Association of Women Surgeons

Abstract: The specialty of trauma/critical care is relatively new and is currently in a state of evolution as we now face not only a shortage of surgeons but also an alarmingly increasing number of well trained surgeons who are unwilling to provide emergency care. Regionalization of both trauma and emergency surgical care nationwide is on the horizon and will require major changes in our surgical training programs. However, careers in trauma/critical care and emergency surgery can offer a controlled life-style, challenging cases that cross over many disciplines, and a rich field for scientific investigation.

Keywords: Trauma, critical care, acute care emergency surgery, global health, prevention

Completion of a general surgery residency is the minimal requirement for working as a trauma surgeon. However, both academic and non-academic trauma surgeons are now opting for at least one year of post-graduate training, primarily in critical care. When choosing a general surgery residency, a student interested in trauma should select a program that includes a broad exposure to organized trauma care, including emergency department training, trauma surgical training, rotations in orthopedic, neurologic and urologic surgery as well as surgical critical care.

Because trauma surgeons must be competent in surgical critical care, a year of critical care fellowship is essential. Critical care boards cannot be obtained without at least one year of critical care training, and there are restrictions on the number of hours spent during that year that can be used for trauma surgical call (3 months on the trauma service). At the end of a one-year critical care fellowship, and provided that the candidate has already passed general surgical boards, the fellow can sit for the Special Competency exam for Surgical Critical Care through the American Board of surgery. The listing of approved trauma/critical care fellowships can be found on the Website of the American Association for the Surgery of Trauma (www.aast.org).

Many programs offer a two-year fellowship, one to fulfill the critical care training, and the second for added experience in trauma surgery. (Note: There is currently no separate board for trauma surgery itself). Trauma fellowships are designed to allow the trainee to learn about the various components of running an organized trauma service (i.e. trauma registry, trauma performance improvement) and to spend time as a junior attending under the guidance of an experienced trauma surgeon. A complete list of RRC Approved Critical Care fellowships can be obtained at the Website of the American Association for the Surgery of Trauma (AAST).⁽¹⁾ Trauma fellowship and trauma research opportunities are also listed on that Website.

Acute Care Surgery

A new paradigm for surgical training is emerging even as this paper is being written. The concept was designed to assure that, as general surgery has become increasingly specialized and fragmented, the acute care surgical fellowship will provide broadly training for surgeon in surgical emergencies, trauma care, and critical care. The curriculum has been finalized and one institution to date has undergone a successful site visit. An example of such a curriculum can be viewed in the newly published book: Acute Care Surgery: Principles and Practice. (Britt, Editor in Chief).⁽⁷⁾ Once again, there has been no decision to date on whether or not this new curriculum will be "certified" by the American Board of Surgery.

Residents who wish to pursue careers in trauma surgery should seek out research positions from one of the 10 NIH centers who have trauma training grants. These grants are designed for residents who plan an academic trauma career and are usually for 2 years during mid-residency. Both basic and clinical research are included at most centers. The NIH-Trauma Training Centers are listed on the AAST Website (www.aast.org). 

Funds for research at the faculty level in trauma are very limited. The American Association for the Surgery of Trauma funds several trauma research fellows per year, at the junior faculty level. NIH funds some basic laboratory work of interest to trauma/critical care surgeons but very little in the area of clinical work. However, the Center for Disease Control for Research and Prevention funds 11 Centers of Excellence in Trauma Care and Injury Prevention. Additional funds for injury and violence prevention projects for individuals are also available from the CDC (www.CDC.gov).  

Members and Associate members of the American College of Surgeons (FACS) can join their local Chapter's Committee on Trauma. By working with the National COT, the Committees on Trauma assist with designation of trauma centers, organizing trauma systems, education of trauma professionals (including sponsoring the Advanced Trauma Life Support Course), advocating for trauma legislation, and injury prevention activities.(www.facs.org; trauma)

This is the largest academic association of trauma surgeons. Their goal is to promote trauma research and dissemination of research findings to the trauma surgical community. Membership requires that the surgeon be a fellow of the ACS and usually has established him/herself in a community as a trauma surgeon for at least 1-2 years after completion of residency/fellowship. (www.aast.org)

This is another large group of both academic and community surgeons that holds annual meetings with formal paper presentations. Additionally, they have developed some very active subcommittees that focus on practice guidelines and trauma literature reviews. Their prevention committee has also been very active. The membership tends to be younger than that of the AAST and it is a good place for a junior attending to present her first national scientific paper. (www.east.org)

The WTA is the only trauma group with wide-spread representation from trauma sub-specialists (i.e. orthopedic surgeons, ENT, emergency medicine, neurosurgery, thoracic surgery). The scientific presentations are of high quality and most papers are found acceptable for publication in the Journal of Trauma and Critical Care. The subspecialty involvement is critical in trauma care, and the WTA will only allow 40% of its 125 members to be from any one field of trauma. This is a great meeting for residents, fellows, and junior faculty to attend, but one must be invited by a member. The multi-center study group from WTA has published over 20 papers and they are heavily cited in the trauma literature. (www.westerntraumaassociation.org)

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3. Emergency Medical Services Systems Act of 1973, Public Law 93-154. Washington D.C. 1973.
    
4. American College of Surgeons Committee on Trauma: Resources for optimal care of the injured patient 2006. American College of Surgeons, Chicago, 2006.
    
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7. Acute Care Surgery: Principles and Practice. L.D.Britt, D.D. Trunkey, D.V. Feliciano (eds). 2007, Springer, New York.
    
8. Panosian C, Coates TJ: The new medical "missionaries"-grooming the next generation of global health workers. New Engl Journal of Medicine. 2006;354:1771.