Injury is the leading cause of death among young adults. The key element in the death of injury patients is failure to control bleeding in a timely and effective manner. For this reason, many projects such as the STB campaign, the Hartford Consensus, and the Federal Emergency Management Agency’s "You are the Help until Help arrives" are calling for the strengthening of trauma hemostasis education for the general public[6, 8, 9, 25]. The STB campaign has been implemented for six years and has achieved remarkable results. The research of AlSabah et al. shows that nearly 90% of participants expressed that the STB campaign contributed to promoting health and improving personal safety awareness[26]. Schroll et al. [27] pointed out that the traumatic hemostasis course is important to the teaching of medical students. The research of Sarah Beth Dinwiddie et al.[28] also proved that STB training is effective at improving students’ knowledge and confidence. However, the traditional teaching method, of one-way skill training, is still adopted in China at present. This is taught only through teachers' explanations and students' personal operations, and cannot be effectively integrated with clinical practice. For the education of outstanding doctoral candidates, more attention should be paid to students’ ability of innovation, exploration, and cooperation. The research of Faisal et al.[29] shows that problem-based learning is more helpful to the training of medical students than traditional lecture-based learning. Burgess et al.[30] introduced team-based learning on the basis of problem learning, and Chakraborti et al.[31] introduced evidence based learning on the basis of team learning, both of which have proven to achieve beneficial results in medical education. Based on the above reasons, we hope to introduce STB courses suitable for the training of outstanding doctoral candidates, to make up for the shortcomings of traditional teaching methods. However, the traditional STB course has also exposed its drawbacks in the implementation process. The research of Villegas et al.[32] shows that people reported overwhelmingly that the model is not authentic enough. If the training is more realistic, it will be more effective. The research of Zwislewski et al.[33] also emphasized the importance of hands-on training in STB skill learning. Therefore, we adopted PTEBL teaching method combined with Caesar, the trauma patient simulator, for the STB skills training of outstanding doctoral candidates.
In this study, all students in the experimental group passed the theoretical test and the scenario simulation test. They also significantly improved their confidence in the three basic skills in the STB course and their willingness to rescue at the first scene of traumatic bleeding. This shows that this teaching method can effectively teach STB skills and help students master and implement them. In the scenario simulation test, the second scenario simulation takes less time than the first scenario simulation, and the average performance was improved, which affirms the training effect of teamwork and scenario simulation on students' mastery and proficiency in STB skills. In our research, we found that although using traditional teaching methods could improve students’ confidence in various hemostasis skills, students’ confidence was still low after the class. This feature is more prominent in the compressing with bandages and compressing with a tourniquet technique, which may be related to the fact that traditional one-way skill training does not allow students to use these two more difficult operations flexibly. The experimental group's confidence in the compressing with bandages and compressing with a tourniquet technique after the class was significantly higher than that of the control group, which indicate that the PTEBL teaching method can effectively improve students' mastery of hemostasis skills and can also make up for the shortcomings of traditional teaching methods. This is closely related to the superiority of STB courses. The research of Ali et al. has proven that the STB course can promote the correct placement of tourniquet and increase levels of comfort in 75% of students[34], which is consistent with the results of our research. In addition, in the after-school questionnaire, we found that compared with the traditional teaching method of students’ autonomous operation, students responded that the use of Caesar for scenario simulation could improve the effectiveness of learning, which is consistent with the results of Villegas’ research[32]. We believe that the use of Caesar, for more realistic scenario simulations, is also one of the reasons for the experimental group's higher confidence in the compressing with bandages and compressing with a tourniquet technique.
The heat map shows that the degree of interaction between teachers and students is highly correlated with the overall effectiveness of the teaching, indicating that students’ mastery of skills largely depends on teacher-student interaction. The research of Burgess et al.[35] proved that team-based learning could improve students' participation in the course. The PTEBL teaching method uses teamwork as the core and increases the communication between students and teachers. As shown in Figure 3, when the teachers’ enthusiasm is the same, the PTEBL teaching method combined with Caesar can effectively improve the interaction between teachers and students, thereby further improving the overall effectiveness of the teaching.
In summary, the PTEBL teaching method combined with Caesar has achieved remarkable results. However, both the traditional method and the PTEBL method can improve students' confidence in hemostatic skills and the willingness to rescue. The PTEBL method improves some of the students' trauma hemostatic skills to a greater extent, and can create a better teaching atmosphere and achieve better effectiveness in teaching STB skills, which is consistent with our expected results.
However, the course still has some limitations. For example, the cost of Caesar, the trauma patient, is relatively high and difficult to obtain, which imposes certain restrictions on the implementation of teaching. Besides, many studies have shown that although the STB course can effectively improve students’ trauma hemostatic skills, the retention of these skills was poor[7, 36, 37]. Therefore, how to increase the retention of skills is extremely important to improve the mastery rate of trauma hemostasis skills. In addition, the research of Dhillon et al.[38] showed that although STB courses can achieve decent results, the general public’s acquisition rate of necessary equipment for these skills is low. Cost, time and accessibility of items during an event are still the most common obstacle. Therefore, in order to improve the general public’s willingness to treat bleeding patients, we must not only strengthen trauma hemostasis education, but also make it so people can easily obtain the required materials for a traumatic bleeding situation. Therefore, the teaching reform of STB skills can be further explored.