Training orthopaedic specialist trainees

We read with interest the results of Eardley et al. regarding trainee perceptions of damage control orthopaedics (DCO) and early total care (ETC) trauma management. They subdivide perceived exposure, decision making, operative role and adequacy of training with regards to DCO, ETC and management of the floating knee with vascular compromise. The authors state that overall perceptions in confidence and adequacy of training are generally positive. We wonder if this sentiment is misplaced. The example of a floating knee with vascular compromise is a potentially limb-threatening injury, which, as noted, is rare. Only 29.7% of trainees (the largest subdivision) consider themselves fully confident in their decision making and stabilisation in this scenario. This is interesting considering that 31.5% have never seen a case and a further 37.5% have witnessed one only every 2 years. The perceived operative role of trainees for this injury is 32.8% to be performing the procedure. As noted by the authors, this perceived operative role is not supported by actual logbook data. To optimise outcome, major trauma needs senior-led care to direct decision making, surgical action and also facilitate teaching of trainees.1,2 Similarly, surgical exposure and experience is demonstrated to improve outcome, decrease complication rate and length of stay.3–5 These data imply an over-confident cohort of trainees, perceiving themselves proficient at managing trauma they may have not previously witnessed. It would have been useful to see the data stratified into trainee years to assess confidence as training progresses. More importantly, it would be valuable to assess corroboration between perceived confidence and actual surgical proficiency. We question the relevance of measuring confidence when actual ability to manage such cases is far more important and relevant.