Department of Trauma, Cook County Health, Chicago, IL 60612, USA.
Navy Medicine Readiness and Training Command Great Lakes, North Chicago, IL 60064, USA.
Mil Med. 2023 Jul 22;188(7-8):e2462-e2466. doi: 10.1093/milmed/usac229.
Trauma surgery skills sustainment and maintenance of combat readiness present a major problem for military general surgeons. The Military Health System (MHS) utilizes the knowledge, skills, and abilities (KSA) threshold score of 14,000 as a measure of annual deployment readiness. Only 9% of military surgeons meet this threshold. Most military-civilian partnerships (MCPs) utilize just-in-time training models before deployment rather than clinical experiences in trauma at regular intervals (skills sustainment model). Our aim is to evaluate an established skills sustainment MCP utilizing KSAs and established military metrics.
Three U.S. Navy active duty general surgeons were embedded into an urban level-1 trauma center taking supervised trauma call at regular intervals prior to deployment. Operative density (procedures/call), KSA scores, trauma resuscitation exposure, and combat casualty care relevant cases (CCC-RCs) were reviewed.
During call shifts with a Navy surgeon present an average 16.4 trauma activations occurred; 32.1% were category-1, 27.6% were penetrating, 72.4% were blunt, and 33.8% were admitted to the intensive care unit. Over 24 call shifts of 24 hours in length, 3 surgeons performed 39 operative trauma cases (operative density of 1.625), generating 11,683 total KSA points. Surgeons 1, 2, and 3 generated 5109, 3167, and 3407 KSA points, respectively. The three surgeons produced a total of 11,683 KSA points, yielding an average of 3,894 KSA points/surgeon. In total, 64.1% of operations fulfilled CCC-RC criteria.
Based on this initial evaluation, a military surgeon taking two calls/month over 12 months through our regional skills sustainment MCP can generate more than 80% of the KSA points required to meet the MHS KSA threshold for deployment readiness, with the majority being CCC-RCs. Intangible advantages of this model include exposure to multiple trauma resuscitations while possibly eliminating just-in-time training and decreasing pre-deployment requirements.
创伤外科技能的维持和战备状态的保持对普通外科军医来说是一个重大问题。军事卫生系统 (MHS) 将知识、技能和能力 (KSA) 阈值分数 14000 用作年度部署准备情况的衡量标准。只有 9%的军事外科医生达到这一标准。大多数军民伙伴关系 (MCP) 在部署前只采用即时培训模式，而不是定期进行创伤临床经验（技能维持模式）。我们的目标是利用 KSA 和既定的军事指标来评估现有的技能维持 MCP。
三名美国海军现役普通外科医生被派驻到一家城市一级创伤中心，在部署前定期接受监督创伤值班。审查了手术密度（手术/值班）、KSA 评分、创伤复苏暴露和战斗伤员救治相关病例（CCC-RC）。
在有海军外科医生值班的值班期间，平均发生 16.4 次创伤激活；32.1%为 1 类，27.6%为穿透伤，72.4%为钝器伤，33.8%收入重症监护病房。在 24 小时长的 24 次值班中，3 名外科医生进行了 39 例手术创伤病例（手术密度为 1.625），共产生 11683 个 KSA 点。外科医生 1、2 和 3 分别产生了 5109、3167 和 3407 KSA 点。这三名外科医生共产生了 11683 个 KSA 点，平均每名外科医生产生 3894 个 KSA 点。总共，64.1%的手术符合 CCC-RC 标准。
根据这一初步评估，一名通过我们的区域技能维持 MCP 每月进行两次值班的海军外科医生，在 12 个月内可以产生超过 80%的 KSA 点，以满足 MHS KSA 部署准备的阈值要求，其中大部分是 CCC-RC。该模型的无形优势包括接触多次创伤复苏，同时可能消除即时培训并减少部署前的要求。
