优化无创伤专科培训的军事外科医生的战备能力：采用“志愿教员”模式。
Optimizing combat readiness for military surgeons without trauma fellowship training: Engaging the "voluntary faculty" model.
机构信息
From the Providence Regional Medical Center, Division of Trauma and Acute Care Surgery, Everett, Washington (J.Y., S.S., J.G.); United States Navy, Naval Hospital Bremerton, Bremerton, Washington (J.P., G.J., B.O.); MedStar Washington Hospital, Division of Trauma and Acute Care Surgery (J.W.), Washington, DC; Madigan Army Medical Center, Joint Base Lewis McChord (G.P.), Washington; and Oregon Health and Sciences University, Division of Trauma and Acute Care Surgery (M.S.), Portland, Oregon.
出版信息
J Trauma Acute Care Surg. 2023 Aug 1;95(2S Suppl 1):S31-S35. doi: 10.1097/TA.0000000000004040. Epub 2023 May 15.
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 (χ 2 = 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.
背景
适当的手术量仍然是减轻手术萎缩和保持临床能力的关键因素。有人提议开展军民医疗合作（MCP），以解决知识、技能和能力（KSA）指标问题，解决对作战准备和军队外科医生面临的低严重程度的关注。本研究调查了第一个海军外科人员与非学术性军事治疗设施（MTF）与地区性学术性陆军军事治疗设施（AMTF）和民用非学术性二级创伤中心的合作，旨在提高主治外科医生的作战准备。我们假设技能维持 MCP 将使军队外科医生能够达到 KSA 衡量的作战准备标准。
方法
海军军事治疗设施（NMTF）、AMTF 和二级民用创伤中心（CTC）之间签署了一份谅解备忘录。该研究中的一名军队外科医生被归类为 CTC 的“志愿教员”。在 11 个月的时间里记录了总病例量和严重程度。使用标准的国家提供者标识符号码和新的病例记录为基础的方法计算 KSA 指标。
结果
在研究期间，一名外科医生共完成了 156 例手术，平均每所机构 52 例。与 NMTF 相比，在 CTC 获得的 KSA 明显更多（5954 比 2707；p<0.001）。与 MTF 相比，在 CTC 观察到更多的紧急情况（χ2=7.1，n=96，p<0.05）。在一个单一的地点，AMTF，在国家提供者标识符和病例记录方法之间观察到 KSA 评分的显著差异（5278 比 3297；p=0.04）。
结论
NMTF 和 CTC 之间的技能维持 MCP 提高了手术准备，并使外科医生接触到更高的手术严重程度。志愿教员模式降低了军队外科医生的直接诉讼风险，并鼓励他们保持临床能力，同时仍然是全球军事努力的可部署资产。
证据水平
治疗/护理管理；四级。
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