title: Trauma operative skills in the era of nonoperative management: the trauma exposure course (TEC).
abstract: BACKGROUND
  Declining trauma operative experience adversely impacts learning and retention of operative skills. Current solutions, such as acute care surgery, may not provide relevant operative experience. We hypothesized that a structured skills curriculum using fresh cadavers would improve participants' self-confidence in surgical exposure of human anatomic structures for trauma.
  
  
  METHODS
  The trauma exposure course, a single-day, 8-hour course with two trainees and one instructor per fresh cadaver, was designed by the faculty of a high-volume, urban, level I trauma center. Trainees included all trauma fellows (n = 6) and surgical chief residents (n = 12) in academic year 2007 to 2008. Using a structured, pretested curriculum, participants were trained by trauma faculty in operative exposure of 48 structures in the neck, chest, abdomen, pelvis, and extremities. For each exposure, participants' self-reported levels of operative confidence were measured using the operating score (OR score, 1 = not confident and 5 = highly confident) before the course (pre), immediately afterward (post), and at long-term follow-up (median, 6 months).
  
  
  RESULTS
  Participation in the trauma exposure course resulted in a significant increase in OR scores for 44 of the 48 exposures (median scores, pre 3 vs. post 5, p < 0.0001), with no decline at long-term follow-up. Participants with less previous operative experience were most likely to benefit from the course.
  
  
  CONCLUSIONS
  A structured skills curriculum using fresh cadavers improved participants' self-confidence in operative skills required for surgical exposure of human anatomic structures for trauma. This model of training may be beneficial for surgical residents and fellows, as well as practicing trauma surgeons.
authors.affiliation: Department of Surgery, Division of Burns, Trauma, and Critical Care, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9158, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Gunst
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.forename: Lisa
authors.initials: L
authors.lastname: Hollett
authors.forename: Mark
authors.initials: M
authors.lastname: Hamill
authors.forename: Larry M
authors.initials: LM
authors.lastname: Gentilello
authors.forename: Heidi
authors.initials: H
authors.lastname: Frankel
authors.forename: Shahid
authors.initials: S
authors.lastname: Shafi
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000706:statistics & numerical data; D003479:Curriculum; D004502:Education, Medical, Continuing; D005257:Fellowships and Scholarships; D006801:Humans; D007396:Internship and Residency; D016730:Program Development; D014194:Traumatology / Q000193:education*; D014947:Wounds and Injuries / Q000601:surgery*