Demetrios Demetriades, MD, PhD, FACS
This lecture highlights the advances, errors, and failures we made during our efforts to improve outcomes and focuses on current challenges in training trauma surgeons.
It highlights the negative effect of the recent uncontrolled and largely unregulated proliferation of trauma centers, driven by profits rather than needs. Other factors inhibiting progress in trauma care is the adherence to dogma, ignoring scientific evidence. The mentality of “This is what I was taught, this is what I do, and this is what I teach” or “It is written in the textbooks” or “This has been the standard of care for decades” is deeply rooted in our education system. It is the responsibility of the academic community to educate young surgeons to be inquisitive, question and challenge practices not based on good science. Another inhibiting factor is the reluctance of the trauma community in introducing practices with strong scientific evidence while at the same time often is quick to accept new concepts of questionable value and with little scientific evidence.
Training in operative trauma is another major challenge, for both civilian and military surgeons. The operative experience has been diminishing over the years, because of changing trauma epidemiology, the widespread use of nonoperative management for both, blunt and penetrating trauma, advances in interventional radiology, and resident work hours. Various trauma training courses and simulation labs using inanimate, animal or cadaver models have been developed to teach surgical procedures in trauma. The ideal system should be as close to reality as possible, cost effective and reproducible on a large scale. The USC Fresh Tissue Dissection Lab, which uses fresh human cadavers with cardiovascular perfusion and mechanical lung ventilation, addresses many of these challenges.
Training and maintaining trauma skills in the military is another major challenge! The experience gained during conflicts is lost soon after the conflicts are over, especially with the departure of experienced surgeons. Structured civilian/military partnerships are essential for maintaining trauma competency for military medical personnel and boost advances in both, civilian and military trauma. Access of the national military trauma databases to civilian academic trauma surgeons in participating centers could encourage joint research and new knowledge.
