Using elective surgical experience to supplement the waning trauma operative experience: is it truly enough?

For trauma surgeons and educators, the worldwide decline in operative trauma exposure is a major concern.1 A variety of explanations exist from traffic safety laws, non-operative/endovascular management, work hour restrictions, and the aging population. Kubota keenly recognizes that the training gap must be addressed in a manner unique to the country’s infrastructure—time/distance to transport, types of trauma, prehospital infrastructure, and surgical training.2 Japan’s hub-and-spoke model relies on paramedic triage to primary, secondary, or tertiary hospitals where emergency medicine and general surgery physicians provide initial evaluation and resuscitation.3