E. J. Onufer1, D. R. Cullinan1, E. G. Andrade1, P. E. Wise1, M. E. Klingensmith1, L. J. Punch1 1Washington University,Surgery,St. Louis, MO, USA
Introduction: Gun Violence (GV) is a complex public health issue which poses unique challenges to the practice of surgery. The management of GV as a disease engages the surgeon in a wide range of both technical and non-technical skills. The Anatomy of Gun Violence (AGV) curriculum was developed to teach surgical trainees these seemingly disparate skills, training residents to manage gunshot wounds in a contextualized setting. Moving beyond the technical aspects of treating penetrating injuries, this curriculum examines the risks for and experience of GV as well as the need for strong leadership, communication, and empathy in the management of GV.
Methods: The AGV curriculum was delivered over six weeks in the 2017-18 academic year and utilized multiple educational methods including didactic lectures, senior resident lead mock oral examination of junior residents, Stop the Bleed training session, a GV survivor’s personal story, and the Surgery for Abdominal-thoracic ViolencE (SAVE) simulation lab. The lab emphasized team-training in operative management of GV in an animate model, featuring stories of real patients treated by resident teams over the prior year. Content reviewed included epidemiology of GV, patterns of injury, management of critically ill patients, effect of GV on mental health, coordinated systems of care, and the importance of team work in managing of GV. Residents were evaluated via survey to assess skills obtained, team leadership, communication styles, overall experience of the curriculum.
Results: 63 surgical residents experienced the AGV curriculum and 42 completed a survey regarding their experiences (67% response rate). Prior to residency, 10 of 42 (24%) residents reported any type of training related to GV. 71% of residents had never heard someone speak about their experience as a GV survivor, and 89% believed this session positively contributed to their understanding of GV. The SAVE lab was the most highly favored with no significant difference between other portions of the curriculum. Overall AGV was rated highly at 4.9/5.0 with individual components rating 4.5-4.8/5.0 (Figure).
Conclusion: Through simulation, didactic, and immersive sessions, AGV created a simultaneous experience of the technical and non-technical skills necessary to manage the complex GV epidemic. The curriculum was well received in both these areas of competency. This comprehensive approach to GV may represent a unique opportunity to engage surgical trainees in both the treatment and prevention of GV.
