Validation of cadaver-based trauma surgery training for lifelong skill development

Validation of cadaver-based trauma surgery training for lifelong skill development | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Validation of cadaver-based trauma surgery training for lifelong skill development Soichi Murakami, Toshiaki Shichinohe, Yo Kurashima, Kazufumi Okada, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6108540/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 May, 2025 Read the published version in World Journal of Emergency Surgery → Version 1 posted 8 You are reading this latest preprint version Abstract Background: The decline in trauma cases and the increase in non-surgical treatments have reduced opportunities for trauma surgery training. This study examined the effectiveness of Cadaver-Based Educational Seminar for Trauma Surgery (C-BEST) as a lifelong educational tool for novice and experienced clinicians. Methods: From 2017 to 2023, 117 clinicians with varying levels of experience participated in the C-BEST program at Hokkaido University. Participants included novice clinicians (median years post-graduation: 5) and experienced clinicians (median years post-graduation: 19). Each participant assessed their confidence in 21 trauma techniques before, immediately after, and 6 months post-course using a self-assessment of confidence levels (SACL) scale. Results: The analysis showed significant improvement in SACL scores immediately after the course, with confidence levels remaining sustained 6 months later. Novice clinicians demonstrated substantial skill acquisition, whereas experienced clinicians reported the reinforcement and refinement of existing skills. Conclusions: C-BEST seems valuable as a training tool for the acquisition and retention of trauma surgery skills, addressing practical needs in trauma care. C-BEST provides an effective and sustained approach to trauma surgery skill development and retention across career stages. Further research on its long-term impact and applicability in diverse clinical settings is recommended. Cadaver-Based Educational Seminar for Trauma Surgery Lifelong Cadaver Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Trauma surgery is a fundamental skill for all surgeons. However, owing to a decline in traffic accidents and advances in non-surgical treatments, such as interventional radiology, training opportunities in clinical settings are diminishing [ 1 – 3 ]. Nevertheless, trauma cases have not entirely disappeared, and surgeries are still performed every year [ 4 ]. In urban areas, hospitals with specialized trauma surgeons can maintain high standards of trauma care through centralized services [ 5 , 6 ]. However, in rural areas, delivering timely treatment and surgical interventions is challenging owing to transportation delays. Moreover, general surgeons infrequently handle severe trauma cases, sometimes only a few cases annually [ 7 ]. Recently, the utility of cadaver-based surgical training has gained recognition, and various medical fields have adopted this training [ 8 – 11 ]. In trauma surgery, training using cadavers is considered valuable for beginners seeking to acquire trauma surgical skills [ 8 , 10 , 12 – 16 ] and has become essential as opportunities to acquire these skills in real-life settings have dwindled. Among training programs, our program, Cadaver-Based Educational Seminar for Trauma Surgery (C-BEST), was primarily designed for novice surgeons and emergency physicians, and its effectiveness has been validated [ 12 – 15 ]. However, many experienced surgeons and emergency physicians also participate in C-BEST to hone their skills, with instructors often joining for this purpose. In this study, we analysed whether C-BEST is an effective means of lifelong education. Methods C-BEST settings C-BEST was developed in 2013 by Dr. Homma, a co-author of this study, at Tokyo Medical University to teach trauma surgery techniques through a combination of lectures and cadaver-based practical training. Between October 2017 and December 2023, we conducted eleven 1-day seminars to teach trauma surgery techniques. We used 2–5 Thiel-embalmed cadavers for each course [ 17 , 18 ], with one cadaver per 4–7 participants. Following the C-BEST program [ 15 ], 21 trauma procedures taught, included ① cricothyroidotomy; ② chest tube insertion; ③ fasciotomy of the lower extremity; ④ exposure of femoral vessels; ⑤ exposure of neck vessels; ⑥ vascular repair (direct suture, patch repair, end-to-end anastomosis, and shunting); ⑦ pericardial window technique; ⑧ left anterior thoracotomy and aortic clamping; ⑨ bilateral anterior thoracotomy (clamshell); ⑩ pulmonary hilar clamping; ⑪ pulmonary injury; ⑫ atrial injury; ⑬ ventricular injury; ⑭ trauma laparotomy; ⑮ portal triad clamping (Pringle manoeuvre); ⑯ liver packing; ⑰ left medial visceral rotation (Mattox manoeuvre); ⑱ right medial visceral rotation (Cattell–Braasch manoeuvre); ⑲ nephrectomy; ⑳ abdominal damage control technique; and ㉑ pelvic packing. The timeframe for this training is shown in Fig. 1 , which includes the detailed schedule of the eleven 1-day seminars. Each session followed a structured format that integrated didactic and interactive components into the hands-on training as follows: Before each practical session, all participants gathered for a brief lecture by the lead instructor covering the procedure, anatomical details, and key technical points. Participants were then divided into small groups to perform surgical techniques under instructor guidance. Each session concluded with a group-based feedback discussion to reinforce learning. The day ended with a final debriefing session to address remaining questions and facilitate discussion. Participants were recruited through the Hokkaido University website. Interested individuals were allowed to apply without restrictions based on specialty, postgraduate years, trauma surgery experience, or previous course attendance. Participants provided information on their specialty, postgraduate years, trauma surgery experience, training experience, and self-assessment of confidence levels (SACL) in performing the 21 training techniques. SACL assessments were conducted before, immediately after, and 6 months after the course. C-BEST instructors certified by the C-BEST director as experienced and capable of teaching trauma surgery provided instruction. Surgeons with prior C-BEST experience who wished to assist joined as assistant instructors. Survey Before participation, trainees reported their postgraduate year, specialty, total number of surgeries performed (selected from 10 categories: 0, 1–5, 6–10, 11–20, 21–50, 51–100, 101–200, 201–500, 501–1,000, and over 1,000), and experience with various surgical areas (head, neck, chest, abdomen, and limbs) across eight categories for each role (lead surgeon, first assistant with guidance, first assistant without guidance, or other assistant). Participants also rated their confidence in performing the 21 trauma procedures (SACL) on an 11-point Likert scale (0: not at all capable, 5: capable with an experienced assistant, 10: capable with a novice assistant). Surveys were completed before (pre), immediately after (post), and 6 months post-training (6 months later). Google Forms (Google LLC, Menlo Park, CA, USA) was used to collect responses, analysing data only from participants who provided answers at all three points. Statistical analyses JMP® 17 (JMP, Cary, NC, USA) was used for statistical processing and evaluation. Background factors, including specialty and surgical volume, were compared between the novice (≤ 10 years post-graduation) and experienced (≥ 11 years post-graduation) groups using the chi-square or Fisher’s exact test when the expected frequencies were low. The SACL at each time point and changes in SACL over time were compared between the two groups using the Wilcoxon rank-sum test with significance set at p < 0.05. The impact of postgraduate year on total SACL at each time point and changes in total SACL over time were evaluated using univariate regression analysis. Results Overview A total of 128 participants attended the 11 seminars and completed the survey. Of these, 117 participants (91.4%) completed all three surveys (pre-course, post-course, and 6 months later), and their data were analysed. Participant background The median postgraduate years of the entire cohort was 8 years [range, 2–36 years] (5 years [2–10 years] for the novice group and 19 years [11–36 years] for the experienced group) (Fig. 2 a). The most common specialty among all participants and experienced surgeons was Acute Care Surgery, whereas Emergency Medicine was the most common among novices, with a significant difference in distribution between the groups (Fig. 2 b). The median range for the total surgeries performed was 201–500 cases; novices had 51–100 cases, while experienced surgeons had 501–1,000 cases, with a significant distribution difference (Fig. 2 c). SACL analysis across groups The median SACL for each item and time point was significantly higher in the experienced group than in the novice group, except for chest tube insertion post-course (Table 1). Changes in SACL across the time points showed three patterns: Type A (average increase of at least 1 point between pre- and post-course, and between pre-course and after 6 months), Type B (less than 1 point average increase between pre- and post-course, but more than 1 point average increase between pre-course and 6 months later), and Type C (no increase of more than 1 point on average between pre- and post-course, or between pre-course and 6 months later) (Table 1 and Fig. 3 ). SACL increases from pre- to post-course were significantly greater in the novice group than in the experienced group for items ①–⑦, ⑨–㉑, and total SACL. SACL increases from pre-course to 6 months later were also significantly greater in the novice group for items ①, ③, ④, ⑥, ⑦, ⑨-⑪, ⑭-㉑, and total SACL. Comparisons between post-course and 6 months later SACL showed significant declines in the novice group for items ③, ⑭, and ㉑ (Table 1). Correlation analysis between postgraduate years and total SACL showed positive correlations at all time points (pre-course: r = 0.61, post-course: r = 0.50, 6 months later: r = 0.57) (Fig. 4 a). Analysis of changes in total SACL revealed weak negative correlations between pre- and post-course (r = − 0.44) and between pre-course and 6 months (r = − 0.35), with no significant correlation between post-course and 6 months later (r = 0.20) (Fig. 4 b). Discussion In this study, we evaluated the effectiveness of trauma surgical skill training using the C-BEST program for a wide range of clinicians, from novices to experienced surgeons. The results showed a significant improvement in participants’ confidence levels (SACL) immediately after the course, with the effects maintained 6 months later. Additionally, a positive correlation was observed between postgraduate years and total SACL at all time points, indicating that the longer the years of surgical experience, the higher the confidence. Unlike animal-based courses, such as The Advanced Trauma Operative Management (ATOM) Course [ 19 , 20 ], in which the necessity of maintaining animal viability restricts the depth of instruction and feedback, cadaver-based training allows for extended feedback and discussion, potentially enhancing learning outcomes. This ability to integrate structured instruction and immediate feedback may explain the sustained improvement in confidence observed among participants. The changes in SACL could be classified into three types. Almost all items showed an average increase of > 1 in SACL immediately after the course and 6 months later compared to before the course, and these were classified as Type A. The SACL increase in Type A indicated that the training items in C-BEST were appropriate. Type B showed no significant increase in SACL immediately after the course, but after 6 months, an average increase of more than 1 was observed, and this was due to two items of the course (“portal triad clamping” and “abdominal damage control technique”) in the experienced group. As the experienced surgeons had the opportunity to perform similar procedures as in their regular practice, their SACL increased over time, which is also believed to show the effectiveness of attending C-BEST. Cricothyroidotomy, chest tube insertion, trauma laparotomy, and liver packing procedures are relatively simple; however, because the surgeons’ initial SACL was high, it created a ceiling effect. Therefore, it was determined that these items could be removed from the training items in C-BEST for relevant groups. The correlation analysis between postgraduate years and changes in SACL showed that younger clinicians experienced significant improvement immediately after the course, whereas experienced surgeons maintained relatively stable confidence. This indicates that C-BEST provides an opportunity for novice clinicians to rapidly acquire new skills and build confidence, while for experienced surgeons, it serves as a place to reinforce and reaffirm existing skills. Many emergency physicians who do not routinely perform surgical procedures have participated in C-BEST. They previously encountered preventable trauma deaths due to the lack of surgical support and attended C-BEST to better prepare for such situations. While some techniques, particularly those involving suturing, require extensive instruction, most trauma procedures rely on fundamental dissection and separation skills, making them feasible for emergency physicians to acquire. Some emergency physicians have successfully applied C-BEST-acquired techniques to save critically injured patients, while others pursued further surgical training and transitioned into Acute Care Surgeons. These findings highlight the importance of C-BEST in preparing emergency physicians for critical trauma situations, particularly in environments with limited surgical support. This study had some limitations. First, the sample size was limited, and the analysis was restricted to data from Hokkaido University; thus, caution is needed when generalizing the results to other facilities or regions that offer the C-BEST program. Additionally, since SACL is based on self-assessment, using other objective measures (e.g., Objective Structured Assessment of Technical Skills (OSATS) scores or surgical performance evaluations) alongside would better evaluate skill improvement. Furthermore, the 6-month follow-up after the training is relatively short; long-term follow-up is needed. Future studies should verify the long-term effects of the C-BEST program using objective indicators, such as surgical outcomes in clinical practice and patient outcomes. To enhance C-BEST’s effectiveness, future research could explore methods to integrate C-BEST training into clinical simulation environments, such as virtual reality or augmented reality platforms. These technologies could provide participants with more frequent and accessible practice opportunities, particularly for techniques that showed a Type B pattern, where confidence waned after 6 months. Additionally, implementing periodic refresher courses or on-demand online modules can address skill decay and help maintain long-term confidence. Another area for improvement is the evaluation of the impact of C-BEST on actual clinical outcomes. Future studies could collect data on patient outcomes and surgical performance metrics from C-BEST participants in clinical settings to quantify the real-world benefits of the program. This approach would provide a more comprehensive assessment of the utility of C-BEST beyond self-reported confidence levels. Finally, expanding C-BEST to include interdisciplinary training with emergency medical technicians or paramedics could enhance teamwork skills that are essential in trauma care. Investigating how multidisciplinary C-BEST sessions affect the confidence and skills of both surgical and non-surgical professionals would be a valuable addition to the current research. Conclusions In summary, the results of this study confirm that C-BEST is effective as a means of lifelong education, providing a critical means for young clinicians to acquire skills and contributing to skill maintenance and enhancement for experienced surgeons. Improving the program by following up participants and collecting feedback is necessary. Abbreviations EMPs emergency medicine physicians ACSs acute care surgeons GSs general surgeons GISs gastrointestinal surgeons OSATS Objective Structured Assessment of Technical Skills OTH others C-BEST Cadaver-Based Educational Seminar for Trauma SACL Surgery self-assessment of confidence levels scale Declarations Ethical approval and consent to participate: This study was approved by the Ethics Committee of Hokkaido University School of Medicine (IRB: Medical 19-011). All cadavers used for Cadaver Surgical Training were donated to Hokkaido University, and the donors had provided written consent during their lifetime for their use in Cadaver Surgical Training. Additionally, all participants in the C-BEST program were fully informed about the study and provided their consent to participate. Consent for publication: Not applicable. This study does not contain any identifiable personal data from participants. Availability of data and materials: The data that support the findings of this study are available on request from the corresponding author. Competing interests: The authors declare no conflicts of interest. Funding: This study and the associated training were supported by the Practical Training Project for Surgical Skill Improvement of the Ministry of Health, Labor and Welfare, JSPS KAKENHI Grant JP22K10408, and Japan Ministry of Defense's Program on Security Technology Research JPJ004596, as well as crowdfunding from “The Project to Eliminate Preventable Trauma Deaths in Hokkaido through the Development of Trauma Surgeons.” Authors' contributions: Soichi Murakami conceived the study, led the study design, survey, and analysis, wrote the main manuscript and prepared all figures and tables. Hiroshi Homma developed C-BEST. Toshiaki Shichinohe and Masahiko Watanabe directed the cadaver training. Yo Kurashima evaluated the educational validity. Kazufumi Okada supervised statistical analyses. Satoshi Hirano oversaw the study. All authors contributed to instructing participants and reviewed the manuscript. Acknowledgements: We wish to acknowledge the contributions of Yo Kurashima, who played a vital role in evaluating the educational validity and reliability of this study. Sadly, he passed away in August 2024 due to a canoeing accident. We honour his memory and dedication to this project. We also extend our heartfelt thanks to all body donors and their families, as well as Shiragiku-kai, the voluntary body donation organization of Hokkaido University, for their invaluable contributions. Authors' information (optional) Soichi Murakami, MD, PhD, is the Vice Director of the Center for Education, Research, and Innovation of Advanced Medical Technology (CERIA-MT) at Hokkaido University Hospital. Toshiaki Shichinohe, MD, PhD, is the Director of CERIA-MT and an associate professor in the Department of Gastroenterological Surgery II at Hokkaido University. Yo Kurashima, MD, PhD, was the Senior Associate Director of the Clinical Simulation Center at Hokkaido University. He passed away before the paper was submitted for publication. Kazufumi Okada, PhD is a specialist in medical and biological statistics. He is affiliated with the Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan. His expertise includes statistical analysis and data science applications in medical research. Yusuke Tsunetoshi, MD, is the Chief of Acute Care Surgery in the Department of Surgery at Teine Keijinkai Hospital. Ryoji Iizuka, MD, PhD, is a former Director of the Emergency and Critical Care Center at Kyoto Daini Red Cross Hospital. Wataru Ishii, MD, PhD, is the Director of the Emergency and Critical Care Center at Kyoto Daini Red Cross Hospital. Kenji Kandori is an attending surgeon in the Emergency and Critical Care Center at Kyoto Daini Red Cross Hospital. Shinichiro Irabu, MD, PhD, is the Director of the Department of Acute Care Surgery at Seirei Hamamatsu General Hospital. Naoki Shinyama, MD, PhD, is the Deputy Director of the Department of Emergency Medicine at Sakai City Medical Center. Hiroshi Homma, MD, PhD, is the Director of the Department of Emergency and Critical Care Medicine at Tokyo Medical University. Masahiko Watanabe, MD, PhD, is a Professor in the Department of Anatomy, Faculty of Medicine at Hokkaido University. Satoshi Hirano, MD, PhD, is a Professor in the Department of Gastroenterological Surgery II, Faculty of Medicine at Hokkaido University. References Bittner JG, Hawkins ML, Medeiros RS, Beatty JS, Atteberry LR, Ferdinand CH, et al. 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The preservation of the whole corpse with natural color. Ann Anat. 1992;174:185–95. Lefor AK. Trauma surgery simulation education in Japan: the Advanced Trauma Operative Management course. Acute Med Surg. 2018;5:299–304. https://doi.org/10.1002/ams2.352 . Jacobs LM, Burns KJ, Kaban JM, Gross RI, Cortes V, Brautigam RT, et al. Development and evaluation of the advanced trauma operative management course. J Trauma Acute Care Surg. 2003;55:471–9. https://doi.org/10.1097/01.TA.0000059445.84105.26 . Table 1 Table 1 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1241230.xlsx Cite Share Download PDF Status: Published Journal Publication published 29 May, 2025 Read the published version in World Journal of Emergency Surgery → Version 1 posted Editorial decision: Accepted 07 Apr, 2025 Reviews received at journal 07 Apr, 2025 Reviewers agreed at journal 03 Apr, 2025 Reviews received at journal 01 Apr, 2025 Reviewers agreed at journal 01 Apr, 2025 Reviewers invited by journal 01 Apr, 2025 Submission checks completed at journal 26 Mar, 2025 First submitted to journal 26 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6108540","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":437009595,"identity":"f638ba97-1454-4a01-8bfb-e78ad2a78275","order_by":0,"name":"Soichi 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shinichiro","middleName":"","lastName":"Irabu","suffix":""},{"id":437009604,"identity":"18326944-d633-4183-a369-2b3fce2b0f79","order_by":9,"name":"Naoki Shinyama","email":"","orcid":"","institution":"Sakai City Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Naoki","middleName":"","lastName":"Shinyama","suffix":""},{"id":437009605,"identity":"31690bb2-fc3f-4d7a-bf6a-782bf0326d0c","order_by":10,"name":"Hiroshi Homma","email":"","orcid":"","institution":"Tokyo Medical University","correspondingAuthor":false,"prefix":"","firstName":"Hiroshi","middleName":"","lastName":"Homma","suffix":""},{"id":437009606,"identity":"b28934f7-aba6-4cbe-aeae-ed5609f9efdf","order_by":11,"name":"Masahiko Watanabe","email":"","orcid":"","institution":"Hokkaido University Graduate School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Masahiko","middleName":"","lastName":"Watanabe","suffix":""},{"id":437009607,"identity":"5937efe8-a843-47a2-9cea-a92da0eb141c","order_by":12,"name":"Satoshi Hirano","email":"","orcid":"","institution":"Hokkaido University Faculty School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Satoshi","middleName":"","lastName":"Hirano","suffix":""}],"badges":[],"createdAt":"2025-02-25 23:53:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6108540/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6108540/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13017-025-00608-4","type":"published","date":"2025-05-29T15:57:52+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":79833573,"identity":"ed2d1d39-e426-4b7a-b186-709af8635051","added_by":"auto","created_at":"2025-04-03 10:58:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":45948,"visible":true,"origin":"","legend":"\u003cp\u003eTimeline of the C-BEST program showing the detailed schedule of the eleven 1-day seminars and the trauma surgery techniques taught during each session.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6108540/v1/845ca2e146bccd8aae0edf51.png"},{"id":79833978,"identity":"689acdad-09f2-4270-a8f2-542926c4147e","added_by":"auto","created_at":"2025-04-03 11:06:38","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":8957,"visible":true,"origin":"","legend":"\u003cp\u003eParticipants’ backgrounds\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(a)\u003c/strong\u003e The median postgraduate year of the participants is 8 years, ranging from 2 to 36 years. For the novice group, the median is 5 years (range: 2–10 years), while it is 19 years (range: 11–36 years) for the senior group. \u003cstrong\u003e(b)\u003c/strong\u003e In terms of specialty, ACSs are the most common among all participants and within the senior group, whereas EMPs are the most prevalent among the novice group. A significant difference is observed in the distribution of specialties between the two groups. \u003cstrong\u003e(c)\u003c/strong\u003e The overall median range for the total number of surgeries performed is 201–500 cases. The median range is 51–100 cases for the novice group and 501–1,000 cases for the senior group, showing a significant difference in distribution between the two groups. Abbreviations: EMPs, emergency medicine physicians; ACSs, acute care surgeons; GSs, general surgeons; GISs, gastrointestinal surgeons; OTH, others\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6108540/v1/4122c1ad21869ed454f9f4d5.png"},{"id":79833574,"identity":"1b5f9847-5ca9-46b0-8abf-3b157266a806","added_by":"auto","created_at":"2025-04-03 10:58:38","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":17170,"visible":true,"origin":"","legend":"\u003cp\u003eClassification of changes in SACL by type for each group.\u003c/p\u003e\n\u003cp\u003eClassification of changes in SACL before, immediately after, and 6 months after the course is shown. In Type A, the average SACL increase is at least 1 point between pre- and post-course and between pre- and 6 months later. Type B also shows more than 1 point increase on average between pre- and 6 months later and an average increase of less than 1 point between pre- and post-course. In Type C, SACL increase is less than 1 point on average between pre- and post-course and between pre- and 6 months later.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6108540/v1/d0b0948cf4fac244da05a112.png"},{"id":79833979,"identity":"373df8da-628f-48d2-b82c-fd875728ebe1","added_by":"auto","created_at":"2025-04-03 11:06:38","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":26522,"visible":true,"origin":"","legend":"\u003cp\u003eRegression analysis between postgraduate years and total SACL scores.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(a)\u003c/strong\u003e Regression analysis between postgraduate years and total SACL scores revealing a positive correlation at all time points: pre-course (slope: 4.45, 95% CI: 3.36–5.53, R\u003csup\u003e2\u003c/sup\u003e = 0.37), post-course (slope: 2.71, 95% CI: 1.83–3.59, R\u003csup\u003e2\u003c/sup\u003e = 0.24), and 6 months later (slope: 3.23, 95% CI: 2.37–4.10, R\u003csup\u003e2\u003c/sup\u003e = 0.32).\u003cstrong\u003e (b)\u003c/strong\u003e Regression analysis of changes in the total SACL scores with respect to postgraduate years showing a weak negative correlation between pre-course and post-course (slope: −1.73, 95% CI: −2.39 to −1.07, R\u003csup\u003e2\u003c/sup\u003e = 0.19) and between pre-course and 6 months later (slope: −1.21, 95% CI: −1.81 to −0.62, R\u003csup\u003e2\u003c/sup\u003e = 0.12). A weak positive correlation is observed between post-course and 6 months later (slope: 0.52, 95% CI: 0.05–0.99, R\u003csup\u003e2\u003c/sup\u003e = 0.04).\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6108540/v1/5a8f232d56fc1c73f846ed7c.png"},{"id":83782972,"identity":"95efc476-b94d-45d0-b666-6577b1b29994","added_by":"auto","created_at":"2025-06-02 16:09:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":672192,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6108540/v1/3001e117-62db-468f-b27c-6e61612fff75.pdf"},{"id":79833572,"identity":"c4a7288a-52ac-42f5-a2ea-5d9224411f0e","added_by":"auto","created_at":"2025-04-03 10:58:38","extension":"xlsx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":20920,"visible":true,"origin":"","legend":"","description":"","filename":"Table1241230.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-6108540/v1/aa461402be412837db201ddc.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Validation of cadaver-based trauma surgery training for lifelong skill development","fulltext":[{"header":"Background","content":"\u003cp\u003eTrauma surgery is a fundamental skill for all surgeons. However, owing to a decline in traffic accidents and advances in non-surgical treatments, such as interventional radiology, training opportunities in clinical settings are diminishing [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Nevertheless, trauma cases have not entirely disappeared, and surgeries are still performed every year [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In urban areas, hospitals with specialized trauma surgeons can maintain high standards of trauma care through centralized services [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, in rural areas, delivering timely treatment and surgical interventions is challenging owing to transportation delays. Moreover, general surgeons infrequently handle severe trauma cases, sometimes only a few cases annually [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRecently, the utility of cadaver-based surgical training has gained recognition, and various medical fields have adopted this training [\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In trauma surgery, training using cadavers is considered valuable for beginners seeking to acquire trauma surgical skills [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan additionalcitationids=\"CR13 CR14 CR15\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and has become essential as opportunities to acquire these skills in real-life settings have dwindled. Among training programs, our program, Cadaver-Based Educational Seminar for Trauma Surgery (C-BEST), was primarily designed for novice surgeons and emergency physicians, and its effectiveness has been validated [\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, many experienced surgeons and emergency physicians also participate in C-BEST to hone their skills, with instructors often joining for this purpose. In this study, we analysed whether C-BEST is an effective means of lifelong education.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eC-BEST settings\u003c/h2\u003e \u003cp\u003eC-BEST was developed in 2013 by Dr. Homma, a co-author of this study, at Tokyo Medical University to teach trauma surgery techniques through a combination of lectures and cadaver-based practical training. Between October 2017 and December 2023, we conducted eleven 1-day seminars to teach trauma surgery techniques. We used 2\u0026ndash;5 Thiel-embalmed cadavers for each course [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], with one cadaver per 4\u0026ndash;7 participants. Following the C-BEST program [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], 21 trauma procedures taught, included ① cricothyroidotomy; ② chest tube insertion; ③ fasciotomy of the lower extremity; ④ exposure of femoral vessels; ⑤ exposure of neck vessels; ⑥ vascular repair (direct suture, patch repair, end-to-end anastomosis, and shunting); ⑦ pericardial window technique; ⑧ left anterior thoracotomy and aortic clamping; ⑨ bilateral anterior thoracotomy (clamshell); ⑩ pulmonary hilar clamping; ⑪ pulmonary injury; ⑫ atrial injury; ⑬ ventricular injury; ⑭ trauma laparotomy; ⑮ portal triad clamping (Pringle manoeuvre); ⑯ liver packing; ⑰ left medial visceral rotation (Mattox manoeuvre); ⑱ right medial visceral rotation (Cattell\u0026ndash;Braasch manoeuvre); ⑲ nephrectomy; ⑳ abdominal damage control technique; and ㉑ pelvic packing. The timeframe for this training is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, which includes the detailed schedule of the eleven 1-day seminars. Each session followed a structured format that integrated didactic and interactive components into the hands-on training as follows:\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e Before each practical session, all participants gathered for a brief lecture by the lead instructor covering the procedure, anatomical details, and key technical points.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eParticipants were then divided into small groups to perform surgical techniques under instructor guidance.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eEach session concluded with a group-based feedback discussion to reinforce learning.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThe day ended with a final debriefing session to address remaining questions and facilitate discussion.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e \u003cp\u003eParticipants were recruited through the Hokkaido University website. Interested individuals were allowed to apply without restrictions based on specialty, postgraduate years, trauma surgery experience, or previous course attendance. Participants provided information on their specialty, postgraduate years, trauma surgery experience, training experience, and self-assessment of confidence levels (SACL) in performing the 21 training techniques. SACL assessments were conducted before, immediately after, and 6 months after the course.\u003c/p\u003e \u003cp\u003eC-BEST instructors certified by the C-BEST director as experienced and capable of teaching trauma surgery provided instruction. Surgeons with prior C-BEST experience who wished to assist joined as assistant instructors.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSurvey\u003c/h3\u003e\n\u003cp\u003eBefore participation, trainees reported their postgraduate year, specialty, total number of surgeries performed (selected from 10 categories: 0, 1\u0026ndash;5, 6\u0026ndash;10, 11\u0026ndash;20, 21\u0026ndash;50, 51\u0026ndash;100, 101\u0026ndash;200, 201\u0026ndash;500, 501\u0026ndash;1,000, and over 1,000), and experience with various surgical areas (head, neck, chest, abdomen, and limbs) across eight categories for each role (lead surgeon, first assistant with guidance, first assistant without guidance, or other assistant). Participants also rated their confidence in performing the 21 trauma procedures (SACL) on an 11-point Likert scale (0: not at all capable, 5: capable with an experienced assistant, 10: capable with a novice assistant). Surveys were completed before (pre), immediately after (post), and 6 months post-training (6 months later). Google Forms (Google LLC, Menlo Park, CA, USA) was used to collect responses, analysing data only from participants who provided answers at all three points.\u003c/p\u003e\n\u003ch3\u003eStatistical analyses\u003c/h3\u003e\n\u003cp\u003eJMP\u0026reg; 17 (JMP, Cary, NC, USA) was used for statistical processing and evaluation. Background factors, including specialty and surgical volume, were compared between the novice (\u0026le;\u0026thinsp;10 years post-graduation) and experienced (\u0026ge;\u0026thinsp;11 years post-graduation) groups using the chi-square or Fisher\u0026rsquo;s exact test when the expected frequencies were low. The SACL at each time point and changes in SACL over time were compared between the two groups using the Wilcoxon rank-sum test with significance set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05. The impact of postgraduate year on total SACL at each time point and changes in total SACL over time were evaluated using univariate regression analysis.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eOverview\u003c/h2\u003e \u003cp\u003eA total of 128 participants attended the 11 seminars and completed the survey. Of these, 117 participants (91.4%) completed all three surveys (pre-course, post-course, and 6 months later), and their data were analysed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eParticipant background\u003c/h2\u003e \u003cp\u003eThe median postgraduate years of the entire cohort was 8 years [range, 2\u0026ndash;36 years] (5 years [2\u0026ndash;10 years] for the novice group and 19 years [11\u0026ndash;36 years] for the experienced group) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ea). The most common specialty among all participants and experienced surgeons was Acute Care Surgery, whereas Emergency Medicine was the most common among novices, with a significant difference in distribution between the groups (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eb). The median range for the total surgeries performed was 201\u0026ndash;500 cases; novices had 51\u0026ndash;100 cases, while experienced surgeons had 501\u0026ndash;1,000 cases, with a significant distribution difference (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ec).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSACL analysis across groups\u003c/h3\u003e\n\u003cp\u003eThe median SACL for each item and time point was significantly higher in the experienced group than in the novice group, except for chest tube insertion post-course (Table\u0026nbsp;1). Changes in SACL across the time points showed three patterns: Type A (average increase of at least 1 point between pre- and post-course, and between pre-course and after 6 months), Type B (less than 1 point average increase between pre- and post-course, but more than 1 point average increase between pre-course and 6 months later), and Type C (no increase of more than 1 point on average between pre- and post-course, or between pre-course and 6 months later) (Table\u0026nbsp;1 and Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eSACL increases from pre- to post-course were significantly greater in the novice group than in the experienced group for items ①\u0026ndash;⑦, ⑨\u0026ndash;㉑, and total SACL. SACL increases from pre-course to 6 months later were also significantly greater in the novice group for items ①, ③, ④, ⑥, ⑦, ⑨-⑪, ⑭-㉑, and total SACL. Comparisons between post-course and 6 months later SACL showed significant declines in the novice group for items ③, ⑭, and ㉑ (Table\u0026nbsp;1).\u003c/p\u003e \u003cp\u003eCorrelation analysis between postgraduate years and total SACL showed positive correlations at all time points (pre-course: r\u0026thinsp;=\u0026thinsp;0.61, post-course: r\u0026thinsp;=\u0026thinsp;0.50, 6 months later: r\u0026thinsp;=\u0026thinsp;0.57) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003ea). Analysis of changes in total SACL revealed weak negative correlations between pre- and post-course (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.44) and between pre-course and 6 months (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.35), with no significant correlation between post-course and 6 months later (r\u0026thinsp;=\u0026thinsp;0.20) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eb).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we evaluated the effectiveness of trauma surgical skill training using the C-BEST program for a wide range of clinicians, from novices to experienced surgeons. The results showed a significant improvement in participants\u0026rsquo; confidence levels (SACL) immediately after the course, with the effects maintained 6 months later. Additionally, a positive correlation was observed between postgraduate years and total SACL at all time points, indicating that the longer the years of surgical experience, the higher the confidence.\u003c/p\u003e \u003cp\u003eUnlike animal-based courses, such as The Advanced Trauma Operative Management (ATOM) Course [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], in which the necessity of maintaining animal viability restricts the depth of instruction and feedback, cadaver-based training allows for extended feedback and discussion, potentially enhancing learning outcomes. This ability to integrate structured instruction and immediate feedback may explain the sustained improvement in confidence observed among participants.\u003c/p\u003e \u003cp\u003eThe changes in SACL could be classified into three types. Almost all items showed an average increase of \u0026gt;\u0026thinsp;1 in SACL immediately after the course and 6 months later compared to before the course, and these were classified as Type A. The SACL increase in Type A indicated that the training items in C-BEST were appropriate. Type B showed no significant increase in SACL immediately after the course, but after 6 months, an average increase of more than 1 was observed, and this was due to two items of the course (\u0026ldquo;portal triad clamping\u0026rdquo; and \u0026ldquo;abdominal damage control technique\u0026rdquo;) in the experienced group. As the experienced surgeons had the opportunity to perform similar procedures as in their regular practice, their SACL increased over time, which is also believed to show the effectiveness of attending C-BEST. Cricothyroidotomy, chest tube insertion, trauma laparotomy, and liver packing procedures are relatively simple; however, because the surgeons\u0026rsquo; initial SACL was high, it created a ceiling effect. Therefore, it was determined that these items could be removed from the training items in C-BEST for relevant groups.\u003c/p\u003e \u003cp\u003eThe correlation analysis between postgraduate years and changes in SACL showed that younger clinicians experienced significant improvement immediately after the course, whereas experienced surgeons maintained relatively stable confidence. This indicates that C-BEST provides an opportunity for novice clinicians to rapidly acquire new skills and build confidence, while for experienced surgeons, it serves as a place to reinforce and reaffirm existing skills.\u003c/p\u003e \u003cp\u003eMany emergency physicians who do not routinely perform surgical procedures have participated in C-BEST. They previously encountered preventable trauma deaths due to the lack of surgical support and attended C-BEST to better prepare for such situations. While some techniques, particularly those involving suturing, require extensive instruction, most trauma procedures rely on fundamental dissection and separation skills, making them feasible for emergency physicians to acquire. Some emergency physicians have successfully applied C-BEST-acquired techniques to save critically injured patients, while others pursued further surgical training and transitioned into Acute Care Surgeons. These findings highlight the importance of C-BEST in preparing emergency physicians for critical trauma situations, particularly in environments with limited surgical support.\u003c/p\u003e \u003cp\u003eThis study had some limitations. First, the sample size was limited, and the analysis was restricted to data from Hokkaido University; thus, caution is needed when generalizing the results to other facilities or regions that offer the C-BEST program. Additionally, since SACL is based on self-assessment, using other objective measures (e.g., Objective Structured Assessment of Technical Skills (OSATS) scores or surgical performance evaluations) alongside would better evaluate skill improvement. Furthermore, the 6-month follow-up after the training is relatively short; long-term follow-up is needed. Future studies should verify the long-term effects of the C-BEST program using objective indicators, such as surgical outcomes in clinical practice and patient outcomes.\u003c/p\u003e \u003cp\u003eTo enhance C-BEST\u0026rsquo;s effectiveness, future research could explore methods to integrate C-BEST training into clinical simulation environments, such as virtual reality or augmented reality platforms. These technologies could provide participants with more frequent and accessible practice opportunities, particularly for techniques that showed a Type B pattern, where confidence waned after 6 months. Additionally, implementing periodic refresher courses or on-demand online modules can address skill decay and help maintain long-term confidence.\u003c/p\u003e \u003cp\u003eAnother area for improvement is the evaluation of the impact of C-BEST on actual clinical outcomes. Future studies could collect data on patient outcomes and surgical performance metrics from C-BEST participants in clinical settings to quantify the real-world benefits of the program. This approach would provide a more comprehensive assessment of the utility of C-BEST beyond self-reported confidence levels.\u003c/p\u003e \u003cp\u003eFinally, expanding C-BEST to include interdisciplinary training with emergency medical technicians or paramedics could enhance teamwork skills that are essential in trauma care. Investigating how multidisciplinary C-BEST sessions affect the confidence and skills of both surgical and non-surgical professionals would be a valuable addition to the current research.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn summary, the results of this study confirm that C-BEST is effective as a means of lifelong education, providing a critical means for young clinicians to acquire skills and contributing to skill maintenance and enhancement for experienced surgeons. Improving the program by following up participants and collecting feedback is necessary.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEMPs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eemergency medicine physicians\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eACSs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eacute care surgeons\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGSs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003egeneral surgeons\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGISs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003egastrointestinal surgeons\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOSATS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eObjective Structured Assessment of Technical Skills\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOTH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eothers\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eC-BEST\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCadaver-Based Educational Seminar for Trauma\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSACL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSurgery self-assessment of confidence levels scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Hokkaido University School of Medicine (IRB: Medical 19-011). All cadavers used for Cadaver Surgical Training were donated to Hokkaido University, and the donors had provided written consent during their lifetime for their use in Cadaver Surgical Training. Additionally, all participants in the C-BEST program were fully informed about the study and provided their consent to participate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This study does not contain any identifiable personal data from participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available on request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study and the associated training were supported by the Practical Training Project for Surgical Skill Improvement of the Ministry of Health, Labor and Welfare, JSPS KAKENHI Grant JP22K10408, and Japan Ministry of Defense's Program on Security Technology Research JPJ004596, as well as crowdfunding from “The Project to Eliminate Preventable Trauma Deaths in Hokkaido through the Development of Trauma Surgeons.”\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSoichi Murakami conceived the study, led the study design, survey, and analysis, wrote the main manuscript and prepared all figures and tables. Hiroshi Homma developed C-BEST. Toshiaki Shichinohe and Masahiko Watanabe directed the cadaver training. Yo Kurashima evaluated the educational validity. Kazufumi Okada supervised statistical analyses. Satoshi Hirano oversaw the study. All authors contributed to instructing participants and reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe wish to acknowledge the contributions of Yo Kurashima, who played a vital role in evaluating the educational validity and reliability of this study. Sadly, he passed away in August 2024 due to a canoeing accident. We honour his memory and dedication to this project.\u003c/p\u003e\n\u003cp\u003eWe also extend our heartfelt thanks to all body donors and their families, as well as Shiragiku-kai, the voluntary body donation organization of Hokkaido University, for their invaluable contributions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' information (optional)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSoichi Murakami, MD, PhD, is the Vice Director of the Center for Education, Research, and Innovation of Advanced Medical Technology (CERIA-MT) at Hokkaido University Hospital.\u003c/p\u003e\n\u003cp\u003eToshiaki Shichinohe, MD, PhD, is the Director of CERIA-MT and an associate professor in the Department of Gastroenterological Surgery II at Hokkaido University.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eYo Kurashima, MD, PhD, was the Senior Associate Director of the Clinical Simulation Center at Hokkaido University. He passed away before the paper was submitted for publication.\u003c/p\u003e\n\u003cp\u003eKazufumi Okada, PhD is a specialist in medical and biological statistics. He is affiliated with the Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan. His expertise includes statistical analysis and data science applications in medical research.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eYusuke Tsunetoshi, MD, is the Chief of Acute Care Surgery in the Department of Surgery at Teine Keijinkai Hospital.\u003c/p\u003e\n\u003cp\u003eRyoji Iizuka, MD, PhD, is a former Director of the Emergency and Critical Care Center at Kyoto Daini Red Cross Hospital.\u003c/p\u003e\n\u003cp\u003eWataru Ishii, MD, PhD, is the Director of the Emergency and Critical Care Center at Kyoto Daini Red Cross Hospital.\u003c/p\u003e\n\u003cp\u003eKenji Kandori is an attending surgeon in the Emergency and Critical Care Center at Kyoto Daini Red Cross Hospital.\u003c/p\u003e\n\u003cp\u003eShinichiro Irabu, MD, PhD, is the Director of the Department of Acute Care Surgery at Seirei Hamamatsu General Hospital.\u003c/p\u003e\n\u003cp\u003eNaoki Shinyama, MD, PhD, is the Deputy Director of the Department of Emergency Medicine at Sakai City Medical Center.\u003c/p\u003e\n\u003cp\u003eHiroshi Homma, MD, PhD, is the Director of the Department of Emergency and Critical Care Medicine at Tokyo Medical University.\u003c/p\u003e\n\u003cp\u003eMasahiko Watanabe, MD, PhD, is a Professor in the Department of Anatomy, Faculty of Medicine at Hokkaido University.\u003c/p\u003e\n\u003cp\u003eSatoshi Hirano, MD, PhD, is a Professor in the Department of Gastroenterological Surgery II, Faculty of Medicine at Hokkaido University.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBittner JG, Hawkins ML, Medeiros RS, Beatty JS, Atteberry LR, Ferdinand CH, et al. 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Cadaveric simulation: a review of reviews. Ir J Med Sci. 2018;187:827\u0026ndash;33. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11845-017-1704-y\u003c/span\u003e\u003cspan address=\"10.1007/s11845-017-1704-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZdilla MJ, Balta JY. Human body donation and surgical training: a narrative review with global perspectives. Anat Sci Int. 2023;98:1\u0026ndash;11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s12565-022-00689-0\u003c/span\u003e\u003cspan address=\"10.1007/s12565-022-00689-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHomma H, Oda J, Sano H, Kawai K, Koizumi N, Uramoto H, et al. 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Effectiveness of cadaver-based educational seminar for trauma surgery: skills retention after half-year follow-up. Acute Med Surg. 2017;4:57\u0026ndash;67. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/ams2.230\u003c/span\u003e\u003cspan address=\"10.1002/ams2.230\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKuhls DA, Risucci DA, Bowyer MW, Luchette FA. Advanced surgical skills for exposure in trauma: a new surgical skills cadaver course for surgery residents and fellows. J Trauma Acute Care Surg. 2013;74:664\u0026ndash;70. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/TA.0b013e31827d5e20\u003c/span\u003e\u003cspan address=\"10.1097/TA.0b013e31827d5e20\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThiel W. Supplement to the conservation of an entire cadaver according to W. Thiel. Ann Anat. 2002;184:267\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/s0940-9602(02)80121-2\u003c/span\u003e\u003cspan address=\"10.1016/s0940-9602(02)80121-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThiel W. The preservation of the whole corpse with natural color. Ann Anat. 1992;174:185\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLefor AK. Trauma surgery simulation education in Japan: the Advanced Trauma Operative Management course. Acute Med Surg. 2018;5:299\u0026ndash;304. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/ams2.352\u003c/span\u003e\u003cspan address=\"10.1002/ams2.352\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJacobs LM, Burns KJ, Kaban JM, Gross RI, Cortes V, Brautigam RT, et al. Development and evaluation of the advanced trauma operative management course. J Trauma Acute Care Surg. 2003;55:471\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/01.TA.0000059445.84105.26\u003c/span\u003e\u003cspan address=\"10.1097/01.TA.0000059445.84105.26\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Table 1","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-emergency-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjes","sideBox":"Learn more about [World Journal of Emergency Surgery](http://wjes.biomedcentral.com)","snPcode":"13017","submissionUrl":"https://submission.nature.com/new-submission/13017/3","title":"World Journal of Emergency Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cadaver-Based Educational Seminar for Trauma Surgery, Lifelong Cadaver","lastPublishedDoi":"10.21203/rs.3.rs-6108540/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6108540/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e The decline in trauma cases and the increase in non-surgical treatments have reduced opportunities for trauma surgery training. This study examined the effectiveness of Cadaver-Based Educational Seminar for Trauma Surgery (C-BEST) as a lifelong educational tool for novice and experienced clinicians.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e From 2017 to 2023, 117 clinicians with varying levels of experience participated in the C-BEST program at Hokkaido University. Participants included novice clinicians (median years post-graduation: 5) and experienced clinicians (median years post-graduation: 19). Each participant assessed their confidence in 21 trauma techniques before, immediately after, and 6 months post-course using a self-assessment of confidence levels (SACL) scale.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The analysis showed significant improvement in SACL scores immediately after the course, with confidence levels remaining sustained 6 months later. Novice clinicians demonstrated substantial skill acquisition, whereas experienced clinicians reported the reinforcement and refinement of existing skills.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e C-BEST seems valuable as a training tool for the acquisition and retention of trauma surgery skills, addressing practical needs in trauma care. C-BEST provides an effective and sustained approach to trauma surgery skill development and retention across career stages. Further research on its long-term impact and applicability in diverse clinical settings is recommended.\u003c/p\u003e","manuscriptTitle":"Validation of cadaver-based trauma surgery training for lifelong skill development","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-03 10:58:33","doi":"10.21203/rs.3.rs-6108540/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accepted","date":"2025-04-08T01:55:34+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-08T01:18:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"314852804737313781109616120239472262550","date":"2025-04-03T17:12:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-01T16:32:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"109185145180822487360531717957890993827","date":"2025-04-01T16:31:03+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-01T14:55:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-27T01:18:54+00:00","index":"","fulltext":""},{"type":"submitted","content":"World Journal of Emergency Surgery","date":"2025-03-26T23:55:31+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-emergency-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjes","sideBox":"Learn more about [World Journal of Emergency Surgery](http://wjes.biomedcentral.com)","snPcode":"13017","submissionUrl":"https://submission.nature.com/new-submission/13017/3","title":"World Journal of Emergency Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b012383f-d847-498a-b6be-3c70de57101c","owner":[],"postedDate":"April 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-06-02T16:03:15+00:00","versionOfRecord":{"articleIdentity":"rs-6108540","link":"https://doi.org/10.1186/s13017-025-00608-4","journal":{"identity":"world-journal-of-emergency-surgery","isVorOnly":false,"title":"World Journal of Emergency Surgery"},"publishedOn":"2025-05-29 15:57:52","publishedOnDateReadable":"May 29th, 2025"},"versionCreatedAt":"2025-04-03 10:58:33","video":"","vorDoi":"10.1186/s13017-025-00608-4","vorDoiUrl":"https://doi.org/10.1186/s13017-025-00608-4","workflowStages":[]},"version":"v1","identity":"rs-6108540","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6108540","identity":"rs-6108540","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}