Trauma education

Resuscitation 48 (2001) 47–56

Trauma education

Simon Carley *, Peter DriscollDepartment of Emergency Medicine, Hope Hospital, Stott Lane, Salford, UK

Abstract

Objecti6e: Trauma is a diverse disease in which time critical decisions and skills affect patient outcome. This review articleexamines the methods and assessment of education for the management of the trauma patient. Method: Literature review. Results:Education is a planned experience that leads to a change in behaviour. Adult education methods can be used to improve theknowledge, skills, attitudes and relationships of health care workers. Adult learners need careful consideration of lecture style,small group work, role play and skills stations in order to achieve these aims. These techniques are typically used in short intensivecourses such as Advanced Trauma Life Support (ATLS®) aimed at the initial care of the trauma patient. There is a relative lackof education directed at definitive care. It is important to assess the impact of trauma education in terms of clinical process,retention of skills/knowledge and the outcome of patients. A generic approach (the ABC approach) is applicable to the care ofall critically ill or injured patients. This approach should be taught at junior level. Conclusion: The care of trauma patients canbe improved by educating health care workers using adult educational strategies. © 2001 Elsevier Science Ireland Ltd. All rightsreserved.

Keywords: Advanced trauma life support; Clinical process; Skilll stations

www.elsevier.com/locate/resuscitation

1. Definitions

Trauma is a word that may be used to describea number of pathological or psychological condi-tions. This article will concentrate on wounds orinjuries that have the potential to be life or limbthreatening.

2. Introduction

The standard of care for trauma patients hasbeen questioned in many papers from around theworld [1–8]. In particular the number of so called‘preventable deaths’ occurring after patients arriveat hospital has caused great concern. Althoughseveral of these studies contained significantmethodological flaws, it was apparent that thecare of the injured was far from optimal [9,10].

Many questions were raised about all aspects oftrauma care from prehospital services through tohospital discharge and rehabilitation. Particularconcern was given to the initial assessment andtreatment of patient injuries. A large number ofthe preventable deaths were thought to result fromclinician failure to identify, investigate andpromptly treat life or limb threatening injuries.These concerns led to an interest in teachingtrauma clinicians better ways in which to ap-proach the initial management of such patients.

This paper looks at the methods used in theeducation of health care workers (primarily doc-tors) in the care of the injured patient.

3. The Generic approach to the initialmanagement of the critically ill or injured patient

Although there are many specific aspects to thetreatment of a patient’s individual injuries or phys-iological status the general approach to a seriouslyinjured patient may be standardised. In fact, the

* Corresponding author. Tel.: +44-161-7874848; fax: +44-4325-185355.

E-mail address: [email protected] (S. Carley).

0300-9572/01/$ - see front matter © 2001 Elsevier Science Ireland Ltd. All rights reserved.PII: S 0 3 0 0 -9572 (00 )00317 -8

S. Carley, P. Driscoll / Resuscitation 48 (2001) 47–5648

approach to a patient with potentially life threat-ening injuries is the same as that of all critically illpatients.

Box 1. The generic ABC approach to the criti-cal patient

Airway1.Breathing2.Circulation3.

4. Disability (neurological)Exposure, environment, events5.

The approach has been termed the ‘ABC’ ap-proach and is designed to allow the clinician toidentify and treat, in appropriate time order, theinjuries that are most likely to lead to death ordisability (Box 1 and 2). Once a problem is iden-tified it is treated immediately before moving on tothe next step.

The logic underlying this protocol is simple.Airway problems will kill before breathing prob-lems, which will kill before circulatory problems,which will kill before neurological problems. Intrauma, the addition of cervical spine controlwhen dealing with the airway is designed to pre-vent any potential morbidity from co-existing cer-vical spine injury.

Box 2. The ABC approach in traumaAirway with cervical spine control1.Breathing2.

3. Circulation and haemorrhage controlDisability (neurological)4.Exposure, environment and events5.

6. Secondary survey

Whilst the approach is clearly a logical one, it isat odds with the way in which medicine is tradi-tionally taught. In the latter a complete historyand comprehensive physical examination is advo-cated before determining a list of differential diag-noses for which a number of investigations maythen be performed [11,12]. Such an approach isclearly too time consuming when dealing with thecritically ill or injured patient.

A more efficient approach is to accept that apresenting complaint may lead to a number ofpossibilities for which certain points in the history,examination or tests may be performed in order todetermine which is the most likely. For example,describing a patient who has obvious seat beltmarking across the abdomen suggests an immedi-ate array of likely injuries to experienced clinician.They will then use a focused history, examinationand investigations to exclude the life threateninginjuries.

This approach is particularly useful when con-sidering injured patients. Trauma is a heteroge-neous disease and an individual patient maysustain an enormous variety or combination ofinjuries, some of which may be unique to thatpatient. However, the conditions most likely to killthe patient are relatively few. The initial manage-ment of traumatic injury therefore adopts ageneric approach that is suited to all conditionsand combinations of injury. The ABC approachallows this by concentrating on life threateninginjuries, before carrying out a full examination ofthe patient during the secondary survey.

Another advantage of teaching a system oftrauma management rather than specific injurymanagement is that it allows the clinician to fallback on a familiar method when the clinical situa-tion may be complicated and stressful. In addition,there are clear advantages for a team approachwhen all members of the team are familiar andworking to the same principles.

3.1. Trauma courses

To many, trauma education is synonymous withthe advanced trauma life support course (ATLS®)[13] . This is a 3-day, course developed in theUSA, which is now taught in 25 countries aroundthe world. It is aimed at physicians and is widelyaccepted as a gold standard in the treatment of theinjured patient. ATLS has developed greatly sinceit’s inception in January 1980 and it’s principlesand methods have been widely adapted by othercourses (Table 1). Such courses and their method-ology, now have a widely accepted place in theeducation of trauma management. All share simi-lar characteristics. They are typically held over ashort period of time, usually 2–5 days, and arequite intensive for the candidates. They all usesome modification of the ABC approach as a

S. Carley, P. Driscoll / Resuscitation 48 (2001) 47–56 49

Table 1Trauma related courses

Course Target audience

Prehospital care staff,Pre-hospital trauma lifesupport (PHTLS) [15] doctors, nurses

Military physicians andBattlefield advanced traumalife Support/combat trauma nurseslife support (BATLS/CTLS)

Trauma nursing care course Nurses(TNCC)

Emergency management of Burns physicians/nursessevere burns (EMSB)

Physicians/nursesAdvanced paediatric lifesupport (UK) traumacomponent [16] (APLS)

Critical care course (Royal Anaesthetists, surgeonsintensivistsCollege of Surgeons of

England)Safe transfer and retrieval Prehospital care staff,

doctors, nursescourse (STAR)

Although difficult to prove, many clinicians ex-posed to the formalised trauma courses such asATLS perceive a benefit in terms of patient care.A key factor in this is the blending together ofclinical practice and the principles of adulteducation.

3.2. Adult education

Education can be defined as a planned experi-ence that leads to a change in behaviour. Clearlythe way that clinicians behave and treat patientsdevelops over a period of time from attitudes,experiences and local preferences. Education onthe other hand is a planned intention to bringabout a change in the way that a person acts sothat a desired form of behaviour is produced.

At the present time most trauma education isdirected at qualified health care personnel. Suchpeople learn best when1. The content is relevant to their own practice.2. The learner is involved in the learning process.3. Objectives are defined and goals set.4. Positive feedback is given.5. Reflection on the learning experience is given.

When developing methods of teaching traumato adult learners the above goals should be bornein mind.

Information that is not directly relevant to anindividual’s practice is unlikely to be assimilated.It is therefore important that educators have anappreciation of the needs and experiences of thelearners they are teaching. This will require adegree of preparation and planning by theeducators.

Involving the learner in the educative process isan essential part of adult learning. Individualswith some knowledge of the subject will come withtheir own ideas, experiences and possibly preju-dices. Involving the learner in the learning processallows such issues to be openly discussed andexplored. If a change in practice is to be facilitatedit is vital that there is a two-way exchange ofinformation between educator and learner. Thisexchange of ideas is hindered by the lecture formatbut actively encouraged in workshops, scenariosand tutorial sessions.

Defining objectives is important, and can beachieved through negotiation with the learners.Allowing the learners to know what is expected ofthem and explaining how this will be assessed

generic system. Candidates are also assessed toensure that they have reached an adequate leveland receive a time-limited form of certification.With respect to ATLS, the candidate must repeatthe course every 4 years to maintain accreditation.

Despite the widespread acceptance of traumacourses, concerns have been raised at the ability ofstudents to retain the knowledge and skills taught.Similarly, the courses listed above concentrate onthe initial assessment and treatment of the traumapatient. Consequently, the subsequent manage-ment of the patients’ care is missed.

The type of short, formalised courses listedabove serve a useful purpose in setting standardsand guidelines for the management of the injuredpatient. However, they cannot be considered, asthe only method or standard in trauma education.Unfortunately, the content of courses such asATLS are commonly considered to be ‘‘the goldstandard of trauma care’’; they are not. Theyrepresent effective and well-accepted methods ofdealing with trauma patients but they are notnecessarily the perfect method for each individualpatient. They are usually aimed at relatively juniorlevels of staff in order to educate and inform themof a safe and reproducible systematic approach.Experienced clinicians may depart from the princi-ples taught on courses but still require a thoroughworking knowledge of the basic principles in orderthat they teach and demonstrate these to theirjunior staff in clinical practice.


clarifies what is required. However, goals must berealistic and should take into account the pastexperience of the learner. For example, the goalsfor a prehospital health worker may be very differ-ent to those for a trauma specialist even thoughthe underlying principles of clinical managementmay be the same.

Letting learners know how they are doing isvery important. It is natural in many cultures toconcentrate the critique on the negative aspects oflearners’ efforts. This does not work well in adulteducation and it is important that educatorsdemonstrate what is going well whilst at the sametime illustrating points for improvement. If feed-back is predominantly negative, the learner islikely to become de-motivated.

Reflection on the learning experience allows thelearner to identify areas of skill and weakness.Knowing one’s strengths and weaknesses allows amore focused approach to the learning process.Reflection can be encouraged through summaries,discussion with educators or with other learners.

4. What is needed to teach trauma?

The ultimate goal of trauma education is toimprove the quality of care delivered by learnersafter they have gone through the educative pro-cess. There are four areas of learning that areimportant for clinicians dealing with trauma:1. Knowledge.2. Skills.3. Attitudes.4. Relationships.

4.1. Knowledge

Knowledge consists of the material facts onwhich clinicians base their actions. Withoutknowledge, the clinician cannot competently treatthe patient. Its acquisition is therefore an impor-tant part of education. Part of all trauma educa-tion programmes will consist of educating learnerson the facts surrounding the subject in question.

4.2. Skills

Successfully managing trauma requires the abil-ity to perform a number of psychomotor skills.

The teaching of practical skills clearly requires adifferent approach to that of learning knowledge,although a background of facts about the proce-dure may be required. Learners cannot learn prac-tical skills from a book or from a lecture, adifferent approach is required.

4.3. Attitudes

Attitudes are an important, but commonly over-looked aspect of clinical management. It is inter-esting to see how learners with the right ‘attitude’or set of values regarding the topic in question feelmore comfortable with the educative process andgain more from it. The teaching of attitudes isdifficult and is not usually formalised. Exploringconcerns and preconceived ideas with learners canallow educators to examine attitudes and identifyareas for change. Initially, it may only be possibleto make learners aware of attitudes and valuesalthough repetition and exploration may help.

4.4. Relationships

It is rare for clinicians to deal with traumavictims on their own. Consequently, team work isa crucial component of education, particularly forthose required to act as team leaders for traumaresuscitation. Whilst it may be difficult to changethe personality of an individual during a shorttrauma educative process, it may be important tofeedback on learners how their actions and atti-tudes affect other members of the team. Thisshould be done in a positive way.

5. Methods of teaching trauma

Having identified the four domains of learningrequired it is then possible to devise specific teach-ing methods. These should have all or some of thefollowing aims:1. To improve the knowledge of the learners.2. To improve the range or degree of skill in

trauma related practical procedures.3. To improve the attitude of the learners to

trauma management.4. To improve the relationships between members

of the trauma care team.To achieve these aims, there are five basic teach-

ing methods:


1. Lectures.2. Workshops/tutorials.3. Discussion groups.4. Skill stations.5. Moulage/scenarios.

Ideally, these methods should be conducted inthe environment in which they will be used. How-ever for practical reasons this is often not possible.

5.1. Lectures

Lectures are a method of imparting facts andknowledge. They are perhaps the most traditionalway of ‘teaching’ learners and they have been usedin just about every subject. Unfortunately, theyare fairly ineffective at imparting new knowledge.The pace of learning during a lecture is determinedby the speed of the lecturer rather than the learner.Whilst this may be satisfactory for some learners itis unlikely to be satisfactory for all. Those wholearn less quickly may struggle to keep up andgain little from the experience. Work from otherareas of education has shown that learners retainrelatively little information from lecture content ifthat is the only means by which it is given. How-ever, this is not to say that lectures have no placein trauma education. They are a valuable way ofreinforcing and reviewing the prior knowledge ofthe learners. By allowing learners to study thesubject before the lecture is given, it can become auseful way of reinforcing the content and to someextent exploring any topics that need clarification.Lectures should therefore be designed to build onadequate pre-course material or prior learningexperiences.

5.2. Workshops/tutorials

Workshops and tutorials take place with smallgroups of learners led by an instructor. Unlikelectures they are designed to allow discussion, andthereby explore knowledge, attitudes and relation-ships. Small group work is suited to discussingcontentious or difficult areas within trauma man-agement and allowing learners’ previous attitudesand experiences to be discussed openly. In thisway, changes in attitude can be explored anddeveloped. The group and educator may thendevelop such ideas leading to a change in knowl-edge and attitudes. The process of discussion andpersonal interaction can help learners understandthe differing views held by other clinicians.

5.3. Discussion groups

Discussion groups, like workshops are usuallyheld with small groups of people. However, theydiffer from workshops as they are used to exploreissues for which there may be no ‘correct’ answer.Issues such as ethics, emotional support or re-source allocation represent typical examples. In-deed the views of the instructor staff may be atodds with many of the learners. When such topicsarise, the learners should be allowed to expressand discuss their views with the educators andwith other learners. This can be facilitated byseating arrangements (a circle works better thansitting in rows) and by the educators encouraginglearners to take part. Discussion groups may bevery valuable but can be difficult to lead, particu-larly if there are very forceful or shy learnersinvolved. A difficult compromise is required be-tween allowing learners to freely talk on a givensubject and ensuring that they achieve the educa-tional aims of the discussion.

The exploratory nature of discussion groupsand the typically contentious subject under discus-sion mean that this form of teaching is an excellentway of unearthing learners’ attitudes andrelationships.

5.4. Skill stations

It is clearly questionable to attempt to teachpractical skills using a lecture format, though it issurprising how often this is attempted. The learn-ing of a skill requires the learner to acquire psy-chomotor skills in an environment that allowsdiscussion and the exploration of past experiences.Skill stations should therefore take place in smallgroups with a high educator: learner ratio. Al-though it is usually not possible to practice skillson real patients there are now a range of man-nequins that can be used for the purpose. Alterna-tively cadaveric animal material may be used or, insome countries, it may be possible to use liveanaesthetised animals.

A four part approach is used to teach practicalskills:1. Instructor demonstrates without commentary.

The skill is demonstrated purely using visualcues. Their should be no verbal cues unlessthese are an essential part of the procedure.Learners are told to watch withoutinterruption.


2. Instructor demonstrates with commentary. Theskill is repeated with a verbal explanation ofeach step.

3. Instructor demonstrates with a learner pro6idingthe commentary. Each step is described by thelearner, the instructor then performs it.

4. Leaner demonstrates the skill. The learnerdemonstrates the skill with or without a verbalcommentary.

This may seem time consuming at first, butadults learn practical skills well by repetition. Adiscussion of the procedure can take place whilstlearners practice the skill. This should be directedtowards the skill in question, examining suchthings as different techniques, past experiences andcomplications. By relating the skill to other topicslearning is reinforced. For example, discussing thecomplication of central line insertion is best re-membered whilst practising the skill. Associationleads to reinforcement of the idea.

5.5. Moulage/scenarios

One of the great difficulties in teaching clini-cians about trauma is knowing how to convertknowledge and skills into an improvement in indi-vidual patient health care. Whilst such teachingmay be performed at the bedside on an ad hocbasis it is clearly not possible to do this on taughtcourses. Another method must be used to allowlearners to learn in as realistic environment aspossible. This is commonly achieved using smallgroups of learners (4–10) in ‘moulage’ or ‘sce-nario’ teaching.

A moulage is a teaching method that uses role-play based upon a clinical scenario to educate ortest the learners. A mannequin or actor may simu-late the casualty whilst an appropriate history isgiven by the instructors. The learner is then taskedto assess and treat the simulated casualty accord-ing to the protocols taught during the course.Additional information that might normally beavailable (for example blood pressure) can begiven by the instructors. One learner deals with thecasualty assisted by an instructor or fellow learner.The other learners watch the resuscitation, andmay be asked to critique the performance of theircolleague at the end. Getting learners to take partin the moulage may be difficult at first as there isoften a natural embarrassment to ‘acting out’ theirrole. This can be avoided by the instructors firstconducting a demonstration moulage.

Moulage is used to demonstrate all aspects ofinitial trauma care. It can be used to demonstratespecific skills (e.g. intubation) or to demonstratethe learners use and adherence to the ABC ap-proach. In fact any and all aspects of the initialmanagement of trauma patients may be tested.

Moulage is a very powerful learning tool as itintegrates the learners knowledge and practicalskills. Many learners find moulage stations stress-ful, this may be because they fear failing or be-cause of their embarrassment. The system is notdesigned solely to cause stress in the learners, butto get learners to apply their knowledge and skillsin a duplication of the stress of a realresuscitation.

If possible, the environment in which the learnernormally practices should be reproduced as closelyas possible. For example, an emergency physicianwould ideally be taught in the emergency depart-ment and the paramedic in the street. The equip-ment that would normally be available should beavailable to the learner so that its use may bedemonstrated. However, if the environment can-not be perfectly reproduced, this is not usually aproblem. Most learners rapidly adapt and acceptthe scenarios as valid and realistic.

6. Assessing the effectiveness of trauma education

The ability of clinicians to perform tasks orapply knowledge in trauma situations may bedetermined from real or mock situations. Suchmeasurements of process areuseful in demonstrat-ing the ability of clinicians to follow guidelinesand apply knowledge. Observing clinicians beforeand after an educational intervention can showsome improvement [17–24] (e.g. meeting ATLSguidelines after an ATLS course). However, thesemeasurements usually record compliance withwhat has just been taught and therefore are lim-ited to only looking at that particular aspect of themanagement.

As previously mentioned a large part of currenttrauma education is centred around short intensivecourses repeated several years apart. Whilst mea-sures of process studies have shown an improve-ment following such courses, there have beenconcerns regarding the ability of candidates toretain skills [25] and knowledge. Such measures ofretention are especially important when assessing


the overall effectiveness of educative interventions.Cognitive skills do decline following educative in-tervention [25], although the rate of decline maybe influenced by the background, and presumablythe ongoing skill practice of the individual [26,27].

As far as the trauma victim is concerned, thekey aspect of any educative intervention in traumamust be the patient outcome. Whilst measures ofprocess and retention may tell us much about theeffectiveness of the teaching methods it is theimpact that such interventions have on patientcare which are the most important [28]. If we areright about the need to improve the managementof trauma via better education then it should bepossible to show an improvement in mortality anda decrease in morbidity in the patient populations.Unfortunately, measuring the effectiveness ofhealth care education in terms of patient outcomeis extremely difficult. This is due to many con-founding variables, such as the heterogeneity oftrauma, the poor methods for assessing morbidityin injured patients and from the difficulty of mea-suring an effect from an intervention affectingonly one aspect of a patient’s care [29] (e.g. assess-ing initial management education without refer-ence to definitive management or rehabilitation).These difficulties are reflected in the small numberand relatively poor quality of studies looking atpatient outcome in comparison to those looking atprocess and retention [30–32].

Those studies that do try and examine the effectof education programs such as ATLS are typicallybefore and after comparisons conducted over aperiod of many years. Such studies are inherentlybiased due to the effect of passage of time and theoften-concurrent changes in other aspects of thetrauma management system [33]. Whilst somepublished research has suggested an improvementin patient outcome [34], others do not [35]. How-ever, interpreting the studies is difficult owing totheir serious methodological flaws.

Another difficulty in measuring the effectivenessof trauma education is that the number of patientsin whom education may make a difference tooutcome can be small. Within any trauma popula-tion there will be a large number of patients whowill survive or suffer a low morbidity even if thestandard of care is considerably less than thatdictated within most trauma education programs.Similarly, there will be a group of patients whoseinjuries are so severe that even with optimal,

prompt management, survival, morbidity or limbloss is inevitable. Improving the knowledge andskills of clinicians can only influence those patientswho lie between these groups of patients. In manytrauma systems, this may represent quite a smallnumber of patients [12]. If the clinical outcomecan only be influenced in a small number ofpatients within a trauma population, clinical stud-ies will need to be very large in order to detect atreatment effect. At present, vast majorities ofstudies are being conducted on relatively smallnumbers of patients.

7. Maintaining knowledge

Learning does not simply occur during taughtcourses, although these are the most visible aspectsof trauma education. All clinicians learn throughtheir own and their peers experiences and actions.Such education is difficult to define and can bedifficult to control but often exerts a profoundinfluence on an individual clinician’s behaviour.

Learners may initially acquire information fromthe literature, taught courses or discussion. How-ever, the mere acquisition of knowledge does notautomatically result in a change in behaviour. It isan assumption that information, followed by itsuse and assessment in real situations leads to agreater understanding and ultimately a more per-manent change in behaviour. Since change is a keycomponent of the educative outcome, the experi-ences of learners after they have completed aneducative program (e.g. a trauma course) areimportant.

Learners should be encouraged to constantlyassess and critique their own practice, reassessingwhat they do and identifying any gaps in theirability. Working with colleagues who understandand also use similar knowledge and principlesencourages this and may lead to a greater use ofthe original information.

Several courses stipulate a period after whichthe learner must repeat the course. This variesfrom 2 to 6 years for the better known courses.This is based on the knowledge that retention fallswith time [14–16]. However, skills fall at a vari-able rate and such rigid intervals may be too longor too short for any given individual. The audit ofan individual or group management of traumapatients may highlight gaps in individual knowl-


edge, which may then be addressed promptly.Learners must be encouraged to critique theirongoing practice.

8. Definitive management of the trauma patient

The majority of trauma education is aimed atthe initial assessment and management of the pa-tient. Some specialist courses do exist. These areprincipally aimed at the surgical specialities. Forexample, in UK orthopaedic surgery training theArbeitgemeinschaft fur Osteosynthesefragen (AO)courses are highly regarded and may form part ofthe compulsory education program in thatspeciality.

Similar courses exist in other surgical specialitiessuch as neurosurgery and general surgery. Thesecourses are specifically aimed at the individualspecialities or even on particular patterns of in-jury. Whilst this may seem appropriate for thesurgical specialities, such detailed knowledge ofinjury patterns and treatment is perhaps not essen-tial for those in working in the more generalspecialities such as emergency medicine, anaesthe-sia or prehospital care. Clinicians in these speciali-ties require a more global view of the patient,without the need for detailed knowledge of anyparticular anatomical or physiological system.However, the reverse is not true. All cliniciansresponsible for the care of injured patients musthave an understanding of the principles behind thegeneric approach to the traumatically injured pa-tient. If all clinicians dealing with an injured pa-tient are aware of the same generic principlesbehind the resuscitation, inter-speciality communi-cation is enhanced. This is because the genericprinciples of resuscitation provide the frameworkon which specialist skills can be hung [36]. Suchcommunication between specialities is vital for thedefinitive care of the trauma victim.

In terms of the methods of teaching definitivecare skills, the methods outlined above for use inadult education apply equally well.

9. When to teach the principles of traumamanagement

Trauma education must be aimed at theproviders of the trauma care. Ideally, all clinicians

working in environments where they may be ex-posed to the management of trauma patientsshould receive specific trauma training.

At present, the vast majority of trauma educa-tion is performed at the postgraduate level. Thishas the advantage of targeting the education to-wards individuals working in trauma environ-ments but does mean that training tends to occurduring, rather than before, an individual takes upa post. This has resulted in many doctors workingin trauma specialities without specific training forlong periods. To some extent, the problems can besurmounted by ensuring that senior staffs are al-ways available to deal with trauma patients butthis is not an option in many health care systems.

Moving some aspects of trauma management tothe undergraduate curriculum has clear advan-tages in ensuring that doctors receive some train-ing in trauma management before starting posts.However, this would not target the education con-tent to those interested in the subject, or eventhose who will eventually work in the trauma field.The current undergraduate curriculum is increas-ingly pressed to accommodate an ever wideningnumber of subjects, thus specific courses aimed ata condition which may be irrelevant for manyqualified doctors is probably not justified. How-ever, the approach to a trauma patient is essen-tially a generic approach to any critically ill orinjured patient. Consequently this is relevant to allmedical practitioners and therefore the genericapproach to the management of critically ill pa-tients should form part of undergraduate educa-tion [37]. Concerns regarding the ability of medicalstudents to understand and acquire the skillstaught on courses such as ATLS® are not borneout by the literature [38–40].

10. Summary

The interest in educating health care profession-als in the management of trauma is a relativelyrecent phenomenon. The nature of traumatic in-jury, and critical illness in general requires a struc-tured approach based on ABC principles. Theteaching of a generic approach to the managementof trauma patients requires the acquisition ofknowledge, cognitive skills, attitudes and relation-ships. All these skills may be taught in a structuredway using techniques aimed at adult learners.


The acquisition of skills from educative pro-cesses must be assessed in terms of improvedpatient outcome. Whilst there is ample evidence todemonstrate the effectiveness of trauma educationin improving the process of trauma care, littleevidence exists to conclusively demonstrate an im-provement in patient outcome. Further work isrequired on this issue.

In many countries the management of traumapatients is undertaken by relatively junior staff.This combined with the universal applicability ofthe generic approach to the critically ill/injuredpatient means that the care of the critically ill orinjured patient should begin at undergraduate orstudent level.

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Further Reading

Mackway-Jones and Walker, 1998K. Mackway-Jones, M.Walker (Eds.), 1998. Pocket Guide to Teaching forMedical Instructors, BMJ Publishing, London.

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Documents

Trauma education