The Trauma Training Score: A Novel and Objective Method for Performance Evaluation.

Background: Assessing proficiency in the initial management of a traumatically injured patient is challenging. Previously developed scoring tools frequently looked to evaluate single domains of a trauma leader or team's performance. An updated multi-domain scoring tool is needed to evaluate individual and group performance in the initial phases of trauma resuscitation.

Methods:  The modified Delphi technique was used to improve and obtain consensus on a multi-domain trauma training score (TTS). Subject matter experts (SMEs) in trauma across the United States were contacted electronically to consider voluntary participation in this study. Elective participants electronically received and commented on statements related to the 10 separate domains of a proposed TTS. These statements were evaluated using a 5-point Likert scale ranging from "Strongly Agree" to "Strongly Disagree". Feedback from the SMEs was used to modify each domain that did not receive consensus, and repeat iterations were performed until 80% or greater consensus was achieved. Internal consistency was measured using Cronbach's-ɑ, with a goal of greater than 0.8.

Results: Twenty-eight SMEs elected to participate in the modified Delphi process representing emergency medicine, trauma surgery, and critical care. Consensus was achieved when 80% or greater of the SMEs responded with a 4 or a 5 to each statement. Four total rounds of review and modification were required to achieve consensus on all statements. Cronbach's-ɑ for each round was greater than 0.85.

Discussion:  A unifying standardized outcome for measuring performance in the initial phases of trauma resuscitation is needed. The TTS developed in this study used expert consensus to provide a multi-domain means of evaluating trauma practitioners of all levels in both live and simulated patients.