The Self-Perceived Role 2 Preparedness of Family Medicine Physicians

Large-scale combat operations (LSCO) are anticipated to restrict casualty evacuation, resulting in an increase in volume and duration of Role 2 care. This study assessed self-perceived preparedness among active-duty Family Medicine physicians to deliver Role 2 care and analyzed the training and experiences associated with that perceived preparedness.

In March 2025, a cross-sectional survey was administered to attendees of the Uniformed Services Academy of Family Physicians (USAFP) Annual Meeting. This study assessed career Role 2 experience, recent participation in Role 2 training, completion of relevant training courses, exposure to caring for critically ill patients, and self-perceived preparedness to deliver Role 2 care. Preparedness was assessed in two domains, damage control resuscitation (DCR) and prolonged casualty care (PCC). Factors were screened for association with self-perceived preparedness using a chi-square test. Factors that showed significant associations were further analyzed for the degree of correlation using Kendall's rank correlation coefficient (τb).

In total, 298 meeting attendees responded to the survey (response rate of 47.5%). The survey found that 55% of active-duty Family Medicine physicians had never provided Role 2 care, 51% had not participated in Role 2 training within two years, and 36% had not provided damage control resuscitative care within three years. Half of respondents reported feeling not prepared or only slightly prepared to provide Role 2 PCC, while just 9% felt very prepared. Results for DCR were similar. The chi-square test identified nine factors associated with self-perceived preparedness: career Role 2 experience (DCR P < .001, PCC P < .001), damage control resuscitation (within 3 years) (DCR P < .001, PCC P = .001), Role 2 training exercises (within 2 years) (DCR P < .001, PCC P = .003), rank (DCR P = .003, PCC P = .006), ATLS course completed (DCR P = .017, PCC P < .001), ASSET course completion (DCR P < .001, PCC P = .009), BEST course completion (DCR P = .017, PCC P = .098), TCCC course completed (DCR P = .103, PCC P = .001), and ventilated patient care (within 3 years) (DCR P = .001, PCC P < .001). Kendall's τb demonstrated that three factors had a moderate to strong correlation: career Role 2 experience, damage control resuscitation (within 3 years), and Role 2 training exercises (within 2 years).

LSCO will require Family Medicine physicians to provide critical care in Role 2 settings, yet half report feeling poorly prepared. This study provides quantitative data demonstrating that Role 2 experience, exposure to hospital-based critical care, and participation in Role 2 training exercises were each meaningfully associated with improved perceived preparedness, supporting recommendations to prioritize these experiences. The absence of an objective measure of Role 2 readiness is a key limitation of this study. Although procedure-based specialties have developed the KSA score, many specialties lack an equivalent means of quantifying readiness. Future efforts should prioritize developing objective readiness metrics and expanding access to Role 2 relevant clinical experiences throughout a Family Medicine physician's career.