Perception does not equal reality for resident vascular trauma skills.
BACKGROUND
Experience with the management of vascular trauma by senior surgical residents is increasingly limited. When queried about their understanding of anatomy and ability to perform specific vascular exposures, residents express a moderately high level of confidence. We hypothesized that this perception does not equal reality.


METHODS
A total of 42 senior surgical residents participating in an ongoing validation study of the Advanced Surgical Skills for Exposures in Trauma course were asked to self-assess their baseline (precourse) confidence of their understanding of the anatomy required to perform and their ability to perform exposure and control of the axillary, brachial, and femoral arteries, as well as lower extremity fasciotomy using a 5-point Likert scale. Residents then performed the four procedures on a fresh cadaver model and were scored in real time by experts using a global assessment of anatomic knowledge and readiness to perform." The Student t-test was used with α set at P < 0.05.


RESULTS
Residents consistently rated their understanding of anatomy and their ability to perform the procedures significantly higher than expert evaluator ultimately scored them. Evaluators also deemed that residents would be unable to perform without help 65%-86% of the time.


CONCLUSIONS
Senior residents are ill-prepared to perform the procedures studied and have an unwarranted confidence in their knowledge and abilities. Perception clearly does not equal reality in preparing these trainees to perform as advertized. The low global scores for anatomy and performance should be a wake-up call for surgical educators prompting curricular reform and evaluation.
The Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland. Electronic address: mark.bowyer@usuhs.edu.
Mark W
MW
Bowyer
USAF Center for Sustainment of Trauma and Readiness Skills, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland.
Stacy A
SA
Shackelford
Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, Maryland.
Evan
E
Garofalo
Shock Trauma Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland.
Kristy
K
Pugh
Shock Trauma Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland.
Colin F
CF
Mackenzie
D000328:Adult; D004521:Educational Measurement; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007396:Internship and Residency / Q000592:standards; D014656:Vascular Surgical Procedures / Q000592:standards*; D057772:Vascular System Injuries / Q000601:surgery*
Anatomical knowledge; Self-assessment; Surgical education; Surgical skills; Trauma; Vascular exposure