Optimizing combat readiness for military surgeons without trauma fellowship training: engaging the 'voluntary faculty' model.

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Publication Date


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J Trauma Acute Care Surg


washington; everett; prmc


BACKGROUND: Appropriate operative volume remains a critical component in mitigating surgical atrophy and maintaining clinical competency. The initiation of military-civilian surgical partnerships (MCP) has been proposed for addressing knowledge, skills, and abilities (KSA) metrics in order to address concerns over operational readiness and the low acuity experienced by military surgeons. This study investigates the first partnership for Navy surgical staff at a non-academic Military Treatment Facility (MTF) with a regional academic Army MTF and a civilian, non-academic level II trauma center devised to improve operational readiness for attending surgeons. We hypothesize that a skill sustainment MCP will allow military surgeons to meet combat readiness standards as measured by the KSA metric.

METHODS: A Memorandum of Understanding (MOU) was initiated between the Navy MTF (NMTF), the Army MTF (AMTF), and the civilian level II trauma center (CTC). The single military surgeon in this study was classified as 'voluntary faculty' at the CTC. Total case volume and acuity were recorded over an 11-month period. KSA metrics were calculated utilizing the standard national provider number (NPI) and the novel case-log based method.

RESULTS: 156 cases were completed by a single surgeon over the study period, averaging 52 cases per institution. Significantly more KSAs were obtained at the CTC compared to NMTF (5954 v 2707; p < 0.001). Significantly more emergent cases were observed at the CTC compared to the MTFs (X2 = 7.1, n = 96, p < 0.05. At a single site, AMTF, a significant difference in the calculated KSA score was observed between the NPI and case-log methods (5278 v 3297; p = 0.04).

CONCLUSION: The skill sustainment MCP between NMTF and CTC increased surgical readiness and exposed surgeons to increased operative acuity. The 'voluntary faculty' model reduces direct litigation exposure and encourages clinical competency for military surgeons, while remaining a deployable asset to the global military effort.

LEVEL OF EVIDENCE: IV, Therapeutic/Care Management.