A General Needs Assessment for Postgraduate Canadian Trauma Training in General Surgery

Background: Trauma is considered a key component of surgical training. However, recent changes in practice patterns and training paradigms have resulted in a critical review of curricula for surgical residents. Specifically, a shift towards non-operative management of traumatic injuries, improvements in motor vehicle safety, and reduced resident work-hours have led to a critical decrease in surgical exposure to trauma. The purpose of this study is to perform a general needs assessment of trauma curricula for general surgery residents across Canada. Study Design: The study design consisted of three parts: (1) a detailed review of existing curricula across Canada; (2) semi-structured interviews with trauma education experts from various sites across the country; and (3) focus groups with varied stakeholder groups. Participants were selected using purposive sampling. Interview guides were designed using two related curricular conceptual frameworks; Kern’s systems-based approach to curriculum development and Lee's four-dimensional curriculum framework for the health professions. The initial interview tool was piloted and initial data led to modifications in successive iterations. Qualitative analysis was performed using inductive thematic analysis by two independent reviewers in order to identify key themes and subthemes. Results: Four trauma education experts participated in the semi-structured interviews and four separate focus groups with varied stakeholders were conducted. Through inductive thematic analysis, two main themes were identified: (1) institutional context and (2) transferability of curricular components. Institutional context was further broken down into sub-themes of culture, resources, trauma system, and trauma volume. Transferability was applied to the broad categories of trainee outcomes and education strategies. A new conceptual framework was developed to guide ongoing curricular reform for trauma within the context of general surgery training. Conclusion: This general needs assessment for trauma training in Canada has provided valuable data to guide a national curriculum development process. We believe that the framework presented here is also generalizable to other settings using appropriate contextual lenses.