Orthopedic Intern Curriculum for Military Medical Officers and Surgeons

Military physicians have unique challenges and responsibilities that require intentional training. The transition from medical student to orthopedic surgery intern and then to second-year resident involves a steep learning curve. The intersection of military and medical training therefore would benefit from an intentional curriculum designed to develop effective surgeons and military officers. To date, the literature describes no military-specific orthopedic intern curriculum.

A one-month curriculum was developed for six orthopedic interns at one military treatment facility. The curriculum was designed using Kern's six-step approach based on an internal needs assessment. The curriculum focused on four core competency domains: taking calls, orthopedic principles, psychomotor and surgical skills, and military surgeon development. The curriculum intentionally used multiple learning modalities to ensure high fidelity, including cadaver labs, sawbone sessions, didactic lectures, interactive sessions, and more. Pre- and post-curriculum surveys were administered to the six interns to evaluate perceived confidence in content areas and to a group of faculty to assess confidence and competence in intern performance. Survey responses were scored on a five-point Likert scale and analyzed using the Wilcoxon signed-rank test (two-sided) and the Mann-Whitney U test. Open-ended questions were analyzed using thematic analysis.

Six interns and 23 teaching faculty (staff surgeons and senior residents) participated. Interns improved across all 16 measured clinical and technical metrics, with statistically significant improvements in six. The most pronounced gains occurred in confidence regarding independent call management (median 1.5 vs. 3.0, p = 0.031) and deployment-specific surgical procedures (e.g., amputations, fasciotomies, external-fixator placement) (median 1.5 vs. 3.0, p = 0.031). Retrospective repeat pre-curriculum survey scores were lower for several items, indicating a "response shift" and improved self-awareness of baseline deficiencies. Faculty reported high confidence in the cohort's readiness to function as competent second-year residents and strongly endorsed the military-specific curricular focus.

This curriculum analysis supports the value of an intentional intern curriculum that develops military officership while building orthopedic foundations. As we prepare for future conflicts, a dedicated military medical curriculum remains vital to success. Similarly, excellence as a military physician requires medical subject matter expertise. Surgeon education, therefore, should occur early and often and requires validated, comprehensive curricula to meet the needs of individual hospitals, commands, and the military as a whole. Finally, despite this curriculum's orthopedic and military focus, we suggest the lessons learned here would be valuable to other surgical subspecialties and civilian institutions and should be replicated broadly.