Military-Civilian Partnerships to Support Military Plastic Surgeons' Readiness: A Blended Practice Model
Sophia R Anderson1, Fatemeh Mirzamohammadi2, Nickolay P Markov3
1School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20854, United States.
Introduction:
Military plastic surgeons play a critical role in the care and rehabilitation of wounded servicemembers. However, the ability of military plastic surgeons to maintain a robust reconstructive skill set within military treatment facilities (MTFs) is often hampered by a narrow case mix and low case volume. We conducted this study to evaluate how integration of a targeted military-civilian partnership (MCP) impacted an MTF-based plastic surgery practice.
Materials And Methods:
Beginning in March 2020, MTF-assigned plastic surgeons expanded their practice through a targeted MCP with a civilian cancer center, whereby military plastic surgeons provided reconstructive care to civilian patients. We obtained clinical workload data through the billing offices at the MCP and comparable offices within the MTF. The primary outcomes measured were the volume of operative procedures and the Joint Knowledge, Skills, and Ability (JKSA) scores related to the clinical workload. Outcomes were standardized to surgeon-months to adjust for variations in surgeon assignment time and then compared between the pre-intervention period (October 2016-February 2020) and the post-intervention period (March 2020-December 2022).
Results:
Throughout the study period, five plastic surgeons contributed 187 surgeon-months at the MTF, spanning before (103 surgeon-months) and after (84 surgeon-months) the intervention. After MCP integration, military plastic surgeons demonstrated a significant increase in procedural volume, with an average of 33.3 procedures per surgeon-month compared to 16.3 before intervention (P < .001). Additionally, there was a substantial rise in the readiness value of the work being performed, as reflected by the JKSA points generated per surgeon-month (108.0 points vs 374.0 points, P < .001). The proportion of operative procedures yielding JKSA points also improved, increasing from 75.2% to 92.4% (P < .001). Notably, several lessons learned were identified to better support MCP integration into MTF based practices including the need for local infrastructure to support these advancements.
Conclusions:
Military-civilian partnerships are essential for military plastic surgeons to sustain the advanced reconstructive skills necessary to treat our nation's wounded service members. Further efforts are necessary to identify best practices in MCP oversight and execution.
