Retention of early trauma management skills in Australian general practitioners

    Research output: ThesisDoctoral Thesis

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    The Advanced Trauma Life Support (ATLS) course, or the Early Management of Severe Trauma (EMST) course as it is known as in Australia, teaches isolated rural general practitioners a protocol-driven system of managing major trauma victims during the "golden hour". However, with any educational activity there is a natural loss of skills over time. The aims of this project were to determine the retention of EMST skills in Western Australian general practitioners and their EMST refresher training needs. This project is based on four separate but related studies. The first three studies were based on the EMST course in Australia while the final study complemented the EMST findings with related trauma education data from the Western Australian Trauma Education Committee datasets. General practitioners averaged 10 major trauma cases over five years. They had low confidence levels in rarely-used skills (e.g. cricothyroidotomy and diagnostic peritoneal lavage) and high confidence levels for frequently used skills (e.g. inserting intravenous cannulae and fluid replacement). The initial survey case-study (ISCS) was used to assess the general practitioners' EMST higher-level skills. The ISCS was found to display poor examiner reliability under EMST-operand conditions and the findings were based on video assessments. As the ISCS assessment was not conducted under EMST-operand conditions, the results represented a crosssectional (i.e. pass/fail) rather than a longitudinal (i.e. retention/loss of skills over time) study of EMST skills. Half the general practitioners failed the ISCS assessment of higher-level skills, thus indicating a need for refresher training in the EMST higher-level skills. General practitioners' higher-level skills levels were not associated with their perceived confidence levels or their background factors (i.e. number of major trauma cases managed, number of years since completing an EMST course and attendance of an EMST refresher course). As EMST higher-level skills are based on general practitioners having a background of cognitive and practical/procedural skills, the refresher training needs to cover the entire course rather than perceived relevant entities of the course. This is in-line with course developers' recommendation that ATLS/EMST is a specific entity and cannot be separated into freestanding lectures or practical sessions. The desirable interval for EMST refresher training could not be determined. Analyses of postal surveys and focus groups indicated that the EMST refresher training should include more opportunities for learning the practical/procedural skills. General practitioners also wanted more hands-on opportunities through clinical placements (e.g. in the Operating Theatre) or by using clinical simulator facilities. An important aspect of the hands-on opportunity is the guidance of a supportive clinical mentor who would provide feedback on their performance. The refresher training should involve nurses, ambulance officers and hospital personnel as trauma management involves team effort. Based on these educational needs, a more appropriate term would be "Refresher Training Programme" rather than "Refresher Training Course". Importantly, course developers should consider addressing the poor reliability of the ISCS assessment before embarking on this "Refresher Training Programme".
    Original languageEnglish
    QualificationDoctor of Philosophy
    Publication statusUnpublished - 2008


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