Institutionally Shared Trauma Rotations Are Viable Solutions to Deficiencies in Trauma Training

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Abstract
Numerous national trauma leaders have expressed concern about the lack of uniformity of trauma training in this country. In 1984 we instituted a trauma rotation between the University of Louisville (U.L.), with a large trauma volume, and Loyola University (L.U.) in the planning stages of trauma center development. Third year L.U. residents rotated at U.L. in 3-month blocks with an increased level of responsibility monthly, culminating in major decision-making roles and operative treatment under the chief resident''s direction. The L.U. residents functioned as full members of the team and not as passive observers. Fifteen L.U. residents and 12 U.L. residents rotated during this period. Yearly major trauma visits, helicopter flights, and trauma service admissions average 1,908, 700, and 1,520, respectively. U.L. chief residents averaged 136 major operative trauma cases and 115 nonoperative trauma cases each were managed during this time period (RRC records > 85th percentile for all U.L. residents). L.U. residents performed an average of 30 major operative cases, nine as teaching assistant, in 3 months. Each managed more than 75 nonoperative cases. Several elements are critical in such a multi-institutional rotation: 1) active communication among the program directors, 2) commitment to one sharing arragement only, 3) financing and malpractice for off-site residents, 4) housing, and 5) the ability to assimilate off-site residents as true trauma team members. The resident-to-resident interplay is crucial and has succeeded because both residency staffs have had excellent early training. Additionally, the U.L. faculty must be willing to teach judgment and technique, and critically evaluate the L.U. residents as their own and not merely treat them as "guests." The arrangement has been mutually advantageious. U.L. added needed manpower on a busy service and has enjoyed the intellectual stimulation of off-site residents. L.U. residents have acquired substantial trauma skills, including major operative experience, while their own trauma service has been developed. We commend this model of sharing to other institutions with a relative richness or paucity of major trauma as a means to eliminate a portion of the inequity in trauma training that exists nationwide.

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