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Trauma Training Courses and Programs in Low- and Lower Middle-Income Countries: A Scoping Review

Injury or trauma is the leading cause of death in low- and lower middle-income countries (LMIC). If implemented effectively, trauma training programs can improve injury outcomes. Through a scoping review, Livergant, Demetrick, Cravetchi, et al, have provided recommendations to improve how training programs are delivered to improve trauma care. Livergant, the lead author, is a third year medical student at the ¾ÅÐãÖ±²¥ and former research assistant with the Office of Global Surgery at the ¾ÅÐãÖ±²¥. This is her second first author publication. See abstract below for more details or .

Abstract

Background- Injury is the leading cause of morbidity and mortality in low- and lower middle-income countries (LMICs). Trauma training is a cost-effective way to improve injury outcomes. Several trauma programs have been implemented in LMICs; however, their scope and effectiveness remain unclear. In this review, we sought to describe and assess the current state of trauma training in LMICs.

Methods- We searched MEDLINE, Embase, Global Health, Cochrane Library, and ProQuest Dissertations & Theses Global for trauma training courses in LMICs. An additional gray literature search was conducted on university, governmental, and non- governmental organizations’ websites to identify trauma-related postgraduate medical education (PGME) opportunities.

Results- Most studies occurred in sub-Saharan Africa and participants were primarily physicians/surgeons, medical students/residents, and nurses. General and surgical trauma management courses were most common, followed by orthopedic trauma or plastic surgery trauma/burn care courses. 32/45 studies reported on participant knowledge and skills, 27 of which had minimal follow-up. Of the four studies commenting on cost of courses, only one demonstrated cost-effectiveness. Three articles evaluated post-course effects on patient outcomes, two of which failed to demonstrate significant improvements. Overall, 43.0% of LMICs have PGME programs with defined trauma competency requirements.

Conclusions- Current studies on trauma training in LMICs do not clearly demonstrate sustainability, cost-effectiveness, nor improved outcomes. Trauma training programs should be in response to a need, championed locally, and work within a cohesive system to demonstrate concrete benefits. We recommend standardized and contextualized trauma training with recertifications in LMICs for lasting and improved trauma care.