The resident experience on trauma: declining surgical opportunities and career incentives? Analysis of data from a large multi-institutional study.
OBJECTIVE
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.


CONCLUSIONS
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.
Fakhry
Samir M
SM
Inova Regional Trauma Center, Inova Fairfax Hospital, Falls Church, Virginia 22042, USA.
Watts
Dorraine D
DD
Michetti
Christopher
C
Hunt
John P
JP
D001291:Attitude of Health Personnel; D002321:Career Choice; D016022:Case-Control Studies; D002983:Clinical Competence / Q000592:standards / Q000706:statistics & numerical data*; D004503:Education, Medical, Graduate / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007396:Internship and Residency / Q000592:standards / Q000706:statistics & numerical data*; D007813:Laparotomy / Q000193:education / Q000706:statistics & numerical data; D009042:Motivation; D010343:Patient Admission / Q000706:statistics & numerical data; D010533:Peritoneal Lavage / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014193:Trauma Centers / Q000706:statistics & numerical data; D014194:Traumatology / Q000193:education*; D014463:Ultrasonography / Q000706:statistics & numerical data; D014481:United States; D000078329:Workforce; D014947:Wounds and Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery