Objective assessment of surgical decision making in trauma after a laboratory-based course: durability of cognitive skills.

BACKGROUND: Because surgical trainees have less exposure to surgical trauma, there is a greater potential of having gaps in decision-making skills. We previously validated a novel assessment tool for decision making in surgical trauma and have documented improvement in resident decision-making skills after a hands-on course. However, brief intensive courses have been criticized for not imparting long-term changes in practice. The purpose of this study was to assess the durability of cognitive skills learned after a 2-day course.

METHODS: Twenty-two residents participated in a 2-day interactive didactic lecture series as well as an animal laboratory focused on practical strategies in dealing with surgical trauma. All participants underwent precourse and immediate postcourse assessment of surgical decision making through a validated short-answer examination. Six months after the course, 12 of these 22 residents completed a third similar examination-the retention test.

RESULTS: The retention test showed good reliability (Cronbach's alpha, .81) and construct validity as evidenced by a positive correlation between test scores and postgraduate year level (r = .9, P < .001). There was no significant difference between retention test scores and posttest scores. However, both were significantly higher than pretest scores (P < .05). This did not change after adjusting for differing degrees of difficulty between the examinations.

CONCLUSIONS: In the context of residency trauma education, there is a measurable positive impact of an intensive, hands-on course on surgical decision making. This impact is durable and cognitive skills persist after the immediate postcourse period. These data support the continued supplementation of traditional residency experiential learning with appropriate laboratory-based skills training.