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. 2021 Feb;13(1):95-102.
doi: 10.4300/JGME-D-20-00278.1. Epub 2021 Jan 8.

COVER: A Curriculum in the Management of Soft Tissue Injury and Infection for Junior Surgery Residents

Emily J Onufer, Erin G Andrade, Angelia DeClue, Grant Bochicchio, Paul Wise, Mary E Klingensmith, Stephen Eaton, John Kirby, L J Punch

COVER: A Curriculum in the Management of Soft Tissue Injury and Infection for Junior Surgery Residents

Emily J Onufer et al. J Grad Med Educ. 2021 Feb.

Abstract

Background: While wound management is a common task for practicing surgeons, there is a paucity of dedicated education on soft tissue management during residency training.

Objective: The COVER (Causes of soft tissue injury, Obstacles to closure, Vacuums and stitches, Epithelialization, Rationale for wound care) curriculum was developed to engage junior surgery residents in the management of soft tissue injury and infection.

Methods: Junior surgery residents participated in the COVER lab during academic years 2018-2020. Residents applied appropriate surgical management and wound care to cadaveric models of soft tissue injury and infection. Assessments included a pre-/post-curriculum and pre-/post-lab multiple choice questionnaire and survey.

Results: All eligible residents (n = 45, 27) participated in the COVER lab for both academic years. Postgraduate year (PGY)-1s, PGY-2s, and PGY-3s showed improvement in wound management knowledge with an average increase in score of 17%, 8%, and 18%, respectively. They also showed a change in their self-reported perceived ability to achieve primary soft tissue closure with confidence levels 22%, 20%, and 16%, respectively. This was again seen in perceived ability to manage soft tissue injuries and infections (28%, 28%, and 23%, respectively). There was a significant increase in performing new wound management skills (PGY-1 mean 51.3%, PGY-2 33.5%, PGY-3 20%; ANOVA, P = .0001).

Conclusions: The COVER curriculum provides a systematic approach to soft tissue injury and infection. Residents showed a significant increase in both soft tissue knowledge as well as confidence in ability to perform wound management.

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Conflict of interest statement

Conflict of interest: The authors declare they have no competing interests.

Figures

Figure 1
Figure 1
Mean Percentage of Knowledge Gained From COVER Curriculum Note: Residents throughout all clinical years showed improvement in their knowledge of soft tissue injury management after the COVER curriculum. Significant improvement was seen in the PGY-2 and PGY-3 residents, with an average improvement in knowledge score of 11% (*P < .027) and 25% (**P = .007), respectively.
Figure 2
Figure 2
Mean Percentage Change in Pre- and Post-Lab Confidence and General Knowledge Note: PGY-1s, PGY-2s, and PGY-3s showed a significant change in their perceived ability to achieve primary soft tissue closure, with confidence levels increasing by 22%, 20%, and 16%, respectively (***P < .0001). PGY-1s, PGY-2s, and PGY-3s showed improvement in perceived ability to manage soft tissue injuries and infections (28%, 28%, and 23%, respectively; ***P < .0001). PGY-1s, PGY-2s, and PGY-3s increase in general knowledge increasing by 17%, 8%, and 18%, respectively (**P < .005, *P < .05).
Figure 3
Figure 3
Mean Percentage of New Wound Management Procedures Performed by PGY Note: PGY-1, PGY-2, and PGY-3 with 51%, 34%, and 20% increases in wound procedures performed (ANOVA ***P < .0001).
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