COGNITIVE AND ATTITUDINAL IMPACT OF THE ADVANCED TRAUMA LIFE-SUPPORT PROGRAM IN A DEVELOPING-COUNTRY

Improvement in trauma patient outcome has been reported after Advanced Training Life Support training (ATLS) in the developing country of Tr inidad and Tobago (T & T). The cognitive impact of ATLS training was a ssessed from pre-ATLS and post-ATLS performance of T & T physicians in multiple choice question tests and comparison with post-ATLS test per formance among Nebraska physicians. Overall, improvement between the p re-test and post-test among the T & T physicians was 22.0% +/- 2.0%. A ll physicians including failures (199 out of 212 passed) improved in t heir post-test scores. Individual item analysis of the post-test, incl uding the KR-20 determination, varied but the overall performance was similar for both physician groups with the T & T physicians performing slightly better in test 2 (6 of 16 vs. 25 of 100 failures, p < 0.05). Attitudinal impact was assessed through 87 questionnaires from 50 phy sicians (92% response) and 37 nurses (89% response). Physicians (97.8% compared with 69.7%) were more aware of the ATLS training, and both g roups (physicians, 77.3%; nurses, 69.6%) differentiated ATLS-trained p hysicians based on better resuscitation, more timely and appropriate c onsultation, greater confidence in trauma management, and improvement in trauma mortality and morbidity; all respondents recommended ATLS tr aining for all emergency room physicians. The demonstrated positive co gnitive and attitudinal effects very likely contributed to the improve d post-ATLS trauma patient outcome.