Original Publication
Open Access

Trauma and Critical Care for the Senior Medical Student Entering Surgery

Published: December 19, 2014 | 10.15766/mep_2374-8265.9976

Included in this publication:

  • Instructor's Guide.doc
  • 1a ICU Management Instructor Blueprint.doc
  • 1b ICU Management Slides.pptx
  • 2a Ventilators Instructor Blueprint.doc
  • 2b Ventilators Slides.ppt
  • 3a Arterial Blood Gases Instructor Blueprint.doc
  • 3b Arterial Blood Gases Slides.ppt
  • 4a Trauma Systems and Initial Trauma Evaluation Instructor Blueprint.doc
  • 4b Trauma Systems and Initial Trauma Evaluation Slides.ppt
  • 5 Trauma and Critical Care Knowledge Test with Key.doc

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.


Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.

Abstract

Introduction: Skills to aid in the management of trauma patients and critically ill surgical patients in the intensive care setting are important topics that are not uniformly covered in medical schools. Significant recent attention has been directed toward developing preparatory courses to bridge this gap and heighten the readiness of senior medical students as they transition to surgical residency. This resource includes comprehensive materials intended to prepare senior medical students for management of trauma patients and critically ill surgical patients in the intensive care setting.  Methods: The materials provided were designed for use as part of a preparatory course for fourth-year medical students entering surgical specialties, and include all instructor's blueprints, PowerPoint slides, and handouts for four separate sessions. A multiple-choice knowledge test is also included. This resource may be used by course directors for surgery PGY-1 preparatory classes/bootcamps, for independent study by individuals planning to matriculate into surgical residencies, or as a review source for those already in surgical training. While these materials were designed to meet the needs of new surgical house staff, the contents are easily generalizable to other medical specialties, and would prove useful for any trainee managing hospital inpatients. Results: The outcomes from this course have been extensively studied. Through pre- and postcourse surveys, knowledge tests, and technical examinations, we measured confidence and skill acquisition in specific, job-related tasks. In 2010, 62 individuals were studied (22 course graduates, 16 PGY-1 nonparticipant controls at our home institution, and 24 nonparticipant peer controls at outside institutions). We found that course participants demonstrated marked improvement in task-specific confidence in all tasks from course beginning to end as indicated by improved scores on written and technical skill examinations. Further, course participants outperformed peers in all tasks one month into internship, with their performance advantage predictably dissipating into the third month of residency. Discussion: Utilizing this resource resulted in objective gains in task-specific confidence and test performance at course conclusion, which, importantly, translated to improved performance upon residency matriculation. These data emphasize the significant impact of these competency-based surgical internship preparation materials in formally preparing senior medical students for the care of surgical inpatients.


Educational Objectives

By the end of this session, learners will be able to:

  1. Introduce the surgical intensive care unit (SICU), its unique environment, and the surgeon’s role in the SICU.
  2. Review the definition and physiologic background of shock.
  3. Review intensive care unit-based hemodynamic monitoring.
  4. Discuss and navigate hemodynamic monitoring devices.
  5. Review different types of shock and their appropriate managements.
  6. Discuss vasoactive medications and their functions.
  7. Discuss indications for mechanical ventilation.
  8. Review the different modalities available for mechanical ventilation.
  9. Discuss the definition and ventilatory management of acute respiratory distress syndrome.
  10. Discuss the role of positive end-expiratory pressure.
  11. Review parameters and techniques for ventilator weaning.
  12. Discuss indications for arterial blood gases (ABGs).
  13. Review the interpretation of ABGs by: (1) defining components and normal values, (2) discussing alveolar ventilation, oxygenation, and oxygen content, and (3) recalling causes of hypoxia.
  14. Review specific acid-base disorders and expected pH values.
  15. Familiarize students with the ABC’s of initial trauma management.
  16. Clarify the role of the intern in initial trauma management.
  17. Provide an overview of specific traumatic injuries and their management.

Author Information

  • Mara Antonoff, MD: University of Minnesota Medical School
  • Courtney Green, MD: University of Minnesota Medical School
  • Jonathan D'Cunha, MD, PhD: University of Pittsburgh School of Medicine

Disclosures
None to report.

Funding/Support
None to report.

Prior Presentations
Antonoff MB, Shelstad R, Reihsen T, et al. A technology-enhanced curriculum for surgical interns improves readiness for acute inpatient care. Presented at: University of Minnesota Academic Health Center Best Practices Institute; May 20, 2008; Minneapolis, MN.  

Antonoff MB, Shelstad R, Reihsen T, Schmitz C, Chipman J, D’Cunha J. A novel “critical skills” curriculum for surgical interns incorporating simulation training improves readiness for acute inpatient care. The American College of Surgeons 94th Annual Clinical Congress Abstracts for the 63rd Annual Sessions of the Owen H Wangensteen Forum on Fundamental Surgical Problems. Journal of the American College of Surgeons 2008;207(3):S93. http://dx.doi.org/10.1016/j.jamcollsurg.2008.06.234

Antonoff MB, Shelstad R, Reihsen T, et al. A critical skills curriculum for surgical interns including simulation improves readiness for acute inpatient care. Presented at: Minnesota Surgical Society Fall Meeting; October 25, 2008; Alexandria, MN. 

Antonoff MB, Shelstad R, Reihsen T, et al. Preparing interns for acute surgical inpatient care: design and implementation of a novel simulation-based curriculum. Presented at: Association for Surgical Education, Surgical Education Week; April 29, 2009; Salt Lake City, UT.   

Antonoff MB, Shelstad R, Chipman JG, Schmitz CC, D’Cunha J. Development and implementation of a simulation-based critical skills course for surgical interns: lessons learned. The American College of Surgeons 95th Annual Clinical Congress Abstracts for the 64th Annual Sessions of the Owen H Wangensteen Forum on Fundamental Surgical Problems. Journal of the American College of Surgeons 2009; 209(3): S108. http://dx.doi.org/10.1016/j.jamcollsurg.2009.06.270

Chipman JG, D’Cunha J, Antonoff MB, Schmitz CC. Critical response simulations: works in progress. Presented at: 2nd Annual Meeting of the Consortium of ACS-Accredited Education Institutes; March 20, 2009; Chicago, IL.

Antonoff MB, D’Cunha J. Improving the transition to surgical internship: increased confidence and anxiety reduction through formal preparatory instruction.  Presented at: Minnesota Surgical Society, Fall Conference; October 24, 2009; Rochester, MN.

Antonoff MB, Maddaus MA, D’Cunha J. Improving the transition to surgical internship: increased confidence and anxiety reduction through formal preparatory instruction. Presented at: 5th Annual Academic Surgical Congress; February 3, 2010; San Antonio, TX.

Antonoff MB, Swanson JA, Acton RD, Chipman JG, Maddaus MA, Schmitz CC, D’Cunha J. Improving surgical intern confidence through the implementation of expanded orientation sessions. Presented at: 5th Annual Academic Surgical Congress; February 3, 2010; San Antonio, TX.

Antonoff MB, D’Cunha J. The benefit of a targeted intervention to improve the transition to surgical residency. Presented at: Association for Surgical Education, Surgical Education Week; April 24, 2010; San Antonio, TX.

Green CA, Antonoff MB, Maddaus MA, Reihsen TE, Sweet R, D’Cunha J. Development and implementation of a simulation-based critical skills course for PGY-1 surgical interns: mid-term analysis. Presented at: American College of Surgeons, Division of Education Medical Student Program; October 4, 2010; Washington, DC.

Antonoff MB, Green CA, Reihsen TE, Sweet R, Maddaus MA, D’Cunha J. A simulation-based critical skills course for surgical interns: mid-term analysis. Presented at: Association of American Medical Colleges Annual Meeting, Modernizing Medicine MedEdPORTAL Poster Session; November 6, 2010; Washington, DC.

Antonoff MB, Maddaus MA, D’Cunha J. Beyond the surgical bootcamp: evaluation of a competency-based curriculum for senior medical students entering surgical internship. Presented at: 6th Annual Academic Surgical Congress; February 3, 2011; Huntington Beach, CA.

Antonoff MB, Maddaus MA, D'Cunha J. PGY-1 preparatory curriculum design: tailoring content to the modern trainee. Presented at: Association for Surgical Education Annual Meeting; March 22, 2011; Boston, MA.

Antonoff MB, D'Cunha J. Competency-based preparation of senior medical students for surgical internship: impact upon task-specific confidence and competence. Presented at: Surgical Education Research Fellowship Forum, Association for Surgical Education Annual Meeting; March 23, 2011; Boston, MA.

Antonoff MB, D'Cunha J. Development of PGY-1 surgery preparatory course curricula: identification of key curricular components. Presented at: Association of Program Directors in Surgery Annual Meeting; March 25, 2011; Boston, MA.

Antonoff MB, Whitson BA, Green CA, Maddaus MA, D’Cunha J. Preparation of the senior medical student for integrated surgery training: significant impact of a competency-based course. Presented at: American College of Surgeons 97th Annual Clinical Congress; October 25, 2011; San Francisco, CA.

Antonoff MB, Green CA, Swanson JA, Maddaus MA, D’Cunha J. Prospective Analysis Of The 2-Year Outcomes From A Competency-Based Preparatory Course For The PGY-1 Resident: Modeling Standards For The Future. Presented at: 7th Annual Academic Surgical Congress; February 14-16, 2012; Las Vegas, NV.

Green CA, Antonoff MB, Swanson JA, D'Cunha J. Preparing Medical Students for Residency Training: 2-year Cumulative Analysis of a Model Preparatory Course. Presented at: Minnesota Surgical Society, Spring 2012 Meeting; May 4, 2012; St. Paul, MN.

Green CA, Antonoff MB, Swanson JA, D’Cunha J. Competency-based Preparation of Senior Medical Students for Residency Training: 2-year Cumulative Analysis of a Model Preparatory Course. Presented at: Association of Women Surgeons Starr Poster Session, AWS Fall Conference; September 30, 2012; Chicago, IL.



Citation

Antonoff M, Green C, D'Cunha J. Trauma and critical care for the senior medical student entering surgery. MedEdPORTAL. 2014;10:9976. https://doi.org/10.15766/mep_2374-8265.9976