From the Department of Surgery, Womack Army Medical Center, Fort Bragg, NC (Sheldon, Bozzay, Brown).
Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD (Sheldon, Bozzay, Brown).
J Am Coll Surg. 2023 Aug 1;237(2):221-228. doi: 10.1097/XCS.0000000000000697. Epub 2023 Mar 31.
The Military Health System (MHS) uses a readiness program that identifies the knowledge, skills, and abilities (KSAs) necessary for surgeons to provide combat casualty care. Operative productivity is assigned an objective score based on case type and complexity and totaled to assess overall readiness. As of 2019, only 10.1% of surgeons met goal readiness threshold. At one tertiary military treatment facility (MTF), leadership has taken an aggressive approach toward increasing readiness by forming military training agreements (MTAs) and allowing Off Duty Employment (ODE). We sought to quantify the efficacy of this approach.
Operative logs from 2021 were obtained from surgeons assigned to the MTF. Operations were assigned CPT codes and processed through the KSA calculator (Deloitte; London, UK). Each surgeon was then surveyed to identify time away from clinical duties for deployment or military training.
Nine surgeons were present in 2021 and spent an average of 10.1 weeks (19.5%) abroad. Surgeons performed 2,348 operations (Average [Avg] 261 ± 95) including 1,575 (Avg 175; 67.1%) at the MTF, 606 (Avg 67.3; 25.8%) at MTAs, and 167 (Avg 18.6, 7.1%) during ODE. Adding MTA and ODE caseloads increased KSA scores by 56% (17,765 ± 7,889 vs 11,391 ± 8,355). Using the MHS threshold of 14,000, 3 of 9 (33.3%) surgeons met the readiness threshold from MTF productivity alone. Including all operations, 7 of 9 (77.8%) surgeons met threshold.
Increased use of MTAs and ODE significantly augments average caseloads. These operations provide considerable benefit and result in surgeon readiness far exceeding the MHS average. Military leadership can maximize the chances of meeting readiness goals by encouraging clinical opportunities outside the MTF.
军事卫生系统 (MHS) 使用一项准备计划，确定外科医生提供战伤救治所需的知识、技能和能力 (KSA)。手术生产力根据手术类型和复杂性获得客观分数，并汇总以评估整体准备情况。截至 2019 年，只有 10.1%的外科医生达到目标准备阈值。在一家三级军事治疗设施 (MTF)，领导层采取了积极措施，通过签订军事训练协议 (MTA) 和允许非工作时间就业 (ODE) 来提高准备水平。我们试图量化这种方法的效果。
从分配到 MTF 的外科医生那里获得了 2021 年的手术记录。手术被分配 CPT 代码，并通过 KSA 计算器（德勤；英国伦敦）进行处理。然后对每位外科医生进行调查，以确定因部署或军事训练而离开临床职责的时间。
2021 年有 9 名外科医生在场，平均有 10.1 周（19.5%）在国外。外科医生进行了 2348 次手术（平均 [Avg] 261±95），包括在 MTF 进行的 1575 次（Avg 175；67.1%）、MTA 进行的 606 次（Avg 67.3；25.8%）和 ODE 进行的 167 次（Avg 18.6，7.1%）。增加 MTA 和 ODE 的病例量使 KSA 分数增加了 56%（17765±7889 比 11391±8355）。使用 MHS 的 14000 阈值，9 名外科医生中有 3 名（33.3%）仅从 MTF 的生产力就达到了准备阈值。包括所有手术，9 名外科医生中有 7 名（77.8%）达到了阈值。
增加 MTA 和 ODE 的使用显著增加了平均病例量。这些手术提供了相当大的好处，并使外科医生的准备水平远远超过 MHS 的平均水平。军事领导层可以通过鼓励 MTF 以外的临床机会，最大限度地提高达到准备目标的机会。
