ectes-2024-eposter-hintergrund-660bca90303c0212783071.jpg

ectes-2024-eposter-logo-660bcc1ca0874706891033.svg

ectes-2024-eposter-start-660bc6df45fbd927741591.jpg

23rd European Congress of Trauma & Emergency Surgery

Prof. Dr.

Do "stop the bleed" training courses for laypersons improve hemorrhage control knowledge, skills, and attitudes? A systematic review

Education

Research

Introduction Most preventable trauma deaths occur within 1 hour of injury due to uncontrolled bleeding. For this reason, training lay first-person responders in trauma care, with a focus on hemorrhage control, has been recommended. Objectives This systematic review will analyze the effect of the STOP THE BLEED (STB) training course on the knowledge, skill, and attitudes of lay first-person responders. Methods PubMed and Google Scholar databases were used to identify relevant peer-reviewed research articles describing evaluations of STB courses for laypersons from 1 December 2013 to 31 October 2022. A hand search of article references was also undertaken. Studies were included if: they implemented the STB course; trainees were laypersons, and they included some type of outcome measures such as knowledge, skill, confidence gained, willingness to provide or utilization of care provided to and outcomes of trauma patients. Results The database searches yielded 2,893 unique papers. We retained 33 papers for fulltext review, resulting in 24 eligible papers. Grey literature and manual searches yielded 11 additional publications, for a total of 35 studies. The most reported finding was a statistically significant increase in hemorrhage control knowledge or tourniquet application skill in 26 studies. Twenty-two studies reported statistically significant improvements in willingness, confidence, comfort, and likelihood to respond to a bleeding patient, and six studies reported significant reductions in the retention of bleeding control. Conclusion STB courses for laypersons have demonstrated significant improvements in knowledge, skill, confidence, and willingness to intervene to stop traumatic exsanguination. The evaluation of clinically relevant patient outcomes, specifically their effect on preventable deaths from traumatic exsanguination, is needed to strengthen further the evidence behind the recommendations for the more widespread teaching of the &quot;STB&quot; course.No

Poster

Prof.

Removing barriers with a revolutionary REBOA training program for non-femoral arterial access specialists

Polytrauma

Introduction Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a potentially life saving intervention in in the resuscitation of the major central/junctional hemorrhages. The study focuses on the development of a simulation-based training program addressing the shortcomings and educational inaccuracies that hinder its implementation in the real-life. Methods The course is based on a mastery-learning educational concept. Phase one involves a comprehensive review of literature. The second phase involves acquiring the ability to identify the puncture area, surgical insertion, and ultrasound puncture. The curriculum includes technical proficiency and effective collaboration across different specialties and disciplines. Multidisciplinary simulations will evaluate the integration of REBOA into a trauma protocol, minimizing delays in definitive treatment promoting implementation on a system. Post-course training to maintain skill will involve the use of phantom technology and surgical simulators created by the Prehospital Critical Care Group, facilitating the recall of the skill. The final evaluation involves the technique itself, patient selection, and integration into the trauma system. Results Resulting in a program that incorporates a self-directed phase, an interactive phase conducted in person using the latest educational methods combined with unique high fidelity low-cost simulatorsand an after-course phase where students recall the technique with minimal skill loss. Conclusion A revolutionary program in REBOA that incorporates unique high fidelity simulators and cutting-edge learning approaches addressing issues in previous programs calls for further research to determine effectiveness NO

PD Dr.

Dr. med.

3D vs. 2D-4K: Performance and self-perception of laparoscopic novices in a randomized prospective teaching intervention using standard tasks and box trainers

Emergency surgery

Introduction The use of 3D laparoscopy in surgical practice and training has been an area of research and discussion. Studies have suggested that 3D vision can improve speed and precision compared to 2D displays, while other authors found no benefits on the learning curves of laparoscopic novices. 2D-4K seems to improve laparoscopic view and helps learners to orientate without stereopsis. However, but evidence comparing those systems for laparoscopic training is limited. Therefore, the impact of viewing mode on learning and task proficiency remains unclear. Material and Methods We performed a 2-hour teaching intervention on basic laparoscopic skills for 38 novices including medical students and junior residents. We randomly assigned learners to 2D-4K or 3D teaching and performed tasks of increasing difficulty and complexity using standard laparoscopy box trainers. Before the last and most challenging task, learners had to crossover to the other laparoscopy setup. Our primary endpoint was task proficiency measured by speed and failure rate. Secondary outcomes were performance using the viewing mode of the other group without familiarization, self-perception, and career aspirations before and after the teaching intervention, expressed on a Likert-Scale. Results Laparoscopy novices were significantly faster using a 3D laparoscopy setup in a standard box trainer model XX and the effect was consistent throughout the learning curve. Failure rate was not significantly affected by the viewing mode. After crossover to the other laparoscopy system precision and time were not significantly different between the groups. Learners rated the difficulty of laparoscopy lower after having 2 hours of basic laparoscopy training. Conclusions Laparoscopic novices can benefit from a 3D laparoscopy training setup. Exclusive 3D training prior to a complex task on a 2D-4K setup doesn&quot;t negatively affect the learner&quot;s performance.No

Training in Virtual Reality (VR): A way to improve situational awareness and patient safety in the operation theatre?

Introduction Patient safety is fundamental to the provision of health care in all settings. However, avoidable errors and risks associated with health care remain major challenges for patient safety globally. Although potential risks are known by healthprofessionals, they often remain undiscovered and uncorrected. Major causes comprise stressful workload, impaired teamwork, as well as reduced situational awareness. Here, the "room of horror" offers an innovative possibility to train situational awareness. It consists of a simulation room prepared as a clinical room containing hidden errors and risks which have to be discovered by health professionals. Objectives The aim of the present work was to analyze if this training can be performed in virtual reality. Second, if situational awareness in the OR differs between different team members and should receive a more specific training. Methods Based on a 3D-Scan of a real operation room, the virtual reality OR was designed with its complete detailed interior (e.g. specific patient medical record, specific medication). 10 errors were implemented representing different categories of medical errors defined by the world health organization, representing frequent errors. After written informed consent and a questionnaire, participants entered the room of horror via VR headsets. They had to identify the potential errors to patient safety within 10 minutes. Their performance was recorded via video and analyzed afterwards. Results The room of horror in VR was highly appreciated by all participants, 2/44 described little nausea. The number and type of identified errors significantly differed between the participating health professionals (Surgeon, anesthesiologists, anesthesia nursing, surgical nurse). Conclusion The VR room of error represents a practical, low-threshold possibility to train health professionals. It allows to identify specific impairments in situational awareness of different health care professionals.No

Does Garden's classification of femoral neck fracture match between orthopedic specialist and clinical resident?

Introduction：Garden&quot;s classification is the most popular classification of femoral neck fractures. Femoral neck fracture should be operated ≦24hr; however Poor agreement make waiting time longer because it takes more time to prepare implants and biological clean room. Objectives: We investigate the agreement of the Garden&quot;s classification (non-displacement type or displacement type) between clinical resident and orthopedic specialist. Material &amp; Methods：The examiner are a clinical resident (2nd year) and an orthopedic specialist (19th year). The subjects were 55 cases of femoral neck fractures treated at our hospital between January and December 2018. First, the examiners classified them into a non- displacement type and a displacement type (test 1). Second, the examiners studied the literature about unclassifiable type. Third, the examiners classified 55 cases one month later once more (test 2). Finally, we compared the first test with the second test using the agreement (the number of matched patients / total) and Kappa coefficient. Results：The test 1 showed that the agreement and Kappa coefficient were 81.8% and 0.337. The test 2 showed agreement was 90.9%, 0.614. The intra-observer agreement of clinical resident was 90.90% and Kappa coefficient was 0.6520. The orthopedic specialist was 98.18%, and Kappa coefficient was 0.930. At test 1, 10 cases did not match. 4 cases of those were unclassifiable type, which were valgus type with medial fracture line. With slight displacement, agreement will get lower; some doctors consider it displacement type. Conclusions： Unclassifiable type makes us confused. It makes agreement better to discuss about unclassifiable type.'No'

Necessity of re-education for supervising physician who is not an orthopedic trauma surgeon to the treatments of the common fractures in Japan

Skeletal trauma and sports medicine

Introduction: In Japan, common fractures must be treated by doctors who do not specialize in trauma at community hospitals. Young doctors often have the opportunity to learn at academic and research conferences and acquire basic knowledge. On the other hand, the supervising doctors, who does not specialize in trauma, treats patients based on the knowledge and experience gained in their youth, resulting in complications that could have been avoided if standard surgery had been provided. Objectives: Present a case in which X-ray postoperatively performed by the supervising doctor indicates that there is a problem. The purpose of the study was to obtain European opinions on how to reeducation non orthopedic trauma surgeons as supervisors. Patients &amp; Methods: The causes of the 17 cases identified as problematic on preoperative or postoperative X-ray for six months from January to June were reviewed. The items considered were selection of treatment (conservative or surgical), selection of implants, and surgical technique. Results: It was determined that the cause was due to treatment selection in 3 cases, implant selection in 4 cases, surgical technique in 9 cases, and implant selection + surgical technique in 1 case. Conclusion: The dissemination of standard treatment of common fracture requires reeducation of teaching physicians who do not specialize in trauma.NO

Is there a gender disparity in the understanding and perceptions of orthopaedic surgery? Outcomes of the South West Orthopaedic Conference 2023

Trauma and Emergency surgery | Miscellaneous

Aim of the study: This study aimed to evaluate the differences in understanding and perceptions of orthopaedic surgery between male and female delegates in a national conference.Method: This was a conference organised by students with the support of consultants from the Princess Elizabeth Orthopaedic Centre in The Royal Devon and Exeter Hospital. Identical questionnaires were completed immediately before and after the conference on google forms. The pre- and post-conference questionnaire had three sections comprising of understanding, motivations and barriers to pursing orthopaedic surgery. The results of this study analysed the pre-conference data differences between male and female delegates. Mann-Whitney test was used to determine differences in pre-conference responses according to gender.Results:62 delegates completed the questionnaire, of which 63% were male. There were no differences between genders on understanding of orthopaedics in the pre-conference questionnaire (p&gt;0.05). There were no difference in motivating factors to pursuing orthopaedics (p&lt;0.05). Female delegates showed a significant increase in lack of role models compared to their male counterparts (p&lt;0.05). Work-life balance was more of a perceived barrier to females compared to males (p&lt;0.01). The number of years spent in orthopaedic training was perceived more of a barrier in females compared to males (p&lt;0.05). There were no differences in lack of exposure during undergraduate training or negative experiences in orthopaedic placements.Conclusion:The conference data highlighted that lack of role models, work-life balance and the length of orthopaedic training were more of a perceived barrier in females compared to males. We therefore encourage organisations such as Women In Surgery (WinS) and orthopaedic surgeons to encourage more female representatives in orthopaedics by providing support for more student-led initiatives to encourage recruitment.No

Impact of a dedicated trauma teams course on attitude change towards non-technical skills

Introduction Non-technical skills (NTS) are one of the main factors affecting the performance of trauma teams. NTS, which includes communication and mutual support, are not traditionally addressed in undergraduate education. Therefore, developing these skills in a postgraduate context becomes extremely important, using simulated environments. To address this gap in the development of non-technical skills among trauma team members of a Level I trauma center, a course was developed to improve their performance. Objectives This study aims to understand the impact of NTS training with an original, dedicated trauma team training program, on the self-reported perception of attitudes regarding non-technical skills. Materials &amp; Methods The study population consists of 16 doctors and nurses, trauma team members of a Level I trauma center. Before starting the course, participants answered the TeamSTEPPS® Teamwork Attitudes Questionnaire. Participants completed the course, which included a brief theoretical introduction and various simulated scenarios consisting of team management of severe trauma, followed by debriefing sessions at the end of each scenario. At the end of the course, participants were asked to retake the questionnaire. Results We observed a significant change in participants' self-perception of attitudes, particularly in Team Structure (z=-2,76 p=0,003), Situation Monitoring (z=-1,95 p=0.026) and Mutual Support (z=-1,98 p= 0,024) Whilst there wasn&quot;t a statistical change in Leadership (z=-2,15 p= 0,984) and Communication (z=-0,61 p= 0,271). Conclusion Based on these results, we can infer that developing dedicated trauma team training courses can improve the self-reported perception of team members in NTS. This can potentially translate into better team performance.No

Arrebol: Soft skills development in a socio-educational first-aid training

Introduction: Arrebol is an extension project created by graduation students from School of Medical Sciences UNICAMP.They executed first-aid training and gave health orientations to teenagers in social vulnerability in Campinas, SP, Brazil. Participating in a project acts directly over and with the community creates a potential scenario for developing Soft Skills, nontechnical abilities related to emotional intelligence and behavior, those being essential for medical practice. Objectives:This study seeks to evaluate the impact of the Arrebol project on learning Soft skills by acting in firstaid training for teenagers from Patrulheiros Campinas - Learning and Mobilization Center for Citizenship. Methods: descriptive, qualitative and observational study, with the target audience being a group of medicine students from UNICAMP. Participation in Project Arrebol activities was evaluated by a Likert type questionnaire, answered by Google Forms. It has been analyzed the contribution of participating in the project in the development of twelve skills. Results:There was a majority of positive answers completely agree and agree and few responses as disagree and completely disagree, no answers choosing the latter option. There was a major agreement about Efficient Communication, Empathy, Collaboration and Interpersonal Relationship. With all the available skills, the sum of positive answers were higher than 75%, except for Working Under Pressure. Conclusion:Being part of the project has been revealed as an enhancer for developing soft skills.There are limitations, mainly with Working under Pressure, which is important in Healthcare.students evaluated positively the contribution of the activities in developing non-technical abilities. References: Hamilton AL Medical Students NonTechnical Skills:preliminary work developing a behavioural marker system fornontechnical skills of medical students in acute care. BMJ Simulation &amp; TechnologyEnhanced Learning. 2019 No

Social media as a new tool to spread information about trauma prevention

Introduction Trauma is a serious disease that causes important morbidity and mortality worldwide, especially among young people. Furthermore, globally, there are over 3,81 million active social media users, with the young population accounting for a significant part of these numbers. Hence, social media could be a strategic ally to diffuse trauma prevention information, targeting the youngest ones that are more present in the online environment. Thus, a Division of Trauma Surgery at University of Campinas Instagram (@trauma_unicamp) has been created in order to disseminate information about trauma prevention and education. Objectives Analyze and discuss the statistics of a Trauma Prevention Instagram, discriminating target public characteristics. Material and methods Engagement is determined by a private Instagram algorithm incorporating the number of comments and likes along a period of time. This algorithm provides additional information about target public characteristics (such as percentage of access per age). Results From July 25 to October 23, our Instagram reached, directly, 8213 different accounts. This number does not include people who accessed the content twice or more, so there is no overestimation. Also, 79,7% of these accounts belong to users between 18 and 44 years old. Regarding engagement, there were 5018 interactions to our online posts. The followers number rose 41,2% in the period, which corresponds to 381 new followers. Among all posts, which are now 350, approximately 23% of them discussed trauma prevention directly. Also, the two most viewed posts are the ones showing how our prevention program directed to youth works and its importance; together, they are responsible for 4213 accesses. Conclusion Accordingly, it is possible to consider social media a promising tool to reach the population when it comes to trauma prevention information, mainly the young ones. It may also encourage medical students and laymen in this task.No.

National surgical undergraduate near peer teaching course. Analysis and insight from feedback for predictors of teaching success

Introduction: The COVID-19 pandemic disrupted traditional ward-based medical student teaching, prompting a swift transition to remote learning platforms. This shift not only addressed immediate challenges but also facilitated inter-regional collaborations in medical education. Recognizing the potential persistence of remote teaching, we present our course and insights to guide improvements in peri-operative education. Methods: We organized a 12-week, 36-session course tailored for medical students nationwide. Each week, university representatives enlisted three students to teach surgical specialties to a diverse audience. We assessed the impact by collecting anonymized data on pre- and post-session subject confidence, teaching quality, relevance, and usefulness via a Likert-type scale (1-10). Results: Over the 12 weeks, we gathered 216 responses. A notable finding was a statistically significant increase in post-session confidence (mean=2.9, s.d=1.5, p&lt;0.001), demonstrating the potential of remote learning to enhance student confidence. Pre-course and post-course confidence, perceived teaching quality (p=0.029), course relevance (p&lt;0.001), usefulness for exam preparation (p&lt;0.001), and teaching appropriateness (p&lt;0.001) correlated positively with higher year groups. Interestingly, the percentage increase in confidence was negatively associated with the year group(p=0.001). Additionally, sessions led by a single teacher showed higher absolute (p=0.011) and percentage(p=0.020) increases in confidence and perceived teaching quality(p&lt;0.001) compared to sessions led by two teachers. Conclusion: In conclusion, online inter-regional near-peer teaching has proven invaluable for medical education. Our analysis reaffirms its effectiveness and highlights factors influencing teaching outcomes. We expect these insights to guide our course's evolution and similar future initiatives, contributing to more effective peri-operative education in the post-pandemic era.no

Educational strategy for implementing negative pressure wound therapy in two Spanish hospitals

Introduction: Education and wound management skills are crucial for residents and nurses. We identified the need to develop an educational strategy to implement negative wound pressure therapy (NPWT) in the hospital and regional centers improving wound management. Objectives:Our main goal was to provide a detailed account of how we implemented the NPWT course in two hospitals in the northern region of Spain. We aimed to evaluate the participants' feedback on the course content, as well as the teaching methods used for learning and implementing NPWT. Methods: The General Surgery department of University Hospital created a one-day course dedicated to teaching nurses the indications and technical skills necessary to implement NPWT autonomously. Four courses were conducted in 2022, consisting of two phases. The first phase involved descriptive and interactive lectures, while the second phase focused on hands-on NPWT simulation. The participants underwent evaluation three times: with a pre-course test to gauge their knowledge level, followed by a post-course assessment, and finally with a satisfaction survey rated from 1 to 10, with 1 being the lowest and 10 being the highest level of satisfaction with the overall course. Results: Most participants were nurses with less than 5 years of experience. The activity was held at two locations, the university hospital and a regional hospital. The course included a total of 24 hours of continuous education, 16 lecture hours and 8 hours of hands-on practice. The pre-course test and post-course test had an average score of 7 and 9.5 respectively. Participants rated the course at 9. Conclusion: Ongoing medical education is essential for introducing new techniques in hospitals that have limited resources. University hospitals should promote activities to enhance and improve the level of care in the hospitals under their area. The one-day program comprising lectures and hands-on activities was well-received by the nursing staff.No

Laparoscopic appendectomy in surgical education: What factors are primarily associated with residents taking on the role of the primary operators?

Introduction: Laparoscopic appendectomy (LA) is the initial surgical procedure introduced to surgical residents (R). The frequency of appendectomies conducted by R plays a pivotal role in assessing residency programs worldwide. Objectives: This study investigates the prevalence of LA performed by R in Italy and seeks to discern the rationale behind the decision to involve R in performing this surgery or not. Materials &amp; Methods: We extracted data from the dataset of the RESIDENT-1 registry (R1). We analyze differences between procedures performed by surgeons (S) and R. A propensity score matching (PSM) was performed. Additionally, to gain a more profound understanding of the real-life factors, we administered a survey to a cohort of S and R within the R1 network. Results: 653 patients were enrolled between October 2019 and October 2022. 234 (35.89%) LA were performed by R. After the PSM two groups of 231 patients each were included. Hospital type (teaching vs non-teaching) and the presence of a dedicated emergency surgery department were significantly related to the increasing rate of procedures performed by R (respectively 57.14% vs 26.84% p&lt;0.001; 51.08% vs 19.05% p&lt;0.001). The survey shows a disparity in perspectives between R and S. While R tend to prioritize clinical factors such as the presence of perforation or gangrene (25.53% vs. 8.33%, p &lt; 0.015), S give greater significance to non-technical and environmental factors such as the year of specialization (63.1% vs. 44.7%, p = 0.05) and punctuality (47.2% vs. 23.4%, p = 0.041). Both S and R agree that a systematic perioperative feedback system would increase the awareness of R operative autonomy (94.4% vs 89.3). Conclusion: Our study reveals that the relatively low rate of LA performed by R in northern Italy is primarily influenced by environmental factors rather than clinical ones and it seems to suggest that a well-structured perioperative teaching method could enhance R involvementno

Poster session 19
Education 2

Appointment

Chairs

Topic

Programme

Poster session 19Education 2

Appointment

Chairs

Topic

Programme

Poster session 19
Education 2