Direct enhancement of readiness for wartime critical specialties by civilian-military partnerships for neurosurgical care: residency training and beyond

Abstract

<jats:p>Military neurosurgery has played an integral role in the development and innovation of neurosurgery and neurocritical care in treating battlefield injuries. It is of paramount importance to continue to train and prepare the next generation of military neurosurgeons. For the Army, this is currently primarily achieved through the military neurosurgery residency at the National Capital Consortium and through full-time out-service positions at the Veterans Affairs–Department of Defense partnerships with the University of Florida, the University of Texas–San Antonio, and Baylor University. The authors describe the application process for military neurosurgery residency and highlight the training imparted to residents in a busy academic and level I trauma center at the University of Florida, with a focus on how case variety and volume at this particular civilian-partnered institution produces neurosurgeons who are prepared for the complexities of the battlefield. Further emphasis is also placed on collaboration for research as well as continuing education to maintain the skills of nondeployed neurosurgeons. With ongoing uncertainty regarding future conflict, it is critical to preserve and expand these civilian-military partnerships to maintain a standard level of readiness in order to face the unknown with the confidence befitting a military neurosurgeon.</jats:p>

Integrated military and civilian partnerships are necessary for effective trauma-related training and skills sustainment during the inter-war period

“…Eighteen articles described MCP where forward deployed caregivers were provided skills sustainment opportunities of previously learned skills (e.g., original Graduate Medical Education (GME) residency training or from previous deployments). These skills sustainment MCP involved multiple provider types, including surgeons (general, trauma/critical care, orthopedic, vascular, and neurosurgery), anesthesia providers (nurse anesthetists or anesthesiologist), nursing (emergency/trauma, critical care, operating room), surgical technicians, paramedics, and medics 13–29 . Twenty-three described just-in-time training MCP where predeployment multidisciplinary trauma team training at civilian Level I academic centers occurred.…”

“…These skills sustainment MCP involved multiple provider types, including surgeons (general, trauma/critical care, orthopedic, vascular, and neurosurgery), anesthesia providers (nurse anesthetists or anesthesiologist), nursing (emergency/trauma, critical care, operating room), surgical technicians, paramedics, and medics. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Twenty-three described justin-time training MCP where predeployment multidisciplinary trauma team training at civilian Level I academic centers occurred. These types of MCP included a combination of didactics, highfidelity simulation using models and/or cadavers and clinical trauma experiences.…”

Global assessment of military and civilian trauma systems integration: a scoping review

“…Skills Sustainment and Academic Integration were not exclusive to physicians and included allied healthcare providers such as first responders/medics and nurses 12 , 13 , 28 , 32 , 34 , 37 , 40 , 41 , 44 , 51 , 52 , 58 , 60 , 66 , 70 , 72 , 75 – 78 , 82 . Studies that involved Skills Sustainment and/or training largely focused on military personnel 12 , 13 , 20 , 27 , 28 , 32 , 34 , 37 , 40 , 41 , 44 , 49 – 53 , 58 , 60 , 62 , 66 , 68 , 70 – 72 , 74 – 78 , 82 . The remainder involved joint military-civilian training for mass casualty events and disaster response 26 , 36 , 47 , 56 , 64 , 83 , 86 .…”

“…Having military providers with adequate and well-maintained trauma skills and knowledge is critical for a ready medical force, which likely motivated research to focus on the applications for military personnel. One reason cited by many papers reflected an aspect of the Military Health System (MHS), in which only one hospital is an American College of Surgeons-verified Level 1 trauma center and the remainder see low volumes of trauma 12 , 13 , 20 , 32 , 37 , 40 , 51 – 53 , 60 , 68 , 70 , 71 , 74 , 77 , 78 . Accordingly, military providers must spend time at civilian hospitals to gain substantive trauma exposure during peacetime.…”

Answering Our Nation's Call: A Solution for Military Neurosurgery Wartime Readiness Through Civilian Collaboration

“…The University of Florida; University of Texas, San Antonio; and Baylor University are currently training and accepting applications for military neurosurgery residents under the Veterans Affairs-Department of Defense partnership. 15 There are currently over 15 active duty neurosurgical residents composed of Army, Navy, and Air Force officers. In addition to the active duty residents, there are several residents in reserve status, completing residency training in the civilian landscape through the Health Professions Scholarship Program.…”