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Surgical Team Assessment Training: improving surgical teams during deployment.

Dwight C Kellicut1, Eric J Kuncir2, Hope M Williamson3

  • 1Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859-5000, USA.

American Journal of Surgery
|June 21, 2014
PubMed
Summary

This study evaluated a new training program for military medical teams working in high-stress combat zones. By using realistic simulations and communication strategies, the program aimed to improve how surgeons and nurses work together during complex trauma care. Participants reported that the training was highly beneficial and likely to save lives in combat. The results suggest that such programs can be successfully delivered even in difficult, austere environments.

Keywords:
SimulationTeamSTEPPSTrauma trainingTrauma Team PerformanceSimulation-Based EducationTeamSTEPPSCombat Casualty Care

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Area of Science:

  • Surgical Team Assessment Training outcomes research within military medicine
  • Clinical education and patient safety strategies

Background:

No prior work had resolved how to effectively deliver specialized team training within active, hostile combat zones. While simulation-based education is recognized for enhancing patient safety, its application in austere military settings remains limited. That uncertainty drove the need for portable, standardized interventions for deployed medical personnel. Prior research has shown that consistent communication principles improve clinical performance in civilian operating rooms. However, the unique stressors of military resuscitation facilities present distinct challenges for implementing these educational frameworks. This gap motivated the development of a program tailored to the specific needs of surgeons and nurses in Iraq. The current study addresses whether such initiatives can be successfully introduced to military staff during active deployment. By examining participant feedback, the researchers sought to determine the perceived value of these interventions in high-stakes environments.

Purpose Of The Study:

The study aimed to evaluate the effectiveness of a new program designed to improve the performance of surgical teams during active military deployment. This research addressed the challenge of maintaining high-quality trauma care within austere and hostile environments. The authors sought to determine if simulation-based training could enhance medical decision-making and communication among surgeons and nurses. By implementing standardized drills, the team intended to test whether such interventions could be successfully introduced to military personnel. The project was motivated by the need to identify strategies that improve clinical outcomes in high-stress combat settings. Researchers investigated whether structured teamwork principles could be effectively taught to deployed staff. They also aimed to capture participant feedback to assess the perceived value and potential for future program expansion. This study specifically focused on whether these educational methods could be integrated into the workflow of military surgical resuscitation facilities.

Main Methods:

The researchers implemented a new educational program across eight Army surgical resuscitation medical treatment facilities located in Iraq. Two teams, each consisting of four surgeons and nurses, traveled to these sites to facilitate the instruction. The study design involved two distinct multi-patient scenarios created to evaluate medical decision-making and care coordination. Review approach included providing two hours of didactic teaching focused on structured communication principles. These sessions emphasized applying specific teamwork concepts during the management of complex traumatic injuries. Following the instruction, all 220 military personnel completed anonymous surveys to assess their perspectives. The evaluation process compared participant opinions before and after the intervention to determine perceived effectiveness. This approach allowed the team to gather data on the feasibility of delivering standardized training in hostile environments.

Main Results:

The primary finding demonstrates that participants were significantly more likely to rate the training as very helpful after completion compared to their initial opinions, with 53% versus 37% (P < .05). Key findings from the literature suggest that 77% of participants believed the program would improve overall patient outcomes. Additionally, 78% of the staff indicated that the training would likely contribute to saving lives in combat situations. A large majority, specifically 98%, expressed that the curriculum should be provided to military emergency medicine and surgical residents. The data indicates that the implementation of these simulation models is feasible even in austere, hostile settings. These results highlight a strong consensus among military medical personnel regarding the value of the intervention. The findings show that the combination of simulation and communication training is well-received by deployed staff. Overall, the quantitative feedback underscores the perceived utility of the program for enhancing trauma team function.

Conclusions:

The authors suggest that this program can be successfully deployed within austere and hostile environments to enhance trauma team function. Their findings indicate that incorporating simulation models and specific communication concepts improves the perceived readiness of medical staff. The researchers propose that expanding this training for predeployment preparation could yield significant benefits for military personnel. They note that the high level of participant approval supports the integration of these methods into standard practice. The study highlights that medical teams value the application of structured teamwork principles during the care of complex traumatic injuries. The authors conclude that such initiatives likely contribute to saving lives in combat scenarios. They emphasize that the program should be provided to emergency medicine and surgical residents to ensure consistent skill development. Future efforts will focus on evaluating the broader impact of this training on clinical outcomes in diverse military settings.

The researchers propose that the program improves trauma team function by integrating simulation-based exercises with TeamSTEPPS communication concepts. This dual approach addresses both technical decision-making and interpersonal coordination during the management of complex, multi-patient traumatic injuries in austere environments.

The program utilizes two multi-patient scenarios designed to test medical decision-making, communication, and care coordination. Additionally, participants receive two hours of didactic instruction focusing on the application of TeamSTEPPS principles specifically tailored for emergency and operating room settings.

The authors emphasize that the training was conducted at eight Army surgical resuscitation medical treatment facilities in Iraq. This setting was necessary to test the feasibility of implementing standardized educational models within active, hostile environments where complex trauma care is provided.

Anonymous surveys served as the primary data source to measure participant perceptions. These instruments allowed the researchers to quantify changes in opinion regarding training helpfulness and the anticipated impact on patient outcomes and survival rates in combat.

Participants were significantly more likely to rate the training as very helpful after completion compared to their pre-participation opinions (53% versus 37%, P < .05). Furthermore, 98% of respondents recommended that the program be provided to military emergency medicine and surgical residents.

The researchers propose that the extremely positive responses from participants justify the expansion of this program for predeployment and resident training. They suggest that these results support the broader adoption of simulation-based teamwork strategies within military medical education.