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

Lee, Joseph; Hall, Andrew B.; Carr, Matthew; MacDonald, Austin G; Edson, Theodore D.; Tadlock, Matthew D.

doi:10.1097/ta.0000000000003477

Cited by 23 publications

(23 citation statements)

References 90 publications

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“…The requirement for more specific trauma training to help bridge the ‘Walker Dip’ (the phenomenon where casualty care improves during a war, only to then degrade during peacetime15) has been echoed in recent articles 16 17. Proposed solutions to this include overseas trauma training programmes and civilian military collaborations,18 19 the latter which has had ongoing benefits for both the civilian and military sectors over the last century 20. Others have echoed the ongoing challenge of maintaining competency in the full range of procedures required in the deployed surgical role21 while delivering services within an increasing subspecialised civilian health service 22 23.…”

Section: Discussionmentioning

confidence: 99%

Acquisition and retention of military surgical competencies: a survey of surgeons’ experiences in the UK Defence Medical Services

et al. 2022

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IntroductionThe acquisition and retention of militarily relevant surgical knowledge and skills are vital to enable expert management of combat casualties on operations. Opportunities for skill sustainment have reduced due to the cessation of combat operations in Iraq and Afghanistan and lack of military-relevant trauma in UK civilian practice.MethodsA voluntary, anonymous online survey study was sent to all UK Defence Medical Services (DMS) surgical consultants and higher surgical trainees in Trauma and Orthopaedics, Plastic and Reconstructive, and General and Vascular surgical specialties (three largest surgical specialties in the DMS in terms of numbers). The online questionnaire tool included 20 questions using multiple choice and free text to assess respondents’ subjective feelings of preparedness for deployment as surgeons for trauma patients.ResultsThere were 71 of 108 (66%) responses. Sixty-four (90%) respondents were regular armed forces, and 46 (65%) worked in a Major Trauma Centre (MTC). Thirty-three (47%) had never deployed on operations in a surgical role. Nineteen (27%) felt they had sufficient exposure to penetrating trauma. When asked ‘How well do you feel your training and clinical practice prepares you for a surgical deployment?’ on a scale of 1–10, trainees scored significantly lower than consultants (6 (IQR 4–7) vs 8 (IQR 7–9), respectively; p<0.001). There was no significant difference in scores between regular and reservists, or between those working at an MTC versus non-MTC. Respondents suggested high-volume trauma training and overseas trauma centre fellowships, simulation, cadaveric and live-tissue training would help their preparedness.ConclusionsThere was a feeling among a sample of UK DMS consultants and trainees that better preparedness is required for them to deploy confidently as a surgeon for combat casualties. The responses suggest that UK DMS surgical training requires urgent attention if current surgeons are to be ready for their role on deployed operations.

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Section: Discussionmentioning

confidence: 99%

Acquisition and retention of military surgical competencies: a survey of surgeons’ experiences in the UK Defence Medical Services

et al. 2022

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“…Senior surgeons should actively seek out those transitioning from civilian training to active service to assist in this process as they often do not have the institutional knowledge military trainees acquire during residency. 12 Transitioning into active service can be an uphill battle with significant bureaucratic hurdles. In many commands junior surgeons are senior officers , without the requisite experience that comes with the rank; while this can be an opportunity, it can also be a pitfall and the right mentorship can help with these challenging transitions.…”

Section: Military Mentorshipmentioning

confidence: 99%

Section: Military Mentorshipmentioning

confidence: 99%

Power of mentorship for civilian and military acute care surgeons: identifying and leveraging opportunities for longitudinal professional development

Knowlton

Butler

Dumas

et al. 2023

Trauma Surg Acute Care Open

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Across disciplines, mentorship has been recognized as a key to success. Acute care surgeons, focused on the care of trauma surgery, emergency general surgery and surgical critical care, practice in a wide variety of settings and have unique mentorship needs across all phases of their career. Recognizing the need for robust mentorship and professional development, the American Association for the Surgery of Trauma (AAST) convened an expert panel entitled ‘The Power of Mentorship’ at the 81st annual meeting in September 2022 (Chicago, Illinois). This was a collaboration between the AAST Associate Member Council (consisting of surgical resident, fellow and junior faculty members), the AAST Military Liaison Committee, and the AAST Healthcare Economics Committee. Led by two moderators, the panel consisted of five real-life mentor-mentee pairs. They addressed the following realms of mentorship: clinical, research, executive leadership and career development, mentorship through professional societies, and mentorship for military-trained surgeons. Recommendations, as well as pearls and pitfalls, are summarized below.

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“…Low volume combined with low operative complexity exacerbates this readiness issue. The dynamics underlying low volume and complexity within the military health care system (MHS) have previously been well described 2–6 …”

mentioning

confidence: 99%

“…Skill sustainment MCPs consist of military surgeons rotating at a local civilian trauma center while remaining on staff at a regional MTF 2 . There are four important distinctions between the integrated and skill sustainment partnerships.…”

mentioning

confidence: 99%

Optimizing combat readiness for military surgeons without trauma fellowship training: Engaging the “voluntary faculty” model

Yonge,

Schaetzel,

Paull

et al. 2023

J Trauma Acute Care Surg

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BACKGROUND Appropriate operative volume remains a critical component in mitigating surgical atrophy and maintaining clinical competency. The initiation of military-civilian surgical partnerships (MCPs) has been proposed for addressing knowledge, skills, and abilities (KSA) metrics 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 nonacademic Military Treatment Facility (MTF) with a regional academic Army Military Treatment Facility (AMTF) and a civilian, nonacademic 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 was initiated between the Navy Military Treatment Facility (NMTF), the AMTF, and the level II civilian 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. Knowledge, skills, and abilities metrics were calculated using the standard national provider identifier number and the novel case-log based method. RESULTS A total of 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 with NMTF (5,954 vs. 2,707; p < 0.001). Significantly more emergent cases were observed at the CTC compared with the MTFs (χ2 = 7.1, n = 96, p < 0.05). At a single site, AMTF, a significant difference in the calculated KSA score, was observed between the national provider identifier and case-log methods (5,278 vs. 3,297; 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 Therapeutic/Care Management; Level IV.

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

Abstract: A total of 866 articles were screened for eligibility and underwent a three-tiered review; 153 articles underwent full-text review. Eighty articles were not utilized for data extraction as

Cited by 23 publications

References 90 publications

Acquisition and retention of military surgical competencies: a survey of surgeons’ experiences in the UK Defence Medical Services

Acquisition and retention of military surgical competencies: a survey of surgeons’ experiences in the UK Defence Medical Services

Power of mentorship for civilian and military acute care surgeons: identifying and leveraging opportunities for longitudinal professional development

Optimizing combat readiness for military surgeons without trauma fellowship training: Engaging the “voluntary faculty” model

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