Disparities in trauma care education: An observational study of the ATLS course within a national trauma system |
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| Institution: | 1. Israel Defense Force Medical Corps, Tel Hashomer, Ramat Gan, Israel;2. Department of Military Medicine, Hebrew University, Jerusalem, Israel;3. Military Medical Academy, Israel Defense Force, Negev, Israel;4. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;5. Department of General Surgery and Shock Trauma Center, Hadassah - Hebrew University Medical Center, Jerusalem, Israel;1. Control Theory and Engineering, School of Astronautics, Harbin Institute of Technology, Harbin, China;2. Shenzhen Engineering Lab for Medical Intelligent Wireless Ultrasonic Imaging Technology, Harbin Institute of Technology, Harbin, China;1. Department of Trauma and Acute Care Surgery, Atrium Health—Carolinas Medical Center, Charlotte NC, USA;2. Campbell University School of Osteopathic Medicine, Lillington NC, USA;3. Department of Trauma and Acute Care Surgery, Atrium Health Cabarrus, Concord NC, USA |
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| Abstract: | BackgroundDisparities in trauma systems, including gaps between trauma center levels, affect patient outcomes. Advanced Trauma Life Support (ATLS) is a standard method of care that improves the performance of lower-level trauma systems. We sought to study potential gaps in ATLS education within a national trauma system.MethodsThis prospective observational study examined the characteristics of 588 surgical board residents and fellows taking the ATLS course. The course is required for board certification in adult trauma specialties (general surgery, emergency medicine, and anesthesiology), pediatric trauma specialties (pediatric emergency medicine and pediatric surgery), and trauma consulting specialties (all other surgical board specialties). We compared the differences in course accessibility and success rates within a national trauma system which includes seven level 1 trauma centers (L1TC) and twenty-three non-level 1 hospitals (NL1H).ResultsResident and fellow students were 53% male, 46% employed in L1TC, and 86% were in the final stages of their specialty program. Only 32% were enrolled in adult trauma specialty programs. Students from L1TC had a 10% higher ATLS course pass rate than NL1H (p = 0.003). Trauma center level was associated with higher odds to pass the ATLS course, even after adjustment to other variables (OR = 1.925 95% CI = 1.151 to 3.219]). Compared to NL1H, the course was two-three times more accessible to students from L1TC and 9% more accessible to adult trauma specialty programs (p = 0.035). The course was more accessible to students at early levels of training in NL1H (p < 0.001). Female students and trauma consulting specialties enrolled in L1TC programs were more likely to pass the course (OR = 2.557 95% CI = 1.242 to 5.264] and 2.578 95% CI = 1.385 to 4.800], respectively).ConclusionsPassing the ATLS course is affected by trauma center level, independent of other student factors. Educational disparities between L1TC and NL1H include ATLS course access for core trauma residency programs at early training stages. Some gaps are more pronounced among consulting trauma specialties and female surgeons. Educational resources should be planned to favor lower-level trauma centers, specialties dealing in trauma care, and residents early in their postgraduate training. |
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