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Readiness accelerators for military general surgeons: Insights from acute care surgery fellowship programs
Joshua C Dilday1, Elise E H Fannon, Kyle Remick
1Department of Surgery, Medical College of Wisconsin, Milwaukee, WI (J.C.D., M.D.M.); Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (E.E.H.F.); Department of Surgery, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD (K.R., E.E., R.M.R); Department of Surgery, Brooke Army Medical Center, San Antonio, TX (J.G.); Department of Surgery, University of California, Davis Health, Sacramento, CA (G.J.J., J.M.G., R.M.R); Department of Defense (E.E.); Department of Surgery, University of California, San Francisco, San Francisco, CA (M.K.).
Background:
Maintaining expeditionary surgical readiness during peacetime is a persistent Military Health System challenge, particularly for general surgeons assigned to low-volume military treatment facilities. Knowledge, Skills, and Abilities-Clinical Activity (KSA-CA) metrics quantify procedural readiness against operational benchmarks, yet many active-duty surgeons do not meet established thresholds. The American Association for the Surgery of Trauma (AAST) Acute Care Surgery (ACS) fellowship includes a dedicated operative year with high-volume trauma and emergency general surgery exposure that could offer insights for how to accelerate procedural readiness, but its performance against KSA-CA standards has not been evaluated.
Methods:
We performed a retrospective, cross-sectional analysis of procedural case logs from fellows enrolled in AAST ACS fellowship programs between February 2021 and April 2023, limited to procedures performed during the 12-month ACS operative year. Each logged Current Procedural Terminology code was scored using the general surgery KSA-CA algorithm, which maps >2,000 Current Procedural Terminology codes to 49 procedure groups. Readiness was defined as achieving a KSA-CA score at or above the established threshold.
Results:
Case logs from 26 of 32 approved AAST ACS fellowship sites contained eligible entries, representing 102 fellows and 24,493 logged procedures. Among fellows meeting inclusion criteria (n = 73), the median cumulative KSA-CA score was 25,464 (IQR, 7,132-42,415). All fellows who completed the ACS year achieved the KSA-CA readiness threshold (100%); 95% achieved readiness before the end of the year, and 93% met readiness within 6 months. Top contributing procedure groups included intra-abdominal open hollow viscus operations, thoracic (or "pneumonectomy" group in KSA nomenclature), and debridement of muscle and fascia.
Conclusions:
The AAST ACS fellowship curriculum reliably meets military procedural readiness standards as measured by KSA-CA metrics in 12 months or less. The ACS fellowship sites and curricular structure have the potential to accelerate expeditionary readiness among Military Health System general surgeons. ( J Trauma Acute Care Surg . 2026;101: S74-S80. Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Surgery of Trauma.).
Level Of Evidence:
Diagnostic Tests or Criteria, Level IV.
