RMO, 3 Medical Regiment, Fulwood Barracks, Preston, UK.
Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK.
BMJ Mil Health. 2024 Mar 20;170(2):117-122. doi: 10.1136/bmjmilitary-2022-002112.
The 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.
A 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.
There 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.
There 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.
获取和保留与军事相关的手术知识和技能对于在行动中对战斗伤员进行专家管理至关重要。由于伊拉克和阿富汗的作战行动停止以及英国平民实践中缺乏与军事相关的创伤，技能维持的机会减少了。
向英国国防医疗服务（DMS）外科顾问和创伤、骨科、整形和普通及血管外科专业的高级外科受训人员（DMS 中人数最多的三个外科专业）发送了一份自愿的、匿名的在线调查研究。在线问卷工具包括 20 个问题，采用多项选择和自由文本，以评估受访者作为创伤患者外科医生部署准备情况的主观感受。
共有 108 名受访者中的 71 名（66%）做出了回应。64 名（90%）受访者是现役军人，46 名（65%）在重大创伤中心（MTC）工作。33 名（47%）从未以外科角色部署过行动。19 名（27%）认为他们有足够的机会接触穿透性创伤。当被问及“您对培训和临床实践在多大程度上为您的外科部署做好准备？”时，受训人员的得分明显低于顾问（分别为 6（IQR 4-7）和 8（IQR 7-9）；p<0.001）。现役和预备役军人之间，以及在 MTC 工作和非 MTC 工作之间的分数没有显著差异。受访者建议增加创伤高容量培训和海外创伤中心奖学金、模拟、尸体和活体组织培训，以提高他们的准备水平。
在英国 DMS 顾问和受训人员的样本中，有一种感觉是，他们需要更好的准备才能自信地部署为战斗伤员的外科医生。这些反应表明，如果目前的外科医生要准备好在部署的行动中发挥作用，那么英国 DMS 外科培训需要紧急关注。
