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J Trauma Acute Care Surg. 2016 Oct;81(4):729-34. doi: 10.1097/TA.0000000000001186.

Teaching leadership in trauma resuscitation: Immediate feedback from a real-time, competency-based evaluation tool shows long-term improvement in resident performance.

Author information

1
From the Bridgeport Hospital, Yale-New Haven Health System (S.C.G.), Bridgeport, Connecticut; and Warren Alpert School of Medicine of Brown University (D.H., M.D.C., A.H.S., S.N.L., D.T.H., J.T.M., C.A.A., and W.G.C.), Rhode Island Hospital, Providence, Rhode Island.

Abstract

BACKGROUND:

Limited data exist on how to develop resident leadership and communication skills during actual trauma resuscitations.

METHODS:

An evaluation tool was developed to grade senior resident performance as the team leader during full-trauma-team activations. Thirty actions that demonstrated the Accreditation Council for Graduate Medical Education core competencies were graded on a Likert scale of 1 (poor) to 5 (exceptional). These actions were grouped by their respective core competencies on 5 × 7-inch index cards. In Phase 1, baseline performance scores were obtained. In Phase 2, trauma-focused communication in-services were conducted early in the academic year, and immediate, personalized feedback sessions were performed after resuscitations based on the evaluation tool. In Phase 3, residents received only evaluation-based feedback following resuscitations.

RESULTS:

In Phase 1 (October 2009 to April 2010), 27 evaluations were performed on 10 residents. In Phase 2 (April 2010 to October 2010), 28 evaluations were performed on nine residents. In Phase 3 (October 2010 to January 2012), 44 evaluations were performed on 13 residents. Total scores improved significantly between Phases 1 and 2 (p = 0.003) and remained elevated throughout Phase 3. When analyzing performance by competency, significant improvement between Phases 1 and 2 (p < 0.05) was seen in all competencies (patient care, knowledge, system-based practice, practice-based learning) with the exception of "communication and professionalism" (p = 0.56). Statistically similar scores were observed between Phases 2 and 3 in all competencies with the exception of "medical knowledge," which showed ongoing significant improvement (p = 0.003).

CONCLUSIONS:

Directed resident feedback sessions utilizing data from a real-time, competency-based evaluation tool have allowed us to improve our residents' abilities to lead trauma resuscitations over a 30-month period. Given pressures to maximize clinical educational opportunities among work-hour constraints, such a model may help decrease the need for costly simulation-based training.

LEVEL OF EVIDENCE:

Therapeutic study, level III.

PMID:
27488489
DOI:
10.1097/TA.0000000000001186
[Indexed for MEDLINE]
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