Risks of Failure in Advanced Trauma Life Support Courses

The Advanced Trauma Life Support (ATLS) course is the common standard for care and disposition of trauma patients across both designated and nondesignated trauma centers. Evidence of individual student risk factors for ATLS course performance are minimal.

A retrospective study was conducted using ATLS course data for hybrid student and refresher courses taught in 2022-2023 from a single American College of Surgeons Regional Committee on Trauma. Marginal performance was defined as a post-test score of < 80% on the written examination or failing the practical test on the first attempt. Univariable analysis by predictor was completed using the χ² test and Mann-Whitney U tests, as appropriate. Multivariable analysis was completed with logistic regression analysis.

Among 996 students in the study, 191 (19%) were identified as having marginal ATLS course performance. Marginal performance was significantly more common in the student course (24%) than in the refresher course (9%). Marginal performers differed by medical degree and training status, medical specialty, and level of their home institution trauma center designation. In regression analysis, lower pretest score was associated with higher odds of marginal performance. As compared to advanced practice providers, an attending physician status was associated with lower odds of marginal performance.

Marginal performance varies by specialty, training level, and home institution trauma center designation. Future work is needed to identify and support at-risk students in both initial and refresher hybrid ATLS courses.