title: Do factors other than trauma volume affect attrition of ATLS-acquired skills?
abstract: BACKGROUND
  We previously demonstrated that trauma patient volume affects attrition rate of Advanced Trauma Life Support (ATLS)-acquired skills. This study assesses the possible roles of age, gender, and practice specialty on attrition of these skills over 8 years.
  
  
  METHODS
  Cognitive (assessed by the 40-item Multiple Choice Question Examination [MCQE]) and clinical (assessed by four trauma Objective Structured Clinical Examination [OSCE] stations) skills performance were compared among physicians who completed the ATLS course 0 months, 6 months, 2 years, 4 years, 6 years, and 8 years previously. The physicians were further divided into the following groups: age < 32 years (n = 72) or 32 years or older (n = 72), gender (41 women and 103 men), and specialty (54 surgeons, 90 nonsurgeons, and 22 general surgeons). Multivariate analysis of variance was used for statistical comparison over time and unpaired t tests for between-group comparisons for each time period, with p < 0.05 being considered statistically significant.
  
  
  RESULTS
  Regarding age, MCQE decreased from 82.3 +/- 2.8% to 62.7 +/- 3.0% (mean +/- SD) for age < 32 and from 84.1 +/- 3.6% to 62.8 +/- 2.1% for age 32 or older (p = not significant). Overall OSCE score (maximum, 20) decreased similarly for age < 32 (18.0 +/- 0.4 to 13.6 +/- 2.0) and age > 32 or older (18.0 +/- 0.3 to 12.4 +/- 1.3). Decrease in Priorities and Organized Approach scores also showed no differences between the groups. Regarding gender, MCQE decreased similarly in both groups (women, 81.5 +/- 2.2% to 64.4 +/- 2.4%; men, 83.3 +/- 3.2% to 64.1 +/- 4.2%) and so did OSCE, Priorities, and Organized Approach scores. Regarding specialty, surgeons (83.0 +/- 3.1% to 66.1 +/- 4.5%), nonsurgeons (82.9 +/- 3.2% to 63.3 +/- 3.9%), and general surgeons (82.5 +/- 3.5% to 63.8 +/- 5.3%) showed similar decreases in MCQE scores. Overall OSCE scores and Priority and Approach scores decreased similarly in all specialty groups. When trauma volume was controlled, there was still no difference in attrition rate between surgeons and nonsurgeons.
  
  
  CONCLUSIONS
  Trauma patient volume is the most critical determinant of attrition rate of ATLS-acquired skills. Gender, age (at time of taking the course), and practice specialty do not alter this attrition rate.
authors.affiliation: Department of Surgery, University of Toronto, National ATLS Faculty, American College of Surgeons, Ontario, Canada. alij@smh.toronto.ca
authors.forename: Jameel
authors.initials: J
authors.lastname: Ali
authors.forename: Mary
authors.initials: M
authors.lastname: Howard
authors.forename: J Ivan
authors.initials: JI
authors.lastname: Williams
mesh_terms: D000328:Adult; D000367:Age Factors; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008020:Life Support Care / Q000592:standards*; D008297:Male; D008511:Medicine; D015999:Multivariate Analysis; D012737:Sex Factors; D013038:Specialization; D013043:Specialties, Surgical; D014194:Traumatology / Q000193:education / Q000592:standards*; D016526:Workload