Mark Bowyer - Independent Researcher (original) (raw)

Papers by Mark Bowyer

Soft Tissue Wounds and Fasciotomies

Virtual reality and haptic interfaces for civilian and military open trauma surgery training: A systematic review

Injury-international Journal of The Care of The Injured, Nov 1, 2022

Dunning-Kruger Effect Between Self-Peer Ratings of Surgical Performance During a MASCAL Event and Pre-Event Assessed Trauma Procedural Capabilities

Annals of Surgery Open

Objectives: The research question asked to what extent do self-rated performance scores of indivi... more Objectives: The research question asked to what extent do self-rated performance scores of individual surgeons correspond to assessed procedural performance abilities and to peer ratings of procedural performance during a mass casualty (MASCAL) event? Background: Self-assessment using performance rating scales is ubiquitous in surgical education as a proxy for direct measurement of competence. The validity and reliability of self-ratings as competency measures are susceptible to cognitive biases such as Dunning-Kruger effects, which describe how individuals over/underestimate their own performance compared to assessments from independent sources. The ability of surgeons to accurately self-assess their procedural performance remains undetermined. Methods: A purposive sample of military surgeons (N = 13) who collectively cared for trauma patients during a MASCAL event participated in the study. Pre-event performance assessment scores for 32 trauma procedures were compared with post-ev...

Feasibility Study Vascular Access and REBOA Placement: From Zero to Hero

Journal of Special Operations Medicine

BACKGROUND Vascular access is a necessary prerequisite for REBOA placement in patients with sever... more BACKGROUND Vascular access is a necessary prerequisite for REBOA placement in patients with severe hemorrhagic shock. METHODS During an EVTM workshop, 10 Special Forces (SOF) medics, five combat nurses, four military nonsurgeon physicians, and four military surgeons participated in our training program. The military surgeons functioned as the control group. A formalized curriculum was constructed including basic anatomy and training in access materials for resuscitative endovascular balloon occlusion of the aorta (REBOA) placement. Key skills were (1) preparation of endovascular toolkit, (2) achieving vascular access in the model, and (3) bleeding control with REBOA. RESULTS The baseline knowledge of anatomy for SOF medics was significantly less than that for nurses and physicians. Medics had a median time of 3:59 minutes to sheath insertion; nurses, 2:47; physicians, 2:34; and surgeons, 1:39. Military surgeons were significantly faster than medics and military nurses (ρ = .037 resp. 0.034). Medics had a median total time from start to REBOA inflation of 5:05 minutes; nurses, 4:06; military physicians, 3:36; and surgeons, 2:36. CONCLUSION This study showed that a comprehensive theoretical and practical training program using a task training model can be used for percutaneous femoral access and REBOA placement training of military medical personnel without prior ultrasound or endovascular experience. Higher levels of training reduce procedure times.

Journal of the Royal Army Medical Corps, 2018

BackgroundThe use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in patient... more BackgroundThe use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with severe haemorrhagic shock is increasing. Obtaining vascular access is a necessary prerequisite for REBOA placement in these situations.MethodsDuring the EVTM workshop (September 2017, Örebro, Sweden), 21 individuals participated in this study, 16 participants and five instructors. A formalised curriculum was constructed including basic anatomy of the femoral region and basic training in access materials for REBOA placement in zone 1. Key skills: (1) preparation of endovascular toolkit, (2) achieving vascular access in the model and (3) bleeding control with REBOA. Scoring ranged from 0 to 5 for non-anatomical skills. Identification of anatomical structures was either sufficient (score=1) or insufficient (score=0). Five consultants performed a second identical procedure as a post test.ResultsConsultants had significantly better overall technical skills in comparison with residents ...

Journal of the Royal Army Medical Corps, 2016

Introduction Military surgeons must be prepared to care for severe and complex life-threatening i... more Introduction Military surgeons must be prepared to care for severe and complex life-threatening injuries rarely seen in the civilian setting. Typical civilian training and practice do not provide adequate exposure to the broad set of surgical skills required. The German Bundeswehr Medical Service has developed and refined the War Surgery Course (WSC) to meet this training gap. This article describes the recent experience with this readiness curriculum. Methods Run annually since 1998, WSC consists nowadays of 5 days with 20 theoretical modules. Four sessions with standardised practical skills training use a live tissue porcine model, and the recently added cadaverbased Advanced Surgical Skills for Exposure in Trauma course. Sixteen military surgeons who participated in the WSC in January 2016 completed a survey of their selfrated readiness for 114 predefined emergency skills before and after completion, and provided an overall evaluation of the course. Results Self-assessed readiness improved significantly over baseline for all areas covered in both the practical skills and theoretical knowledge portions of the WSC curriculum. Additionally, all participants rated the course as important and universally recommended it to other military surgeons preparing for missions. Conclusions The WSC course format was well received and perceived by learners as a valuable readiness platform. Ongoing evaluation of this course will enable data-driven evolution to ensure a maximum learning benefit for participants. With the increasing multinational nature of modern military missions, surgeons' training should follow international standards. Continuing evolution of military surgical training courses should further encourage the sharing and adoption of best educational practices.

Attenuation of Renal Ischemia-Reperfusion Injury in Rats by Allopurinol and Prostaglandin E1

European Surgical Research, 1998

50 Sprague-Dawley rats were used to study the effect of allopurinol and prostaglandin E1 (PGE1) o... more 50 Sprague-Dawley rats were used to study the effect of allopurinol and prostaglandin E1 (PGE1) on renal ischemia-reperfusion injury. They underwent left renal ischemia for 1 h and reperfusion. A right nephrectomy was performed, and 5 groups were made. Group AP received allopurinol 50 mg/kg and PGE1 20 µg/kg; group A, allopurinol; group P, PGE1; group C, control, and group S, sham group. Five animals from each group were used to study renal functions and 5 for renal histology. The serum creatinine values were lower in the treatment groups compared to the controls on days 1–3 and 7 (p < 0.05). The blood urea nitrogen values showed a similar trend. Maximum histological damage was seen in group C, followed by groups A, P and AP, in this order. We conclude that allopurinol and PGE1 attenuate renal ischemia-reperfusion injury in rats.

Surgery, Oct 6, 2016

Training of emergency procedures is challenging and application is not routine in all health care... more Training of emergency procedures is challenging and application is not routine in all health care settings. The debate over simulation as an alternative to live tissue training continues with legislation before Congress to banish live tissue training in the Department of Defense. Little evidence exists to objectify best practice. We sought to evaluate live tissue and simulation-based training practices in 12 life-saving emergency procedures. In the study, 742 subjects were randomized to live tissue or simulation-training. Assessments of self-efficacy, cognitive knowledge, and psychomotor performance were completed pre- and post-training. Affective response to training was assessed through electrodermal activity. Subject matter experts gap analysis of live tissue versus simulation completed the data set. Subjects demonstrated pre- to post-training gains in self-efficacy, cognitive knowledge, psychomotor performance, and affective response regardless of training modality (P < .01 e...

Journal of Special Operations Medicine

Military Medicine

Introduction Preservation of life, preservation of limb, and preservation of eyesight are the pri... more Introduction Preservation of life, preservation of limb, and preservation of eyesight are the priorities for military medical personnel when attending to casualties. The incidences of eye injuries in modern warfare have increased significantly, despite personal eye equipment for service members. Serious eye injuries are often overlooked or discovered in a delayed fashion because they accompany other life- and limb-threatening injuries, which are assigned a higher priority. Prehospital military ocular trauma care is to shield the eye and evacuate the casualty to definitive ophthalmic care as soon as possible, with exceptions for treatment of ocular chemical injury and orbital compartment syndrome. Retrospective analysis of eye injuries in recent conflicts identified gaps in clinical capabilities with up to 96% of ocular injuries being suboptimally managed. Ocular compartment syndrome (OCS) is a complication associated with orbital hemorrhage, where significant morbidity occurs as a r...

Challenges and opportunities for artificial intelligence in surgery

The Journal of Defense Modeling and Simulation: Applications, Methodology, Technology

Surgery is an exceptionally complex domain where multi-dimensional expertise is developed over an... more Surgery is an exceptionally complex domain where multi-dimensional expertise is developed over an extended period of time, and mastery is maintained only through ongoing engagement in surgical contexts. Expert surgeons integrate perceptual information through both conscious and subconscious awareness, and respond to the environment by leveraging their deep understanding of surgical constructs. However, their ability to utilize these deep knowledge structures can be complicated by continuous advances in technology, medical science, pharmacology, technique, materials, operative environments, etc. that must be routinely accommodated in professional practice. The demands on surgeons to perform perfectly in ever-changing contexts increases cognitive load, which could be reduced through judicious use of accurate and reliable artificial intelligence (AI) systems. AI has great potential to support human performance in complex environments such as surgery; however, the foundational requireme...

Military medicine, 2022

INTRODUCTION As combat-related trauma decreases, there remains an increasing need to maintain the... more INTRODUCTION As combat-related trauma decreases, there remains an increasing need to maintain the ability to care for trauma victims from other casualty events around the world (e.g., terrorism, natural disasters, and infrastructure failures). During these events, military surgeons often work closely with their civilian counterparts, often in austere and expeditionary contexts. In these environments, the primary aim of the surgical team is to implement damage control principles to avert blood loss, optimize oxygenation, and improve survival. Upper-extremity vascular injuries are associated with high rates of morbidity and mortality resulting from exsanguination and ischemic complications; however, fatalities may be avoided if hemorrhage is rapidly controlled. In austere contexts, deployed surgical teams typically include one general surgeon and one orthopedic surgeon, neither of which have acquired the expertise to manage these vascular injuries. The purpose of this study was to exa...

PENETRATING INJURIES ASSOCIATED WITH pulseless

Learning and memory is preserved after induced asanguineous hyperkalemic hypothermic arrest in a ... more Learning and memory is preserved after induced asanguineous hyperkalemic hypothermic arrest in a swine model of traumatic exsanguination

Military Medicine, 2021

Introduction Airway obstruction is the third most common cause of preventable death on the battle... more Introduction Airway obstruction is the third most common cause of preventable death on the battlefield, accounting for 1%–2% of total combat fatalities. No previous surgical cricothyroidotomy (SC) studies have analyzed the learning curve required to obtain proficiency despite being studied in numerous other surgical technique training experiments. The aims of this study were to establish expert SC performance criteria, develop a novel standardized SC curriculum, and determine the necessary number of practice iterations required by a novice to reach this pre-determined performance goal. Materials and Methods A standardized checklist and SC performance standards were established based on the performance of 12 board certified Military Health System surgeons with prior experience on performing a SC using a simulated trauma mannequin. Expert-level criteria were defined as a SC time to completion of 40 s or less and checklist score of at least 9/10, including all critical steps. Study sub...

Position Paper on Education and Training in Emergency Surgery

Resources for Optimal Care of Emergency Surgery, 2020

Quality outcomes in emergency surgery are achieved by knowledge and training in emergency surgery... more Quality outcomes in emergency surgery are achieved by knowledge and training in emergency surgery. This requires standards and KPIs which need to be measured and reported regularly.

Trauma Surgery & Acute Care Open, 2021

The management of non-compressible torso hemorrhage in military austere/remote environments is a ... more The management of non-compressible torso hemorrhage in military austere/remote environments is a leading cause of potentially preventable death in the prehospital/battlefield environment that has not shown a decrease in mortality in 26 years. Numerous conceptual innovations to manage non-compressible torso hemorrhage have been developed without proven effectiveness in this setting. This scoping review aims to assess the current literature to define non-compressible torso hemorrhage in civilian and military austere/remote environments, assess current innovations and the effectiveness of these innovations, assess the current knowledge gaps and potential future innovations in the management of non-compressible torso hemorrhage in civilian and military austere/remote environments, and assess the translational health science perspective of the current literature and its potential effect on public health. The Joanna Briggs Institute for evidence synthesis will guide this scoping review to...

Journal of Surgical Education, 2020

a g g e d E n d OBJECTIVE: Scope evidence on technical performance metrics for open emergency sur... more a g g e d E n d OBJECTIVE: Scope evidence on technical performance metrics for open emergency surgery. Identify surgical performance metrics and procedures used in trauma training courses. DESIGN: Structured literature searches of electronic databases were conducted from January 2010 to December 2019 to identify systematic reviews of tools to measure surgical skills employed in vascular or trauma surgery evaluation and training.

Do Core Competency Trauma Surgical Procedural Skills Degrade with Time Since Training?

Journal of the American College of Surgeons, 2016

How Competent in Vascular Exposure and Fasciotomy Are Residents after Training?

Journal of the American College of Surgeons, 2016

Chest Tubes

Critical Care Secrets, 2007

Soft Tissue Wounds and Fasciotomies

Virtual reality and haptic interfaces for civilian and military open trauma surgery training: A systematic review

Injury-international Journal of The Care of The Injured, Nov 1, 2022

Dunning-Kruger Effect Between Self-Peer Ratings of Surgical Performance During a MASCAL Event and Pre-Event Assessed Trauma Procedural Capabilities

Annals of Surgery Open

Objectives: The research question asked to what extent do self-rated performance scores of indivi... more Objectives: The research question asked to what extent do self-rated performance scores of individual surgeons correspond to assessed procedural performance abilities and to peer ratings of procedural performance during a mass casualty (MASCAL) event? Background: Self-assessment using performance rating scales is ubiquitous in surgical education as a proxy for direct measurement of competence. The validity and reliability of self-ratings as competency measures are susceptible to cognitive biases such as Dunning-Kruger effects, which describe how individuals over/underestimate their own performance compared to assessments from independent sources. The ability of surgeons to accurately self-assess their procedural performance remains undetermined. Methods: A purposive sample of military surgeons (N = 13) who collectively cared for trauma patients during a MASCAL event participated in the study. Pre-event performance assessment scores for 32 trauma procedures were compared with post-ev...

Feasibility Study Vascular Access and REBOA Placement: From Zero to Hero

Journal of Special Operations Medicine

BACKGROUND Vascular access is a necessary prerequisite for REBOA placement in patients with sever... more BACKGROUND Vascular access is a necessary prerequisite for REBOA placement in patients with severe hemorrhagic shock. METHODS During an EVTM workshop, 10 Special Forces (SOF) medics, five combat nurses, four military nonsurgeon physicians, and four military surgeons participated in our training program. The military surgeons functioned as the control group. A formalized curriculum was constructed including basic anatomy and training in access materials for resuscitative endovascular balloon occlusion of the aorta (REBOA) placement. Key skills were (1) preparation of endovascular toolkit, (2) achieving vascular access in the model, and (3) bleeding control with REBOA. RESULTS The baseline knowledge of anatomy for SOF medics was significantly less than that for nurses and physicians. Medics had a median time of 3:59 minutes to sheath insertion; nurses, 2:47; physicians, 2:34; and surgeons, 1:39. Military surgeons were significantly faster than medics and military nurses (ρ = .037 resp. 0.034). Medics had a median total time from start to REBOA inflation of 5:05 minutes; nurses, 4:06; military physicians, 3:36; and surgeons, 2:36. CONCLUSION This study showed that a comprehensive theoretical and practical training program using a task training model can be used for percutaneous femoral access and REBOA placement training of military medical personnel without prior ultrasound or endovascular experience. Higher levels of training reduce procedure times.

Journal of the Royal Army Medical Corps, 2018

BackgroundThe use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in patient... more BackgroundThe use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with severe haemorrhagic shock is increasing. Obtaining vascular access is a necessary prerequisite for REBOA placement in these situations.MethodsDuring the EVTM workshop (September 2017, Örebro, Sweden), 21 individuals participated in this study, 16 participants and five instructors. A formalised curriculum was constructed including basic anatomy of the femoral region and basic training in access materials for REBOA placement in zone 1. Key skills: (1) preparation of endovascular toolkit, (2) achieving vascular access in the model and (3) bleeding control with REBOA. Scoring ranged from 0 to 5 for non-anatomical skills. Identification of anatomical structures was either sufficient (score=1) or insufficient (score=0). Five consultants performed a second identical procedure as a post test.ResultsConsultants had significantly better overall technical skills in comparison with residents ...

Journal of the Royal Army Medical Corps, 2016

Introduction Military surgeons must be prepared to care for severe and complex life-threatening i... more Introduction Military surgeons must be prepared to care for severe and complex life-threatening injuries rarely seen in the civilian setting. Typical civilian training and practice do not provide adequate exposure to the broad set of surgical skills required. The German Bundeswehr Medical Service has developed and refined the War Surgery Course (WSC) to meet this training gap. This article describes the recent experience with this readiness curriculum. Methods Run annually since 1998, WSC consists nowadays of 5 days with 20 theoretical modules. Four sessions with standardised practical skills training use a live tissue porcine model, and the recently added cadaverbased Advanced Surgical Skills for Exposure in Trauma course. Sixteen military surgeons who participated in the WSC in January 2016 completed a survey of their selfrated readiness for 114 predefined emergency skills before and after completion, and provided an overall evaluation of the course. Results Self-assessed readiness improved significantly over baseline for all areas covered in both the practical skills and theoretical knowledge portions of the WSC curriculum. Additionally, all participants rated the course as important and universally recommended it to other military surgeons preparing for missions. Conclusions The WSC course format was well received and perceived by learners as a valuable readiness platform. Ongoing evaluation of this course will enable data-driven evolution to ensure a maximum learning benefit for participants. With the increasing multinational nature of modern military missions, surgeons' training should follow international standards. Continuing evolution of military surgical training courses should further encourage the sharing and adoption of best educational practices.

Attenuation of Renal Ischemia-Reperfusion Injury in Rats by Allopurinol and Prostaglandin E1

European Surgical Research, 1998

50 Sprague-Dawley rats were used to study the effect of allopurinol and prostaglandin E1 (PGE1) o... more 50 Sprague-Dawley rats were used to study the effect of allopurinol and prostaglandin E1 (PGE1) on renal ischemia-reperfusion injury. They underwent left renal ischemia for 1 h and reperfusion. A right nephrectomy was performed, and 5 groups were made. Group AP received allopurinol 50 mg/kg and PGE1 20 µg/kg; group A, allopurinol; group P, PGE1; group C, control, and group S, sham group. Five animals from each group were used to study renal functions and 5 for renal histology. The serum creatinine values were lower in the treatment groups compared to the controls on days 1–3 and 7 (p < 0.05). The blood urea nitrogen values showed a similar trend. Maximum histological damage was seen in group C, followed by groups A, P and AP, in this order. We conclude that allopurinol and PGE1 attenuate renal ischemia-reperfusion injury in rats.

Surgery, Oct 6, 2016

Training of emergency procedures is challenging and application is not routine in all health care... more Training of emergency procedures is challenging and application is not routine in all health care settings. The debate over simulation as an alternative to live tissue training continues with legislation before Congress to banish live tissue training in the Department of Defense. Little evidence exists to objectify best practice. We sought to evaluate live tissue and simulation-based training practices in 12 life-saving emergency procedures. In the study, 742 subjects were randomized to live tissue or simulation-training. Assessments of self-efficacy, cognitive knowledge, and psychomotor performance were completed pre- and post-training. Affective response to training was assessed through electrodermal activity. Subject matter experts gap analysis of live tissue versus simulation completed the data set. Subjects demonstrated pre- to post-training gains in self-efficacy, cognitive knowledge, psychomotor performance, and affective response regardless of training modality (P < .01 e...

Journal of Special Operations Medicine

Military Medicine

Introduction Preservation of life, preservation of limb, and preservation of eyesight are the pri... more Introduction Preservation of life, preservation of limb, and preservation of eyesight are the priorities for military medical personnel when attending to casualties. The incidences of eye injuries in modern warfare have increased significantly, despite personal eye equipment for service members. Serious eye injuries are often overlooked or discovered in a delayed fashion because they accompany other life- and limb-threatening injuries, which are assigned a higher priority. Prehospital military ocular trauma care is to shield the eye and evacuate the casualty to definitive ophthalmic care as soon as possible, with exceptions for treatment of ocular chemical injury and orbital compartment syndrome. Retrospective analysis of eye injuries in recent conflicts identified gaps in clinical capabilities with up to 96% of ocular injuries being suboptimally managed. Ocular compartment syndrome (OCS) is a complication associated with orbital hemorrhage, where significant morbidity occurs as a r...

Challenges and opportunities for artificial intelligence in surgery

The Journal of Defense Modeling and Simulation: Applications, Methodology, Technology

Surgery is an exceptionally complex domain where multi-dimensional expertise is developed over an... more Surgery is an exceptionally complex domain where multi-dimensional expertise is developed over an extended period of time, and mastery is maintained only through ongoing engagement in surgical contexts. Expert surgeons integrate perceptual information through both conscious and subconscious awareness, and respond to the environment by leveraging their deep understanding of surgical constructs. However, their ability to utilize these deep knowledge structures can be complicated by continuous advances in technology, medical science, pharmacology, technique, materials, operative environments, etc. that must be routinely accommodated in professional practice. The demands on surgeons to perform perfectly in ever-changing contexts increases cognitive load, which could be reduced through judicious use of accurate and reliable artificial intelligence (AI) systems. AI has great potential to support human performance in complex environments such as surgery; however, the foundational requireme...

Military medicine, 2022

INTRODUCTION As combat-related trauma decreases, there remains an increasing need to maintain the... more INTRODUCTION As combat-related trauma decreases, there remains an increasing need to maintain the ability to care for trauma victims from other casualty events around the world (e.g., terrorism, natural disasters, and infrastructure failures). During these events, military surgeons often work closely with their civilian counterparts, often in austere and expeditionary contexts. In these environments, the primary aim of the surgical team is to implement damage control principles to avert blood loss, optimize oxygenation, and improve survival. Upper-extremity vascular injuries are associated with high rates of morbidity and mortality resulting from exsanguination and ischemic complications; however, fatalities may be avoided if hemorrhage is rapidly controlled. In austere contexts, deployed surgical teams typically include one general surgeon and one orthopedic surgeon, neither of which have acquired the expertise to manage these vascular injuries. The purpose of this study was to exa...

PENETRATING INJURIES ASSOCIATED WITH pulseless

Learning and memory is preserved after induced asanguineous hyperkalemic hypothermic arrest in a ... more Learning and memory is preserved after induced asanguineous hyperkalemic hypothermic arrest in a swine model of traumatic exsanguination

Military Medicine, 2021

Introduction Airway obstruction is the third most common cause of preventable death on the battle... more Introduction Airway obstruction is the third most common cause of preventable death on the battlefield, accounting for 1%–2% of total combat fatalities. No previous surgical cricothyroidotomy (SC) studies have analyzed the learning curve required to obtain proficiency despite being studied in numerous other surgical technique training experiments. The aims of this study were to establish expert SC performance criteria, develop a novel standardized SC curriculum, and determine the necessary number of practice iterations required by a novice to reach this pre-determined performance goal. Materials and Methods A standardized checklist and SC performance standards were established based on the performance of 12 board certified Military Health System surgeons with prior experience on performing a SC using a simulated trauma mannequin. Expert-level criteria were defined as a SC time to completion of 40 s or less and checklist score of at least 9/10, including all critical steps. Study sub...

Position Paper on Education and Training in Emergency Surgery

Resources for Optimal Care of Emergency Surgery, 2020

Quality outcomes in emergency surgery are achieved by knowledge and training in emergency surgery... more Quality outcomes in emergency surgery are achieved by knowledge and training in emergency surgery. This requires standards and KPIs which need to be measured and reported regularly.

Trauma Surgery & Acute Care Open, 2021

The management of non-compressible torso hemorrhage in military austere/remote environments is a ... more The management of non-compressible torso hemorrhage in military austere/remote environments is a leading cause of potentially preventable death in the prehospital/battlefield environment that has not shown a decrease in mortality in 26 years. Numerous conceptual innovations to manage non-compressible torso hemorrhage have been developed without proven effectiveness in this setting. This scoping review aims to assess the current literature to define non-compressible torso hemorrhage in civilian and military austere/remote environments, assess current innovations and the effectiveness of these innovations, assess the current knowledge gaps and potential future innovations in the management of non-compressible torso hemorrhage in civilian and military austere/remote environments, and assess the translational health science perspective of the current literature and its potential effect on public health. The Joanna Briggs Institute for evidence synthesis will guide this scoping review to...

Journal of Surgical Education, 2020

a g g e d E n d OBJECTIVE: Scope evidence on technical performance metrics for open emergency sur... more a g g e d E n d OBJECTIVE: Scope evidence on technical performance metrics for open emergency surgery. Identify surgical performance metrics and procedures used in trauma training courses. DESIGN: Structured literature searches of electronic databases were conducted from January 2010 to December 2019 to identify systematic reviews of tools to measure surgical skills employed in vascular or trauma surgery evaluation and training.

Do Core Competency Trauma Surgical Procedural Skills Degrade with Time Since Training?

Journal of the American College of Surgeons, 2016

How Competent in Vascular Exposure and Fasciotomy Are Residents after Training?

Journal of the American College of Surgeons, 2016

Chest Tubes

Critical Care Secrets, 2007