Evidenced-Based Practice Among Trainees: A Survey on Facial Trauma Wound Management.

Journal of surgical education 2020 Vol.77(5) p. 1063-1068

Choi J, Traboulsi AA, Okland TS, Sadauskas V, Perrault D, Spain DA, Lorenz HP, Weiser TG

Abstract

[OBJECTIVE] Assess whether facial trauma wound care and antibiotic use recommendations are guided by evidence-based practice (EBP) or practice patterns, and investigate strategies to improve EBP adoption among surgical trainees.

[DESIGN] We conducted a survey of all trainees who manage facial trauma (general surgery, emergency medicine, plastic surgery, otolaryngology) to assess clinical knowledge and sources of treatment recommendations. Clinical questions were based on Oxford Center for Evidence-Based Medicine Level 1 or 2 evidence. We measured internal validity of questions using Cronbach's α. Results were weight-adjusted for nonresponse and then analyzed using Welch t test and descriptive statistics.

[STUDY SETTING] Stanford Hospital and Clinics, a Level I trauma center.

[RESULTS] Response rate was 50.3% overall (78/155). For recommendations on facial trauma wound and antibiotic use, nonspecialty junior residents most frequently relied on their own senior or specialty residents (79.1%); nonspecialty senior residents relied on specialty residents (67.9%). Specialty junior residents most often relied on their own senior residents (51.0%), the majority of whom made recommendations based on their own knowledge (73.2%). Questions assessing EBP knowledge had Cronbach's α of 0.98; response accuracy was similar between specialty and nonspecialty residents (54.6% vs 55.5%, p = 0.96). When provided recommendations that conflict with EBP, both nonspecialty and specialty residents more frequently followed recommendations rather than EBP; junior residents reported doing so to avoid conflict with superiors. Total 92.6% of surveyed residents felt cross-departmental EBP guidelines would improve patient care.

[CONCLUSIONS] Facial trauma wound care and antibiotic recommendations disseminate down seniority and from craniofacial specialty to nonspecialty residents, yet knowledge of EBP among senior specialty and nonspecialty residents was weak. EBP may be difficult to adopt in the absence of consensus society guidelines. To address this gap, we published a review of EBP for facial trauma and plan to update our trauma manual with cross-departmental guidelines to facilitate EBP adoption among trainees.

추출된 의학 개체 (NER)

유형영어 표현한국어 / 풀이UMLS CUI출처등장
해부 EBP → evidence-based practice scispacy 1
합병증 Facial Trauma Wound scispacy 1
합병증 wound scispacy 1
약물 [OBJECTIVE] scispacy 1
약물 [DESIGN] scispacy 1
약물 weight-adjusted scispacy 1
약물 [CONCLUSIONS] Facial trauma wound care scispacy 1
질환 Trauma C0043251
Wounds and Injuries
scispacy 1
기타 patient scispacy 1

MeSH Terms

Emergency Medicine; Humans; Internship and Residency; Otolaryngology; Surgery, Plastic; Surveys and Questionnaires