Yellow wave: impact of a structured educational initiative on trauma education developmentABSTRACT
Purpose: To evaluate the impact of the Yellow Wave Initiative on trauma surgery education, academic skills, career choices, and educational equity among medical students from three Brazilian medical schools.
Methods: This prospective longitudinal study enrolled 58 medical students from three institutions in Campinas, SP, Brazil. The intervention consisted of scientific mentorship, research methodology training, manuscript development for the 23rd European Congress of Trauma, and presentation skills workshops. Academic development, research capabilities, career intentions, and program satisfaction were assessed through post-congress electronic questionnaires using McNemar tests for paired comparisons and χ2 tests for associations.
Results: Trauma league members showed higher interest in general surgery compared to non-members (61.5 vs. 22.7%, odds ratio = 10.88, p = 0.002). Significant improvements were observed across key academic skills post-intervention (all p < 0.001), including presentation abilities (from 20.8% good/very good pre to 85.4% post), research capabilities (25 to 79.2%), and academic writing (20.8 to 83.3%). Additionally, 62% of participants reported positive impact on their academic career aspirations (p = 0.006).
Conclusion: The initiative enhanced academic skills and career development among Brazilian medical students, increasing engagement in trauma surgery and prevention activities while addressing educational gaps through hands-on learning.
Key words
Education, Medical; Mentoring; Students, Medical; Educational Measurement; General Surgery
Introduction
Injuries account for 8% of global deaths, resulting in 4.4 million fatalities annually, primarily from road traffic collisions (33%), suicide (17%), and homicide (10%)1. Non-fatal injuries impose a substantial burden, particularly in low- and middle-income countries, necessitating improved trauma education and prevention strategies. To address gaps in trauma surgery education, the Yellow Wave Initiative (YWI) was developed as a collaborative program among three medical schools in Campinas, SP, Brazil. This initiative involved medical students and residents in producing scientific papers for an international congress through structured mentorship and research activities.
The purpose of this study was to evaluate the impact of YWI on participants’ academic writing skills, research capabilities, presentation abilities, career choices, awareness of preventive programs, and understanding of educational equity. We hypothesized that this structured educational intervention would significantly enhance professional development and influence career trajectories in trauma surgery.
Methods
This prospective longitudinal observational study was approved by the Ethics in Research Committee of the Universidade Estadual de Campinas (UNICAMP)—Certificado de Apresentação para Apreciação Ética: 84544624.1.0000.5404; approval date: December 3, 2023. Written informed consent was obtained from all participants prior to enrollment, with detailed explanations of the study’s objectives, procedures, potential risks, and benefits provided via e-mail. Participation was voluntary, and participants could withdraw at any time without consequences. All data were anonymized, stored securely on password-protected servers, and accessed only by the research team, in compliance with the Declaration of Helsinki and Brazilian ethical guidelines.
The study assessed the impact of a structured academic program on trauma surgery education and research among 58 participants from three medical schools in Campinas: UNICAMP, Pontifícia Universidade Católica de Campinas (PUCC), and Faculdade São Leopoldo Mandic (SLM). These institutions were selected for their collaborative learning environments and established trauma leagues. The study population comprised medical students (third to sixth year) and general surgery residents whose abstracts were accepted for the 23rd European Congress of Trauma in Estoril, Portugal (October 2023). Inclusion criteria included enrollment in one of the participating schools, submission and acceptance of a congress abstract related to trauma or medical education, and availability to complete the program. Exclusion criteria were non-acceptance of abstracts or inability to participate due to academic conflicts. Participants were recruited voluntarily through institutional e-mails and trauma league announcements, with no incentives provided.
The initiative encompassed three phases (Fig. 1). Phase 1 (pre-congress, May to September 2023) involved structured scientific mentorship, research methodology training (e.g., conducting systematic literature reviews using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and collecting clinical data from institutional databases), and presentation skills development through workshops. Participants, under faculty supervision, prepared abstracts for international submission. Phase 2 (congress activities, October 2023) included oral or poster presentations, panel discussions, and networking opportunities. Phase 3 (post-congress assessments, November 2023) focused on evaluation. The program adopted a competency-based education framework, pairing experienced faculty mentors with students to develop key skills in a collaborative model.
Overview of the Yellow Wave Initiative phases, including pre-congress preparation, congress activities, and post-congress evaluation.
Participant competencies were assessed using a retrospective pre-post design (also known as then-test methodology), wherein participants rated their academic skills both before and after the YWI within a single anonymous electronic questionnaire administered 30 days post-congress. This approach was selected to ensure uniform reference frames for self-assessment and practical feasibility in the educational context, as participants evaluated their before and after states using the same internal criteria developed through the learning experience. The questionnaire, pilot-tested with five non-participating students, assessed five domains: academic development, research capabilities, career intentions, social engagement, and program satisfaction. It included 5-point Likert scales for paired pre-post comparisons (e.g., Rate your academic writing skills before AND after the initiative: 1 = poor to 5 = excellent) and standardized open-ended questions. The 30-day post-congress timeframe and anonymous data collection (via Google Forms; Suppl. Mat. 1) balanced memory retention with completion feasibility while minimizing recall and social desirability bias.
Primary outcomes were changes in academic skills (writing, research, presentation), measured via Likert scale shifts. Secondary outcomes included social engagement (e.g., participation in trauma prevention activities) and knowledge accessibility indicators (e.g., socioeconomic equity in participation).
Statistical analyses were performed using SAS System for Windows (version 9.4). Descriptive statistics summarized data as frequencies, percentages, means ± standard deviations. Associations between categorical variables (e.g., trauma league membership and career interest) were evaluated using χ2 tests, with odds ratios (OR) and 95% confidence intervals (95%CI) calculated. Paired before-after comparisons of dichotomized self-rated competencies (poor/fair vs. good/very good/excellent) employed McNemar tests. Proportional analyses assessed participation patterns across socioeconomic strata. Qualitative data were analyzed through content analysis by two independent researchers, with themes identified inductively and discrepancies resolved by consensus. Statistical significance was defined as p < 0.05. This study conforms to the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement2 (Suppl. Mat. 2).
Results
The YWI enrolled 58 participants, including medical students from the third to sixth years and general surgery residents, with 48 completing the post-congress questionnaire (response rate = 82.8%). Participants had a mean age of 24.3 ± 2.1 years old, and 56.2% were female (n = 27). Institutional distribution was predominantly UNICAMP (72.9%, n = 35), followed by PUCC (22.9%, n = 11) and SLM (4.1%, n = 2). Among the 18 abstracts submitted, 16 were accepted (88.9%), comprising 15 posters and one oral presentation; 75% (n = 12) focused on medical education and 25% (n = 4) on trauma and emergency surgery. All analyses were based on the 48 respondents.
Trauma surgery classes were attended by 89.5% of participants (n = 43), with 54.1% (n = 26) involved in trauma leagues. Importantly, trauma league members demonstrated significantly higher interest in general surgery careers compared to non-members (61.5 vs. 22.7%; OR = 10.88, 95%CI 2.9–40.7, p = 0.002), indicating a nearly 11-fold increased likelihood. League participation also correlated significantly with greater research engagement (p = 0.028) and prevention activities (p = 0.038), as detailed in Table 1.
Most participants were fourth- or fifth-year students (54.1%, n = 26), followed by third-year students (20.8%, n = 10), residents (12.5%, n = 6), sixth-year students (8.3%, n = 4), and multidisciplinary staff (4.1%, n = 2). Socioeconomic analysis revealed a predominance of higher- and middle-income participants (81.2%), with 79.1% relying on family financial support (p < 0.001; Table 2).
Significant improvements were observed across key academic skills post-intervention (all p < 0.001), including presentation abilities (from 20.8% good/very good pre to 85.4% post), research capabilities (25 to 79.2%), and academic writing (20.8 to 83.3%), underscoring the program’s efficacy in scholarly development (Fig. 2). Self-rated competencies are showed in Table 3.
Interprofessional components yielded strong outcomes, with 95% of participants engaging in trauma prevention activities and 52.5% in more than five such events. The Prevent Alcohol and Risk-related Trauma in Youth (P.A.R.T.Y.) program was most common (79%), followed by mass casualty simulations (45%), and trauma symposia (30%). Reported challenges during abstract preparation included situational anxiety (35%), language barriers (24%), topic unfamiliarity (18%), and limited presentation experience (16%), while 7% faced none.
Career aspirations showed notable shifts, with 62% reporting positive influence on academic trajectories (p = 0.006) and high intentions for continued research (81.3%, p < 0.001) and international submissions (83.3%, p < 0.001), among other impacts (Table 4).
Discussion
The YWI introduces a collaborative, mentorship-driven model for trauma surgery education in Brazil, integrating interprofessional research, experiential learning, and financial support to promote educational equity and address curriculum gaps. Unlike traditional didactic programs, YWI engaged students from three Campinas medical schools in producing and presenting scientific work at an international congress, fostering skill development and surgical interest while emphasizing prevention and global networking.
This experiential approach aligns with frameworks shown superior for clinical competencies in studies on extracurricular leagues3,4. Brazil hosts 437 medical schools as of 2025—the second highest globally after India’s 605—, despite India’s population being approximately 6.6 times larger, with over 79% private institutions raising quality concerns in emergency trauma training5. YWI’s integration of adapted programs like P.A.R.T.Y. from Toronto, Canada, implemented locally since 2010 with broad community outreach, exemplifies how student-led efforts surpass classroom methods in engagement and awareness, consistent with evaluations of similar initiatives6,7. Participation skewed toward mid-curriculum years mirrors literature on reduced extracurricular activity in later stages due to exam focus. YWI’s novelty includes promoting multidisciplinary involvement, countering barriers like workloads that restrict non-physicians, as systematic reviews demonstrate improved outcomes through such engagement8.
This underscores institutional needs for inclusive research teams, extending beyond benefits in emergency nursing. Socioeconomic disparities reflect Brazil’s inequities, and economic factors hinder access; YWI’s aid for lower-income participants enabled merit-based achievements, supporting theories that equitable knowledge reduces inequalities9.
The YWI’s mentorship accelerated development beyond conventional models, influencing aspirations amid global surgical recruitment declines. As a Brazilian innovation, trauma leagues—linked to superior cognitive and clinical performance—offer solutions through competency-based training10. Despite opportunities, general surgery faces challenges, with historically unfilled residency positions in the United States of America and patterns in diverse countries over decades11–15. Landmark surveys highlight low trauma interest due to non-operative demands and patient complexities, yet integrated models like Louisville’s emphasize early exposure for commitment16,17. YWI echoes that leagues shaped specialty choices, attributing surgical decisions to experiential involvement. Unfortunately, in Brazil, trauma surgery is not officially recognized as a specialty, representing a significant barrier to both trauma-care quality and medical education. This gap is particularly concerning as approximately 70% of healthcare professionals working in emergency departments manage trauma patients during their careers18. Hindawi et al.19 reported that lower- and middle-income countries face persistent challenges in surgical care delivery, including inadequate infrastructure, limited availability of trained surgical personnel, lack of essential medical equipment, and insufficient financial resources allocated to healthcare. Brazil’s failure to recognize trauma surgery as a specialty illustrates how these systemic barriers manifest in practice, directly impacting the quality and development of emergency surgical services.
This study employed a retrospective pre-post assessment design, which may introduce response-shift bias and recall limitations. However, this approach offers advantages for educational evaluation: the response-shift effect itself reflects metacognitive development, and retrospective designs ensure uniform reference frames as participants use consistent internal standards to evaluate their competencies. Additionally, post-congress questionnaires were administered after participants had already produced their abstracts, potentially influencing their self-assessment. Strategic design elements—anonymous data collection, 30-day post-congress timing, and pilot-tested prompts—were implemented to minimize social desirability bias. The substantial effect sizes across all domains and high completion rate (86.8%) support the validity of reported gains. Retrospective pre-post designs are established in health professions education literature when prospective baseline assessment is impractical. Future studies should incorporate objective measures such as publication rates or independent competency assessments to complement self-reported data.
Conclusion
The YWI represents a competency-based educational model that positively impacts Brazilian medical students’ academic development and career choices. Through structured mentorship and hands-on activities, the program enhances scholarly skills, boosts interest in surgical specialties, and promotes engagement in trauma prevention, thereby addressing gaps in trauma education and offering a replicable framework for innovation in resource-constrained environments.
Acknowledgements
The authors express sincere gratitude to all participants in this project, including students and residents dedicated to addressing trauma as a neglected disease in Brazil through international research presentations. Special thanks to Professor Dr. Gustavo Pereira Fraga for his visionary leadership in trauma surgery, traffic injury prevention, and educational initiatives nationwide. We also acknowledge the Division of Trauma Surgery at the UNICAMP for their ongoing support in advancing trauma care education. This initiative succeeded due to the enthusiasm and dedication of everyone involved.
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Research performed at School of Medicine of Universidade Estadual de Campinas, Campinas, SP, Brazil. Tutor: Prof. Dr. Gustavo Pereira Fraga.
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Funding
Not applicable.
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Declaration of use of artificial intelligence tools
The authors used generative AI language models to improve the readability and language.
Data availability statement
Supplementary Material 1: https://docs.google.com/forms/d/e/1FAIpQLSfKg1G4NNkalT1WYQ93nXDDkaha8BQlzr3cPTuhY648_vf6qA/closedform.
Supplementary Material 2: https://doi/org/10.6084/m9.figshare.31272658.
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Edited by
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Section editor:
Marcelo Augusto Fontenelle Ribeiro Jr. https://orcid.org/0000-0001-9826-4722
Source: Elaborated by the authors.
Source: Elaborated by the authors.