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Optimizing Military Neurosurgery Readiness and Validation of the Knowledge Skills and Abilities Metric Threshold
Callum D Dewar1, Samuel Woodle1, Melissa Meister1
1Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD 20814, United States.
Introduction:
During interwar transition periods, military medical volume, particularly surgical volume, declines dramatically. The Knowledge, Skills, and Abilities (KSA) metric was developed to assess "readiness" and the ability of the Military Treatment Facilities (MTFs) to prepare active duty (AD) surgeons for deployment. The KSA metric, or threshold for readiness, has not been validated externally. We seek to provide that validation by comparing KSA statistics of the military neurosurgery community to those of civilian neurosurgeons at level 1 civilian trauma centers.
Materials And Methods:
The Carepoint Health Data base compiles KSA totals for each surgeon over a 12-month period for their current stationed MTF. Forty-six AD attending neurosurgeons were included for the 2022 calendar year. To determine reliability of the Carepoint database, we secondarily analyzed the 2023-2024 academic year case logs of every AD neurosurgeon at 2 individual MTFs (N = 11). Civilian neurosurgeon KSA data was compiled by evaluating the case logs of neurosurgeons from 4 level 1 trauma centers (N = 29). We additionally utilized the database to analyze local Purchased Care Markets for each of the neurosurgery supported MTFs during that year to explain the historically low case volumes at the MTFs.
Results:
In 2022, the average KSA per AD neurosurgeon per month was 393, extrapolated to 4,725 annually. Two of the 46 surgeons reached the KSA threshold. For the 2023-2024 academic year, the average AD military annual KSA was 3,192 (N = 9) and the average civilian KSA was 11,272 (N = 29) (P < .0001). Twenty-four of the 29 civilian surgeons met KSA goal 8,000; none of the AD surgeons met goal. Total neurosurgical KSA in Purchased Care was 3,01,535 compared to 1,39,005 for all MTFs. Operative cases were 7,324 deferred to the civilian sector compared to 2,286 performed at MTFs.
Conclusions:
The KSA Metric is a reasonable and attainable readiness standard based on civilian level 1 trauma center statistics but does have its limitations. The current MTF neurosurgery case volume does not support wartime readiness as described by the KSA Metric.
