The Anatomy of Gun Violence: A contextualized curriculum designed to train surgical residents in technical and non-technical skills in handling gun violence. Photo credit: American College of Surgeons

Gun violence affects not only individuals and their communities, but also the health care providers who treat them. For surgeons, treating these victims and understanding the implications of gun violence as a public health issue requires both technical and non-technical skills. Researchers at Washington University School of Medicine in St. Louis, Missouri, developed a multidisciplinary curriculum to train surgical residents to best treat victims of gun violence and feel confident contributing to the national conversation on gun violence as a public health issue . Study results appear as “articles in the press” on the Journal of American College of Surgeons website prior to printing.

The Anatomy of Gun Violence (AGV) curriculum was developed at the Washington University School of Medicine to teach surgical trainees how to deal with gun violence while understanding the injuries associated with the public health gun violence epidemic. To achieve these goals, the curriculum was delivered to general surgery residents over six weeks in the 2017-18 and 2018-19 academic years. The curriculum includes several teaching methods: a core curriculum of didactic lectures, simulated oral examinations, a bleeding control training session, a aortic occlusion endovascular balloon (REBOA) resuscitation session, gun violence survival session, and surgery for abdominal simulation laboratory for thoracic violence (SAVE), along with other specialty programs. The authors believe this is the first attempt to educate surgical residents about gun violence as a disease process in their social context.

“We wanted to create a more holistic curriculum that included not just epidemiological aspects of gun violence, but also preventive medicine and its impact on the emotional and psychosocial parts of our lives,” said lead study author Emily J. Onufer, MD. MPH, a general surgery at Washington University School of Medicine.

In both academic years, 60 surgical residents participated in the AGV curriculum and 41 and 36 residents, respectively, took part in a survey of their experience with the curriculum. Residents reported an average improvement in knowledge of 7.5 percent, with juniors showing an even larger increase. The SAVE lab, where residents are teamed up and complete five pervasive trauma scenarios, was the highest-rated component of the curriculum. Respondents also asked for a debriefing after the SAVE Laboratory to discuss best practices and a session on safety, guidelines and opportunities for the gun advocacy profession to make them feel safe to contribute to the national gun violence conversation.

Washington University School of Medicine researchers developed a curriculum that allows surgical trainees to best treat gun violence victims and learn more about their path to survival. Photo credit: American College of Surgeons

Dr. Onufer and her co-authors emphasized the importance of the gun violence survival session in the curriculum. She said that surgeons tend to depersonalize the treatment of victims of gun violence as a coping mechanism. The survival session helped humanize and personalize the gun violence epidemic in St. Louis.

“One of the hardest things for residents in surgery is that we see these patients and do everything we can to help them, but then we can stop the service and not find out what is happening to them,” said study co-author Erin Andrade, MD, MPH, general surgeon at Washington University School of Medicine. “Bringing a patient back through the violence-at-arms survival session meant coming full circle. The survivor could come back and show us the impact we can have on a patient’s life.”

The AGV curriculum also included a section on STOP THE BLEED, which trained residents in hands-on exercises in direct manual pressure, using tourniquets, and packing wounds to stop heavy bleeding. Residents put together their own bleeding control kits during the training and had the opportunity to act as an instructor for a session with hospital environmental workers for the second year, if they had previously completed the STOP THE BLEED session. Serving as instructors gave residents an opportunity to teach life-saving skills to members of their community.

“The surgeon is relevant to the public health experience of violence. We can have an impact outside of the operating room. I think many residents, who may never have seen this possibility before, believe this,” said study co-author LJ Punch , MD, FACS, President, Power4STL, St. Louis, Mo.

Washington University School of Medicine researchers developed a curriculum that allows surgical trainees to best treat gun violence victims and learn more about their path to survival. Photo credit: American College of Surgeons

Each scenario in the AGV curriculum represented actual patients treated at the trauma center. Each scenario was also named after the residents who were involved in caring for this patient. Naming each scenario in this way has highlighted the tremendous impact that surgical trainees have on the lives of victims of gun violence. “I went through the surgery records and found the names of the residents who took care of the patient from the emergency room to the operating room and I named the case after them. It’s not something residents get feedback about often – that their work is the reason why this person lives, “said Dr. Punch.

Researchers are looking for ways to track the clinical implications of the curriculum beyond the six-week course. They noted that this is a single center experience in a municipal training program with a high prevalence of firearms injuries, which could limit the applicability of the curriculum in other regions. However, they emphasized that gun violence is an epidemic in the United States and that this curriculum provides an opportunity to standardize the teaching of piercing traumatic injuries for surgical trainees.

Combating violence against firearms as part of a public health approach is also a focus of the American College of Surgeons Task Force on Improving Social Determinants to Mitigate Violence (ISAVE), which recently outlined steps taken by the medical community must take action to understand and address the root causes of gun violence.

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More information:
Emily Jean Onufer et al. Gun Violence Anatomy: Contextualized Curriculum to Train Surgeons in Technical and Non-Technical Skills in Gun Violence, Journal of the American College of Surgeons (2020). DOI: 10.1016 / j.jamcollsurg.2020.09.025 Provided by the American College of Surgeons

Quote: A New Curriculum Helps Surgical Trainees To Comprehensively Treat Victims of Gun Violence (2020, November 2), accessed November 2, 2020 from https://medicalxpress.com/news/2020-11-curriculum-surgical-trainees-comprehensively -victims.html

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