1. The Resident Experience on Trauma: Declining Surgical Opportunities and Career Incentives? Analysis of Data from a Large Multi-institutional Study
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Ajai K. Malhotra, Antoinette Kanne, Lawrence Lottenberg, Michael F. Rotondo, Richard A. Pomerantz, Andrew B. Peitzman, Scott G. Sagraves, Pascal Udekwu, Juan L. Peschiera, Jennifer L. Sarafin, David J. Dries, Thomas M. Scalea, Gary W. Welch, Kwang I. Suh, Juan A. Asensio, Michael Oswanshi, Farouck N. Obeid, Ronald G. Albuquerque, Victor L. Landry, Hans Joseph Schmidt, Deborah Baker, Dorraine D. Watts, Raymond Talucci, Scott B. Frame, John B. Holcomb, Lewis J. Kaplan, Dennis Wang, S. M. Siram, Grace S. Rozycki, Russell Dumire, Benjamin D. Mosher, Eliza Enriquez, Terrence H. Liu, Samir M. Fakhry, Anne Kuzas, F.Barry Knotts, Sherry M. Melton, John F. Bilello, George M. Testerman, Blaine L. Enderson, James S. Gregory, Dennis W. Ashley, Patrick A. Dietz, Karlene E. Sinclair, Diane Higgins, Ivan Puente, Barbara Esposito, Stuart J.D. Chow, William F. Pfeifer, Daniel C. Cullinane, Judith Phillips, James K. Lukan, Michael Moncure, John L. Hunt, John R. Hall, Susan Schrage, Pauline Park, Faran Bokhari, Jeffery Rosen, Kathleen A. LaVorgna, Gerard J. Fulda, Monica Newton, Macram M. Ayoub, Leanne Adams, Mark L. Gestring, Thomas A. Santora, Paul R. Kemmeter, Joan L. Huffman, William Marx, Mitchell S. Farber, Karyn L. Butler, Collin E.M. Brathwaite, Jon Walsh, Jeffrey P. Salomone, John D. Josephs, Timothy C. Fabian, Frederick A. Moore, Murray J. Cohen, Paul E. Bankey, Wayne E. Vander Kolk, Dan A. Galvan, John Bonadies, Walter Forno, James M. Cross, Nirav Patel, Pam Nichols, Carnell Cooper, Michael Haraschak, Judith A. O'connor, Daniel Powers, Mary B. Myers, Kathleen P. O’hara, A. Jay Raimonde, Hani Seoudi, Juan B. Grau, Imtiaz A. Munshi, Kimberly K. Nagy, Peter Rhee, Eddy H. Carrillo, Sharon Buchro, Mary Jo Wright, Lisa A. Patterson, Dennis B. Dove, C. M. Buechler, Wendy L. Wahl, Wendy Sue Shreve, Thomas H. Cogbill, Robert A. Cherry, Scott H. Norwood, J. Martin Perez, Bernard R. Boulanger, J. P. Dineen, John E. Sutton, Arthur B. Dalton, Scott Monk, Carl P. Valenziano, Christopher D. Wohltmann, Michael Schurr, Robert A. Jubelelirer, William J. Mileski, Tiffany K. Bee, Kathy Coon, Fred A. Luchette, April Settell, Arthur L. Ney, Jonathan Kohn, Mary E. Fallat, Sheila Staib, Dennis C. Gore, Van L. Vallina, Jose A. Acosta, David Kam, Jeff Strickler, Eileen Corcoran, Leon H. Pachter, Anne O'Neill, Lonnie W. Frei, Larry M. Jones, David G. Jacobs, Om P. Sharma, Curt S. Koontz, Christopher P. Michetti, Michael D. Pasquale, Raymond P. Bynoe, Pablo Rodriguez, Robert Marburger, Michael C. Chang, Karla S. Ahrns, Michael D. McGonigal, Paula Griner, Gustavo Roldán, Leonard J. Weireter, Sharon S. Cohen, Andrew J. Kerwin, L. F. Diamelio, Mauricio Lynn, Donald H. Jenkins, John P. Hunt, W. Michael Johnson, Robert Holtzman, Brian J. Daley, Paul Dabrowski, Jeffrey J. Morken, Vicki J. Bennett-Shipman, Stanley Kurek, Charles J. Yowler, Christopher Salvino, Dale Oller, Brian J. Norkiewicz, Vicki Hardwick-Barnes, Don Fishman, Frederic J. Cole, John C. Layke, Frederick B. Rogers, James Davis, Keith D. Clancy, Emily M. Sposato, Judith Johnson, Charles E. Wiles, Uretz J. Oliphant, and James V. Yuschak
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medicine.medical_specialty ,Attitude of Health Personnel ,medicine.medical_treatment ,Specialty ,Traumatology ,Critical Care and Intensive Care Medicine ,Patient Admission ,Diagnostic peritoneal lavage ,Blunt ,Trauma Centers ,Surveys and Questionnaires ,Laparotomy ,medicine ,Humans ,Focused assessment with sonography for trauma ,Peritoneal Lavage ,Ultrasonography ,Motivation ,Career Choice ,medicine.diagnostic_test ,business.industry ,General surgery ,Trauma center ,Internship and Residency ,United States ,Education, Medical, Graduate ,Blunt trauma ,Case-Control Studies ,Workforce ,Physical therapy ,Wounds and Injuries ,Surgery ,Clinical Competence ,business - Abstract
Purpose: The surgical resident experience with trauma has changed. Many residents are exposed to predominantly nonoperative patient care experiences while on trauma rotations. Data from a large multicenter study were analyzed to estimate surgical resident exposure to trauma laparotomy, diagnostic peritoneal lavage (DPL), and focused abdominal sonography for trauma (U/S). Methods: Centers completed a self-report questionnaire on their institutional demographics, admissions, and procedure for a 2-year period (1998-1999). Results: A total of 82 trauma centers that provide resident teaching were included. The included centers represent over 247,000 trauma admissions. The majority of trauma centers (65.9%) had > 80% blunt injury. Although all centers performed laparotomies, other results were more variable. For U/S, 24.2% performed none at all and 47.0% performed fewer than two U/S examinations per month. For DPLs, 3.8% performed none and 66.7% performed fewer than two per month. Assuming 1 night of 4 on call, the average surgical resident training at a trauma center performing > 80% blunt trauma has the potential to participate in only 15 trauma laparotomies, 6 diagnostic peritoneal lavages, and 45 ultrasound examinations per year. In addition, the resident will care for an average of 500 blunt trauma patients before performing a splenectomy or liver repair. Conclusion: Surgical resident experience on most trauma services is heavily weighted to nonoperative management, with a relatively low number of procedures, little experience with DPL, and highly variable experience with ultrasound. These data have serious implications for resident training and recruitment into the specialty.
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- 2003