Abstract
BACKGROUND: In Japan-particularly in the Hokkaido region-a limited number of dedicated trauma surgeons often compels general surgeons to serve as frontline providers of trauma care. However, their ability to perform critical trauma procedures and their level of confidence remain unclear. Understanding this gap is vital for guiding targeted training programs aimed at improving patient outcomes. Although conducted in one region, these findings may inform strategies in other remote or resource-limited settings worldwide, where timely surgical intervention significantly affects survival. Therefore, the objective of this study was to evaluate the experience and confidence of general surgeons in Hokkaido in performing 35 essential trauma procedures. METHODS: This prospective observational study surveyed all general surgeons and surgical residents working in hospitals that regularly perform surgical procedures in Hokkaido. Participants provided demographic information, trauma training history, and self-assessed confidence and experience in performing 35 procedures identified via a previous Delphi study. Confidence was defined as a Likert scale rating of 4 or 5. Comparisons were made between respondents with and without advanced trauma training (e.g., ATOM, DSTC) and between those who had managed more than 50 trauma cases versus fewer than 50. RESULTS: Of 730 eligible participants, 444 completed the survey (62.2%). Over half (57.9%) reported fewer than 10 lifetime trauma surgeries, and 64.4% had not managed a trauma case in the past year. Only six procedures were rated confidently (≥ 4) by more than half the respondents, including endotracheal intubation, chest tube placement, and selected gastrointestinal procedures. Subgroup analyses indicated that surgeons generally had higher confidence in procedures related to their subspecialty, whereas less frequent or advanced trauma skills remained areas of concern. Surgeons with advanced trauma training or a higher trauma case volume (> 50) demonstrated significantly greater confidence in multiple trauma-specific skills. CONCLUSION: General surgeons in Hokkaido lack confidence in most essential trauma procedures, particularly those encountered infrequently. Although these findings originate from one region, they underscore training gaps potentially relevant to other remote or resource-limited areas, where frontline trauma care demands targeted, high-yield interventions to improve outcomes.