Initial Assessment of a Regional Military–Civilian Partnership on Trauma Surgery Skills Sustainment

Abstract

Introduction Trauma surgery skills sustainment and maintenance of combat readiness present a major problem for military general surgeons. The Military Health System (MHS) utilizes the knowledge, skills, and abilities (KSA) threshold score of 14,000 as a measure of annual deployment readiness. Only 9% of military surgeons meet this threshold. Most military–civilian partnerships (MCPs) utilize just-in-time training models before deployment rather than clinical experiences in trauma at regular intervals (skills sustainment model). Our aim is to evaluate an established skills sustainment MCP utilizing KSAs and established military metrics. Materials and Methods Three U.S. Navy active duty general surgeons were embedded into an urban level-1 trauma center taking supervised trauma call at regular intervals prior to deployment. Operative density (procedures/call), KSA scores, trauma resuscitation exposure, and combat casualty care relevant cases (CCC-RCs) were reviewed. Results During call shifts with a Navy surgeon present an average 16.4 trauma activations occurred; 32.1% were category-1, 27.6% were penetrating, 72.4% were blunt, and 33.8% were admitted to the intensive care unit. Over 24 call shifts of 24 hours in length, 3 surgeons performed 39 operative trauma cases (operative density of 1.625), generating 11,683 total KSA points. Surgeons 1, 2, and 3 generated 5109, 3167, and 3407 KSA points, respectively. The three surgeons produced a total of 11,683 KSA points, yielding an average of 3,894 KSA points/surgeon. In total, 64.1% of operations fulfilled CCC-RC criteria. Conclusions Based on this initial evaluation, a military surgeon taking two calls/month over 12 months through our regional skills sustainment MCP can generate more than 80% of the KSA points required to meet the MHS KSA threshold for deployment readiness, with the majority being CCC-RCs. Intangible advantages of this model include exposure to multiple trauma resuscitations while possibly eliminating just-in-time training and decreasing pre-deployment requirements.

Comparison of military and civilian surgeon outcomes with emergent trauma laparotomy in a mature military-civilian partnership

“…There are currently a multitude of active MCPs throughout the USA that support Army, Air Force, and Navy surgeons. 2 3 8–10 26–28 Recent data suggest that these programs may be beneficial in helping military surgeons obtain the knowledge, skills, and abilities (KSA) thresholds that the Military Health System has adopted to assess for readiness deficits. 1–3 19 KSA metrics, which were designed to encompass the attributes required to be a proficient surgeon for critical wartime procedures, assign a point system to individual surgeon case volumes based on the level of complexity and scope of the procedure.…”

“…Ruggero et al recently described an MCP program that also used general surgeons within a major level 1 trauma center; however, this program fundamentally differed from our model in that the general surgeons described within their MCP act as fellow-level physicians. 2 Similarly, Yonge et al described their experience in the Pacific Northwest, which used general surgeons at a non-academic level II center where they operated under the supervision of a staff surgeon. 1 Despite being non-fellowship trained, SOST surgeons are expected to act in the same capacity as their civilian counterparts at our institution.…”

“… 1–8 The importance of these partnerships spans across all branches of the military during both times of active combat and peacetime efforts. 2 3 5 8–11 Moreover, expansion of these partnerships to include graduate medical education, as well as non-physician medical personnel, has increased the outreach of said programs and further augmented the capabilities of their respective civilian centers. 9 10 Thus, military-civilian partnerships (MCPs) are believed to offer a dynamic and symbiotic relationship for all parties involved.…”

Optimizing combat readiness for military surgeons without trauma fellowship training: Engaging the “voluntary faculty” model

“…Finally, maintaining a direct presence within the surgeon's military command is critical for the development of a military officer 12 and distinct from the benefits offered at civilian institutions or within the integrated MCP model. Ruggero et al 13 recently published their experience with three non–fellowship-trained surgeons using the “voluntary faculty” model at a level 1 trauma center. They report over a 12-month period, covering 12 calls lasting 24 hours per call the accumulation of 11,683 KSAs with an average of 3,894 KSA per surgeon 13 .…”

“…Ruggero et al 13 recently published their experience with three non–fellowship-trained surgeons using the “voluntary faculty” model at a level 1 trauma center. They report over a 12-month period, covering 12 calls lasting 24 hours per call the accumulation of 11,683 KSAs with an average of 3,894 KSA per surgeon 13 . The current study further supports the generation of a substantial volume of KSAs to be completed at civilian institutions.…”