Importance of having a level 1 trauma center?

[pocket-medicine]

I go to med school that has a busy level 1 trauma center and we were all required to do a trauma rotation as a third year. I am going into general surgery and I feel like regardless of what field you're interested in, trauma experience is really important. It trains you to think fast and become very competent in critical care.
Now that I'm interviewing for gen surg spots, I was wondering what everyone thinks about the importance of having a level one trauma center at your home program. Many programs that don't have it claim that
1) They'll send you to another institution to do a trauma month
2) You'll learn to hate trauma
3) Our level 2 trauma center is just as intense

I feel like doing a separate rotation at another hospital is just not the same as having one at your own program all the time.
I am not necessarily interested in going into trauma/cc but would like to be a competent general surgeon that takes trauma calls. What are your thoughts?

---

Members don't see this ad.

 

[balaguru]

Good for you for having that insight as a student. I didn't appreciate how much of a confidence booster a good trauma experience was until I was a resident. To answer your questions, it all depends.
1. If they are sending you somewhere else for trauma what about critical care? A big part of taking care of trauma patients is managing them in the unit. Also, since your chief year must be spent at your home institution the oldest you could be and do an away is a PGY4. If a trauma patient becomes operative are you going to be doing that case with a fellow and maybe even an attending scrubbed in. After all, how much can they trust a resident that's only rotated with them for a few months over a 4 year period.
2. Just about everybody hates trauma as a resident--especially when call is over and you round on your rock garden. That point is irrelevant.
3. If the level 2 trauma program at the home institution is truly busy then probe them about it. If there's a service dedicated to taking only trauma call then it's probably pretty busy. You can ask them for stats about the number of level 1 activations, operative cases and such.

I'm not sure I buy the point that level 2 hospitals ship out nonoperative stuff...at least, they shouldn't be. Transfers are tracked and if those hospitals are billing the activation fee and then transferring inappropriately they could get into big trouble. I work at a few level 2 hospitals and we rarely send anything out. The only stuff we seem to send out are ocular trauma, rare OMF trauma and some operative pelvic fractures. Level 2 centers are required to have neurosurgery coverage and at least in my experience the average neurosurgeon can handle most of the stuff that comes in. Also, I wouldn't call severe TBI nonoperative. They can be your biggest source of tracheostomies, G tubes and IVCF's for the junior residents.

 

[Winged Scapula]

I go to med school that has a busy level 1 trauma center and we were all required to do a trauma rotation as a third year. I am going into general surgery and I feel like regardless of what field you're interested in, trauma experience is really important. It trains you to think fast and become very competent in critical care.
Now that I'm interviewing for gen surg spots, I was wondering what everyone thinks about the importance of having a level one trauma center at your home program. Many programs that don't have it claim that
1) They'll send you to another institution to do a trauma month
2) You'll learn to hate trauma
3) Our level 2 trauma center is just as intense

I feel like doing a separate rotation at another hospital is just not the same as having one at your own program all the time.
I am not necessarily interested in going into trauma/cc but would like to be a competent general surgeon that takes trauma calls. What are your thoughts?

Ditto great question (was getting boring around here).

Disclosure #1: I don't do trauma any more
Disclosure #2: I've only trained at Level 1 trauma centers (med school, residency and fellowship)

I don't think any one will argue #2. Trauma is draining, depressing (alcoholics hitting grannies, gang bangers shooting each other and sometimes innocent baby bystanders, teenagers fooling around and dying) and sometimes, if you're lucky, boring. There are lots of procedures generally, regardless of Level 1 or 2. Good for med students and junior residents because you might actually get to participate in some lines, PEGs, trachs etc. As noted above, operative trauma is increasingly less common. However, #2 is irrelevant if you do decide to do trauma full time as an attending. The programs that say, "you'll learn to hate it" are probably right but are using that, IMHO, as an excuse to downplay their lack of training in that arena.

Number #3 *might* be true. Disclosure #3: ex is a trauma surgeon at a Level 2. He was at a L2 during residency and chose it for practice because he didn't want to the academic hassles of a L1. He still sees a lot of operative trauma and ICU time living in a city with a lot of stupid drunk people. So, it would depend on where you're doing the rotation at. Maybe you don't see Peds trauma (that's probably a good thing) at an L2; the data should be available to you as @balaguru notes and its pretty easy to see who has volume and who doesn't. You'll want data on SICU admissions, TICU (if they have one), operative volume, # of trauma alerts, other residencies and coverage.

I'm not convinced that a "trauma month" is enough and surely cannot replace the draining…oops sorry I meant training…in a Level 1. If you wish to be a GS competent to handle trauma, my belief is that if your residency is at a L1 center, you don't need a fellowship (except for CC cert or bragging/marketing rights). Are you on trauma call when not on service? That would "enhance" your trauma experience outside of the "month" on service.

SICU training is just as/if not more important/maybe the same as than a dedicated trauma month.

Ok, so chardonnay at 10,000 ft over Denver is kicking in, so I'm going for a cat nap.

 

[mimelim]

We aren't a level 1 trauma center and rotate at one nearby. We do 5 months of trauma including 2 months as a chief and we aren't even gen surg... How anyone can poo poo trauma training is mind blowing to me.

 

[vhawk]

Because some of us have done more than 5 months, and trauma is soul-crushing for all the reasons WS mentions. I did 7 months of trauma in first 4 years, and that doesnt even include 7 more months of night float which is basically just "trauma at night." Now thats probably not representative and the average program probably does less, but it is very easy for me to understand how one could "poo poo" [sic] trauma training.

 

[Winged Scapula]

Because some of us have done more than 5 months, and trauma is soul-crushing for all the reasons WS mentions. I did 7 months of trauma in first 4 years, and that doesnt even include 7 more months of night float which is basically just "trauma at night." Now thats probably not representative and the average program probably does less, but it is very easy for me to understand how one could "poo poo" [sic] trauma training.

Exactly. We did about the same amount (I think it was 2 months each PGY1 and 2, and 3 months each as PGY 4 and 5) and then you cover it on call at night (we didn't have NF back then).

And let's not forget SICU which is a lot of trauma patients as well.