The need to train surgeons to apply emergency surgery techniques not commonly applied, and to use new instrumentation has led to the spread of training programs based on life-like simulations, using instrumental or animal models [11–14]. Normally, the participants attending the courses are post-graduate students of surgery, or general surgeons, who have no familiarity with the management of trauma patients.
The problem concerning specific training for the trauma surgeon has been dealt with in the past years by organizing courses with surgical simulation. The International Association for Trauma Surgery and Intensive Care organized a two-day course on the Definitive Surgical Trauma Care, including both theoretical and practical training on cadavers and live animals [15]. A one-day course focusing on the lesions of penetrating trauma was organized at Hartford, Connecticut, (ATOM, Advanced Trauma Operative Management) and was divided into a theoretical section and a practical part involving surgical training on large-sized swine. The details of the course and the results obtained from the first 50 participants have been recently published [9].
Though we started from a different background, our proposal is very similar. The structure of our course is original but comparable to the few courses held in the USA and in other non-European countries. The "main topics" and the life-like situations for the evaluation of practical skills are essentially the same. However, the peculiarity of our course is that we pay more attention to the multidisciplinary approach as well as to diagnostic and resuscitation problems. Another peculiarity of our course is the presentation of some lectures by experienced nurses, in the idea of providing supportive arguments to the concept that the traumatized patient is a very complex one, and that only a multidisciplinary approach can produce the best outcome.
We obtained very encouraging results from the first courses due to the high degree of attention paid during teaching sessions and the participation in the discussion of clinical cases. Therefore, although the parameters were not easily quantifiable, all the participants demonstrated with varying degrees of skill that they could successfully manage "unfamiliar surgical situations". Moreover, the participants judged the course to be very useful for their own training: more precisely, 98.3% rated the course favorably with regards to the need for personal updating; 99.1% for the quality of the teaching and 89,6% for the efficacy of the course for personal training. To further improve the theoretical aspects of the course, we currently mail some of the lectures before the course begins, with the aim of giving the participants pre-course preparation.
On this basis, we can reasonably assume that the course was successful, due both to the peculiarity of the topic and the involvement in the practical section of the course. The participants coming from all the Italian regions indicated that the need for CME for surgeons involved in the management of such injuries was felt in many centers.
Of note, all but two of the participants had previous vast working experience. This can be explained by the fact that participation fee (the fee for 2005 was € 1200) is quite high and more likely to be afforded by senior surgeons. However this cost only covers the overheads of the course. This highlights the difficulties in participation of post-graduate residents that are still in training, unlike the American course that attracts not only attending surgeons but also fellows and residents [9]. One way to attract the young surgeons to this valuable course would be if it became recognized as an integral part of the residency.
Ideally, a course should provide a theoretical education and a practical training of participants, by obtaining their direct involvement, and thus responding to their needs and expectations. With regards to the continuous education program, a future improvement of the course might be achieved by organizing workshops on particular clinical cases or on particular implications in the treatment of polytrauma. We are currently preparing a questionnaire to distribute to ex-participants in order to verify the course's impact on their day-to-day work.
The problem of training trauma surgeons, i.e. the lack of experience in treating traumas in operating room, is common to all countries [16] and the education programs proposed are substantially similar in content and practical approach (the use of animal models and the modality of the surgical scenarios); because all trauma surgeons mainly treat thoraco-abdominal injuries, except for the surgeons practicing in German speaking countries, who usually treat even orthopedic and neurosurgery traumas [5].
Since we are aware that most participants of our courses work in hospitals where the management of trauma patients is not common, we have introduced sections focusing on diagnosis, the emergency approach, and nursing management in the operating room and in the ward. This represents the peculiarity of our course compared to others.
Finally, considering that most training programs have a common basis and teaching method, we think that cooperation among the teaching staffs that organize similar courses would be useful to ensure a uniform standard course with a single tested method with regards to evaluation of the participants, choice and assessment of the teaching staff, and planning of updating. This could lead to obtaining official approval as already occurs for the ATLS and, therefore, provide all participants with a similar background.
