Table 2.
Summary of included studies.
| First author | Course location | Course audience | Course assessment | Results | Kirkpatrick level of evaluation |
|---|---|---|---|---|---|
| Primary trauma care courses | |||||
| Muzzammil M, 2021 [10] | Pakistan | Physicians (n = 3770) Medical students (n = 2200) Postgrad trainees (n = 782) Paramedics (n = 1100) |
30 MCQ pre- and post-test Confidence matrix |
Mean MCQ score increased from 60% to 82% Confidence score increased from 70% to 93% (p values not reported) |
2 |
| Tolppa T, 2020 [11] | Democratic Republic of Congo | Physicians (n = 36) Nurses (n = 23) |
20 MCQ pre- and post-test 8 Item confidence matrix (CM) Post-test and CM repeated at 12 months (Group A, n = 13); 16 months (Group B, n = 9); 24 months (Group C, n = 29) |
Mean MCQ score increased from 43.8% to 70.5% (p < 0.001) Confidence score increased from 57% to 81% (p < 0.001) Retention testing: Group A: MCQ = 71%, CM = 75% Group B: MCQ = 70%, CM = 87.5% Group C: MCQ = 65.5%, CM = 67% |
2 |
| Uma K, 2020 [12] | India | Senior medical students (n = 327) | 20 MCQ pre- and post-test | Mean MCQ score increased from 30% to 56% (p < 0.001) | 2 |
| Sadiq MA, 2018 [13] | Pakistan (Foundation University Medical School, Islamabad) |
Senior medical students (n = 77) | 30 MCQ pre-and post-test | Mean MCQ score increase from 53.3% to 70% (p < 0.000) | 2 |
| Ologunde R, 2017 [14] | COSECSA Countries (Burundi, Ethiopia, Kenya, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia, Zimbabwe) | Physicians (n = 253) Nurses (n = 98) Clinical officers (n = 40) Medical students (n = 44) |
Post-course trauma systems survey (immediately post-course and 6 months) | 6 months post-course 92.7% of participants reported improvement in trauma management; 26% reported an increase in staffing for trauma; 29% reported improvement in equipment to care for trauma patients; 24.8% reported perceived change in mortality rates for trauma patients | 4 |
| Peter NA, 2016 [15] | COSECA Countries | Physicians (n = 450), Nurses (n = 260), Clinical Officers (n = 119), Medical Students (n = 111) | 30 MCQ pre- and post-test 8 Item confidence matrix |
Mean MCQ score increased from 58% to 77% (p < 0.05) Confidence increased 68% to 90% (p < 0.05) |
2 |
| Nogaro MC, 2015 [16] | COSECSA Countries | Physicians (n = 240) Non-physicians (105) |
30 MCQ pre- and post-test 8 Item confidence matrix |
Mean MCQ score increased from 70% to 87% (p < 0.05) Confidence increased 73% to 95% (p < 0.05) |
2 |
| Jawaid M, 2013 [17] | Pakistan | Physicians (n = 21) | 30 MCQ pre- and post-test 20 point OSCE |
Median MCQ score increased from 65% to 83.3% (p < 0.0001) Median OSCE Scenario score increased from 17.5% to 47.5% (p < 0.0001) |
2 and 3 |
| Amiri H, 2013 [18] | Iran | Physicians (n = 64) | 30 MCQ pre- and post-test, retention post-test randomly administered between 6 and 12 months | Median MCQ score increased from 62.8% to 89% (p < 0.001) and for delayed post-test to 73.9% (p < 0.001) | 2 |
| Trauma Evaluation and Management (TEAM) courses | |||||
| Soomro R, 2020 [19] | Pakistan | Senior medical students (n = 294) | 20 MCQ test given afterward teaching (Group A, n = 105), ward teaching plus TEAM book and video (Group B, n = 92), ward teaching plus full TEAM course (Group C, n = 97) | Mean MCQ score was 30% in Group A, 40% in Group B, and 45% in Group C (p = 0.000) | 2 |
| Berndtson AE, 2019 [20] | Ghana | Senior medical students (n = 62) | 18 MCQ pre- and post-test, 6 month retention post-test | Mean MCQ score increased from 44.2% to 69.1% (p < 0.001) and for 6 month post-test to 81.6% (p < 0.01) | 2 |
| Hill KA, 2018 [21] | Kenya | Senior medical students (n = 61) | 20 MCQ pre- and post-test | Mean MCQ score increased from 57% to 72% (p < 0.001) | 2 |
| Delgado-Reyes L, 2016 [22] | Mexico | Pre-Clinical medical students (n = 71) Clinical cycle medical students (n = 44) |
20 MCQ pre- and post-test | Mean MCQ score increased by 24.4% (p < 0.01) for pre-clinical group Mean MCQ score increased by 22.5% (p > 0.05) for clinical group |
2 |
| Ali J, 2003 [23] | Jamaica | Senior medical students (n = 32) compared with control group of senior medical students | 20 MCQ pre-and post-test | TEAM group increased mean score from 53.1% to 69.4% TEAM group post-test scores (69.4%) higher than No Team post-test (52.2%) (p < 0.0001) |
2 |
| Trauma Team Training (TTT) courses | |||||
| Pemberton J, 2013 [24] | Guyana | Physicians (n = 20) Nurses (n = 17) Paramedical (n = 10) |
15 MCQ pre- and post-test, 4 month retention post-test OSCE graded group simulation post-course and at 4 months |
Mean MCQ score increased from 72.6% to 84.6% (p < 0.0001) and for 4 month post-test to 80% (p < 0.0001) Mean OSCE score dropped from 76% to 63.8% (p < 0.0001) at 4 months post-course |
2 and 3 |
| Bergman S, 2008 [25] | Tanzania | Physicians (n = 7) Nurses (n = 13) |
15 MCQ pre- and post-test OSCE graded group simulation |
Mean MCQ score increased from 60% to 86.6% (p = 0.0004) Teams scored range of 84% to 96% on group simulation |
2 and 3 |
| Acute Trauma Care (ATC)-Fundamental Critical Care Support (FCCS) combined courses | |||||
| MacLeod JBA, 2010 [26] | Zambia Kenya |
Medical officers (n = 27) COSECA trainees (surgeons) (n = 21) Clinical officers (n = 13) Nurses (n = 14) |
20 MCQ pre-test 30 MCQ post-test 37 Item confidence matrix |
Mean MCQ score increased by 12.3% (p < 0.0001) Confidence increased from 78% to 94% (p < 0.0001) for trauma scenarios and from 66% to 86% (P < 0.0001) for procedures |
2 |
| Rural Trauma Team Development Course (RTTDC) | |||||
| Ali J, 2015 [27] | India | Total (n = 43); Participant cadres undifferentiated | 20 MCQ pre- and post-test | Mean MCQ score increased from 32% pre-test to 66% post-test (p < 0.0001) | 2 |
| Ali J, 2014 [28] | Pakistan | Physicians (n = 10) Nurses (n = 2) |
20 MCQ pre- and post-test | Mean MCQ score increased from 65% pre-test to 70% post-test (p < 0.05) | 2 |
| Better and Systematic Team Training (BEST) Courses | |||||
| Hanche-Olsen TP, 2015 [29] | Botswana | Total (n = 977); Participant cadre numbers undifferentiated but included general surgeons, medical officers, nurses, xray techs, lab techs, physiotherapists | Prospective systems analysis adapted from WHO “Guidelines for Essential Trauma Care” performed at all 27 government hospitals in Botswana before course and 2 year follow-up 64 Item equipment checklist 59 Item trauma skills checklist |
55% of hospitals instituted a local trauma committee 14.8% of hospitals developed a trauma registry Equipment and skills for assisting airway and breathing increased in most hospitals, particularly for pediatric population Availability of diagnostic imaging did not improve |
4 |
| Emergency room trauma courses | |||||
| Shrestha, 2018 [30] | Nepal | Physicians (n = 97) (new interns) |
25 MCQ pre- and post-test 25 Item OSCE |
Mean MCQ score increased from 64.2% pre-test to 89.8% post-test (p = 0.000) Mean OSCE score increased from 33.2% pre-test to 78.6% post-test (p = 0.000) |
2 and 3 |
| Kampala Advanced Trauma Courses (KATC) | |||||
| Ullrich SJ, 2020 [31] | Uganda | Physicians (n = 106) | Confidence matrix assessed through post-course survey administered average 1 year after course completion | 80% of participants were confident performing all skills with the exception of venous cutdown | 2 |
| Novel/pilot courses | |||||
| Babu BV, 2021 [32] | India “AIIMS Trauma Assessment and Management” (ATAM) |
Physicians (n = 315) Nurses (n = 345) Medical students (n = 33) Paramedical/Allied Health (n = 50) |
30 MCQ pre- and post-test Self-rated knowledge, skill, confidence, and capability pre- and post-training on 10 point scale |
Mean MCQ increased from 51.6% to 75% (p < 0.0001) Mean self-rated scores: Knowledge 45% to 75%; Skill 44% to 76%; Confidence 46% to 78%; Capability 47% to 78% (p < 0.0001) |
2 |
| Taylor S, 2021 [33] | Dominican Republic | Resident physicians (n = 29) Medical students (n = 36) |
40 MCQ pre- and post-test and 2 month retention | Mean MCQ increased from 37.2% pre-test to 63.5% post-test and 52.2% at 2 months (p < 0.0001) | 2 |
| Figueroa JF, 2020 [34] | Ecuador “Basic Trauma Course” |
Resident physicians (n = 39) | 30 MCQ pre- and post-test and 1 year retention | Mean MCQ increased from 23.9% to 25.5% post-test (p < 0.01) and 23.8% at 1 year | 2 |
| Tang H, 2020 [35] | China “China Trauma Care Training” |
Physicians (n = 854) Nurses (n = 357) |
20 MCQ pre- and post-test | Mean MCQ increased from 71% to 84.2% (p < 0.001) | 2 |
| Anderson GA, 2018 [36] | Uganda “Emergency Ward Management of Trauma” |
Physicians (n = 15) | 20 MCQ pre- and post-test | Mean MCQ scores improved from 67.5% pre-test to 86.3% post-test (p < 0.001) | 2 |
| Oussi N, 2018 [37] | Malawi | Physicians (n = 13) Nurses (n = 2) |
33 MCQ pre- and post-test and 6 month post-test 5 Question confidence matrix |
Mean MCQ scores improved from 69% to 81.5% post-test(p = 0.001) and 77.8% (p = 0.003) 6 months post- test Confidence score increased 12% |
2 |
| Wanjiku G, 2017 [38] | Kenya | Medical students (n = 22) | 23 MCQ pre- and post-test and 9 month retention 36 Question confidence matrix OSCE scored with 116 point check list |
Mean MCQ scores improved from 62% to 73% post-test (p < 0.0001) to 75% at 9 months OSCE scores improved from 32.6% to 70% post-course and to 61.7% at 9 months Confidence score increased from 60% to 94% post-course and to 91.8% at 9 months |
2 and 3 |
| Pringle K, 2015 [39] | Nicaragua | Physicians (n = 33) | 26 MCQ pre- and post-test OSCE scored with 100 point check list |
Mean MCQ scores improved from 58% pre-test to 75% post-test (p < 0.001) Mean Simulation scores improved from 39% to 68% (p < 0.01) |
2 and 3 |
| Noordin S, 2011 [40] | Pakistan | Physicians (all residents and faculty from multiple specialties, number not given) | Quasi-experimental cohort study: Compared in-hospital mortality, hospital and ICU length of stay for patients prior to course implementation (Group A) and after course (Group B) | Group B (n = 574) had lower mortality rate (5.7%) compared to Group A (n = 435) (9.7%, p = 0.019) ICU stay was longer for Group B 2.3 days compared to Group A 1.7 days (p = 0.006); Hospital stay was shorter for Group B (5.9 days) compared to Group A (6.3 days) but not statistically significant |
4 |
| Aboutanos MB, 2007 [41] | Ecuador | Physicians (n = 26) | 30 MCQ pre- and post-test OSCE (Pass/Fail) |
Mean MCQ scores improved from 72% to 79% post-test (p < 0.032) 76% participants passed OSCE |
2 and 3 |
| Tchorz KM, 2007 [42] | India “Essential Principles and Practices of Trauma Care” |
Physicians (n = 32) | 20 MCQ pre- and post-test | Mean MCQ scores improved from 70.7% to 87.5% post-test (p = 0.000) | 2 |
| Mock CN, 2004 [43] | Ghana “Kwame Nkrumah University of Science and Technology Trauma Course” |
Physicians (n = 83) | 30 MCQ pre- and post-test | Mean MCQ scores improved from 69% to 80% post-test (p < 0.001) | 2 |