCE] trauma stations) performances were compared among physicians who completed the ATLS course, subdividing them into groups treating more than 50 and fewer than 50 trauma patients per year. Both groups had 12 physicians from six periods (n = 144) related to time of course completion: immediate (0), 6 months, 2 years, 4 years, 6 years, and 8 years after ATLS. OSCE scores (maximum standardized: 20), the degree of adherence to priorities (priority score: range 1 to 7), the degree of organized approach (approach score: range from 1 to 5) were compared.
  
  
  RESULTS
  The mean precourse MCQ scores (59.4% to 62.4%) were similar for both groups. Immediate and progressive cognitive skill attrition and detailed clinical skill attrition were worse in the low volume group. Global skills (organized approach and adherence to priorities) were preserved similarly for at least 8 years in all groups.
  
  
  CONCLUSIONS
  Our data suggest that trauma volume affects trauma skills attrition.
authors.affiliation: Centre for Research in Education, Department of Surgery, University of Toronto and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Jameel
authors.initials: J
authors.lastname: Ali
authors.forename: Mary
authors.initials: M
authors.lastname: Howard
authors.forename: Jack
authors.initials: J
authors.lastname: Williams
mesh_terms: D000704:Analysis of Variance; D002983:Clinical Competence; D003071:Cognition; D004502:Education, Medical, Continuing; D004521:Educational Measurement; D005260:Female; D006801:Humans; D008020:Life Support Care / Q000592:standards*; D008297:Male; D009864:Ontario; D011795:Surveys and Questionnaires; D014194:Traumatology / Q000193:education*