Effectiveness and retention of extremity and junctional tourniquet training among medical interns

BACKGROUND: Traumatic hemorrhage, particularly in extremities and junctional regions, is a life-threatening condition requiring rapid intervention. Although a critical competency for medical interns, tourniquet training remains frequently underrepresented in curricula. This study evaluates the impact of structured, simulation-based training on interns’ knowledge, attitudes, self-confidence, self-efficacy, and skills. It also assesses the learning curve for junctional tourniquet application and skill retention over two months. METHODS: This prospective, longitudinal study included 32 medical interns during their emergency medicine rotation. Participants received three hours of theoretical and simulation-based training based on Advanced Trauma Life Support, Tactical Combat Casualty Care, and Stop the Bleed curricula. Training utilized commercial extremity and SAM Junctional tourniquets. Knowledge, practical skills, attitudes, self-confidence, and self-efficacy were assessed pre-training, immediately post-training, and at a two-month follow-up. Data were analyzed using Friedman and Wilcoxon signed-rank tests with Bonferroni correction. RESULTS: All 32 participants completed the study. Following training, significant improvements were observed in knowledge, skills (extremity and junctional), attitudes, self-confidence, and self- efficacy scores (p < 0.001). Notably, junctional tourniquet skill scores, in which participants had almost no prior familiarity, increased from 1.7 ± 2.1 to 10.8 ± 0.9 and these skill gains were statistically maintained at the two-month follow-up (10.4 ± 1.0). Although extremity tourniquet skill and self-confidence scores declined significantly at two months compared with immediate post-training levels (p < 0.001), they remained above baseline values. Demographics and prior experience did not significantly impact outcomes. CONCLUSION: Simulation-based tourniquet training significantly improves medical interns’ tourniquet knowledge and skills. The findings suggest that interns can effectively acquire and maintain the skill of applying junctional tourniquets, an area often underrepresented in standard medical curricula. In contrast, the observed modest decline in extremity tourniquet skills and self-confidence suggests that a single training exposure may not be sufficient to fully mitigate skill decay, highlighting the potential value of periodic refresher sessions. Interestingly, a comparable decline was not evident in junctional tourniquet application. This pattern may be interpreted within the framework of deep processing, whereby information perceived as novel and clinically salient is processed with greater cognitive engagement, potentially facilitating more durable encoding and retention.

Athletic training · Bleed · Bonferroni correction · Demographics · Tourniquet · Training effect · Wilcoxon signed-rank test · Simulation-Based Education in Healthcare · Trauma and Emergency Care Studies · Trauma, Hemostasis, Coagulopathy, Resuscitation