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IT'S NOT ALL ABOUT NUMBERS: IS THE SUPPLY OF LEARNING ENCOUNTERS SUFFICIENT TO GENERATE COMPETENCE IN TRAUMA TEAM LEADERSHIP DURING HIGHER SPECIALITY TRAINING?
  1. B Graham,
  2. T Nutbeam,
  3. J Smith
  1. Plymouth Hospitals NHS Trust, Plymouth, UK

    Abstract

    Objectives & Background Higher Speciality Trainees (HSTs) are expected to gain competence required for autonomous practice as a consultant. Whether EM HSTs have adequate exposure to achieve competence in the trauma team leader (TTL) role is unclear.

    Our primary aim was to investigate whether the supply of learning encounters is sufficient to generate competence in the TTL role during HST. Secondary aims were to explore HSTs' participation in trauma calls, roles undertaken, confidence and competence within the TTL role, supervision, opinions on training and the number of TTL encounters required to attain competence.

    Methods HSTs in the West Midlands completed a survey exploring the study objectives including confidence in the TTL role. Consultants completed a separate survey assessing HST competence in the TTL role, reasons for lack of competence, and the desired number of supervised encounters required for HSTs to attain competence.

    To estimate the supply of TTL encounters available, the number of trauma calls was derived from regional and TARN data. This number was proportionally reduced to represent a 48 hour week, divided by the number of HSTs. To assess demand, the supply estimate was compared to the mean number of supervised TTL encounters specified by consultants.

    Results 27/27 eligible HSTs responded. HSTs reported attending 67% of activations during working hours, frequently in the TTL (67%) or Primary Survey roles (29%) but rarely in the airway role (3.2%). 39% of TTL encounters were supervised. 70% reported being confident in the TTL role.

    35/37 eligible consultants responded. 42% felt that their HSTs were competent in the TTL role. Common deficiencies were lack of exposure and leadership ability.

    100% of HSTs and 88.5% of consultants reported that a dedicated trauma placement would be desirable (median duration=6 months).

    Analysis estimates that the number of actual supervised TTL encounters during HST (n=33) is in keeping with the number desired by consultants (n=36) (figure 1).

    Conclusion The quantity of TTL encounters during HST broadly matches the demand for exposure specified by consultants. Despite this, there is a disparity between trainee confidence and consultant assessment of competence. Exploration of reasons underlying this difference and the desire for dedicated training may identify areas where HSTs development can be enhanced.

    Figure 1

    Flow diagram demonstrating methodology to estimate supply of supervised TTL encounters and average number of supervised TTL encounters desired by consultants.

    • emergency departments

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