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

Abstract

BACKGROUND Appropriate operative volume remains a critical component in mitigating surgical atrophy and maintaining clinical competency. The initiation of military-civilian surgical partnerships (MCPs) has been proposed for addressing knowledge, skills, and abilities (KSA) metrics to address concerns over operational readiness and the low acuity experienced by military surgeons. This study investigates the first partnership for Navy surgical staff at a nonacademic Military Treatment Facility (MTF) with a regional academic Army Military Treatment Facility (AMTF) and a civilian, nonacademic level II trauma center devised to improve operational readiness for attending surgeons. We hypothesize that a skill sustainment MCP will allow military surgeons to meet combat readiness standards as measured by the KSA metric. METHODS A memorandum of understanding was initiated between the Navy Military Treatment Facility (NMTF), the AMTF, and the level II civilian trauma center (CTC). The single military surgeon in this study was classified as “voluntary faculty” at the CTC. Total case volume and acuity were recorded over an 11-month period. Knowledge, skills, and abilities metrics were calculated using the standard national provider identifier number and the novel case-log based method. RESULTS A total of 156 cases were completed by a single surgeon over the study period, averaging 52 cases per institution. Significantly more KSAs were obtained at the CTC compared with NMTF (5,954 vs. 2,707; p < 0.001). Significantly more emergent cases were observed at the CTC compared with the MTFs (χ2 = 7.1, n = 96, p < 0.05). At a single site, AMTF, a significant difference in the calculated KSA score, was observed between the national provider identifier and case-log methods (5,278 vs. 3,297; p = 0.04). CONCLUSION The skill sustainment MCP between NMTF and CTC increased surgical readiness and exposed surgeons to increased operative acuity. The voluntary faculty model reduces direct litigation exposure and encourages clinical competency for military surgeons while remaining a deployable asset to the global military effort. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.

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

“… 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. 19 Although scores greater than 14,000 per year suggest that a military surgeon is ready to effectively deploy, recent data suggest that only roughly 10% of military surgeons are meeting the aforementioned threshold.…”

“…Although our study did not specifically assess the individual KSA values assigned to each surgeon, a multitude of recently published studies have addressed this at various MCPs and concluded that MCPs offer a feasible way to successfully increase individual KSA values to promote surgical readiness. 1–3 …”

“… 10 Other MCP models encompass programs that allow military surgeons to act as volunteer clinical faculty and still retaining a significant portion of their clinical duties at their respective MTF or MEDCEN. 1 3 Furthermore, other models offer a “just-in-time” concept where military medical teams will travel to a level 1 trauma center during their predeployment training to gain exposure and build team dynamics. 3 Although these programs offer improvements within the current readiness structure, the institutional model here offers a multitude of unique opportunities to further support career development through mentorship, academic teaching of embedded military medics, residents and fellows, and access to a robust research infrastructure.…”

“… 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. This provides SOST surgeons enhanced opportunities akin to their combat deployments, with the ability to actively oversee and run acute trauma resuscitations, perform all indicated surgical procedures, and actively manage critically ill trauma patients during their hospital admission.…”

“…Partnerships between the military and civilian hospital systems have become increasingly recognized as an important tool for augmenting clinical practice and maintaining critical wartime medical skills necessary for military medical professionals. [1][2][3][4][5][6][7][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.…”