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Optimizing combat readiness for military surgeons without trauma fellowship training: Engaging the "voluntary
John Yonge1, Shaina Schaetzel, Jessie Paull
1From the Providence Regional Medical Center, Division of Trauma and Acute Care Surgery, Everett, Washington (J.Y., S.S., J.G.); United States Navy, Naval Hospital Bremerton, Bremerton, Washington (J.P., G.J., B.O.); MedStar Washington Hospital, Division of Trauma and Acute Care Surgery (J.W.), Washington, DC; Madigan Army Medical Center, Joint Base Lewis McChord (G.P.), Washington; and Oregon Health and Sciences University, Division of Trauma and Acute Care Surgery (M.S.), Portland, Oregon.
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 (χ 2 = 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.
