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Horn CB, Kopchak MC, Pritts TA, Sams VG, Remick KN, Strilka RJ, Earnest RE. Quality of Integration of Air Force Trauma Surgeons Within the Center for Sustainment of Trauma and Readiness Skills, Cincinnati: A Pilot Study. Mil Med 2023:usad441. [PMID: 37997688 DOI: 10.1093/milmed/usad441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/28/2023] [Accepted: 10/31/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION While previous studies have analyzed military surgeon experience within military-civilian partnerships (MCPs), there has never been an assessment of how well military providers are integrated within an MCP. The Center for Sustainment of Trauma and Readiness Skills, Cincinnati supports the Critical Care Air Transport Advanced Course and maintains the clinical skills of its staff by embedding them within the University of Cincinnati Medical Center. We hypothesized that military trauma surgeons are well integrated within University of Cincinnati Medical Center and that they are exposed to a similar range of complex surgical pathophysiology as their civilian partners. MATERIALS AND METHODS After Institutional Review Board approval, Current Procedural Terminology (CPT) codes were abstracted from billing data for trauma surgeons covering University of Cincinnati Hospitals in 2019. The number of trauma resuscitations and patient acuity metrics were abstracted from the Trauma Registry and surgeon Knowledge, Skills, and Abilities clinical activity (KSA-CA) scores were calculated using their CPT codes. Finally, surgeon case distributions were studied by sorting their CPT codes into 23 categories based on procedure type and anatomic location. Appropriate, chi-squared or Mann-Whitney U-tests were used to compare these metrics between the military and civilian surgeon groups and the metrics were normalized by the group's full-time equivalent (FTE) to adjust for varying weeks on service between groups. RESULTS Data were available for two active duty military and nine civilian staff. The FTEs were significantly lower in the military group: military 0.583-0.583 (median 0.583) vs. civilian 0.625-1.165 (median 1.0), P = 0.04. Per median FTE and surgeon number, both groups performed a similar number of trauma resuscitations (civilian 214 ± 54 vs. military 280 ± 13, P = 0.146) and KSA-CA points (civilian 55,629 ± 25,104 vs. military 36,286 ± 11,267; P = 0.582). Although the civilian surgeons had a higher proportion of hernia repairs (P < 0.001) and laparoscopic procedures (P = 0.006), the CPT code categories most relevant to combat surgery (those relating to solid organ, hollow viscus, cardiac, thoracic, abdominal, and tissue debridement procedures) were similar between the surgeon groups. Finally, patient acuity metrics were similar between groups. CONCLUSION This is the first assessment of U.S. Air Force trauma surgeon integration relative to their civilian partners within an MCP. Normalized by FTE, there was no difference between the two groups' trauma experience to include patient acuity metrics and KSA-CA scores. The proportion of CPT codes that was most relevant to expeditionary surgery was similar between the military and civilian partners, thus optimizing the surgical experience for the military trauma surgeons within University of Cincinnati Medical Center. The methods used within this pilot study can be generalized to any American College of Surgeons verified Trauma Center MCP, as standard databases were used.
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Affiliation(s)
- Christopher B Horn
- United States Air Force, Center for Sustainment of Trauma and Readiness Skills, Cincinnati, Cincinnati, OH 45267, USA
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Maura C Kopchak
- University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Timothy A Pritts
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Valerie G Sams
- United States Air Force, Center for Sustainment of Trauma and Readiness Skills, Cincinnati, Cincinnati, OH 45267, USA
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Kyle N Remick
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - Richard J Strilka
- United States Air Force, Center for Sustainment of Trauma and Readiness Skills, Cincinnati, Cincinnati, OH 45267, USA
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Ryan E Earnest
- United States Air Force, Center for Sustainment of Trauma and Readiness Skills, Cincinnati, Cincinnati, OH 45267, USA
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
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Osborn PM. Letter to the Editor Regarding "The Relation of Surgical Volume to Competence: When Is Enough, Enough?". Mil Med 2023; 188:85-87. [PMID: 36369965 DOI: 10.1093/milmed/usac336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/15/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Patrick M Osborn
- Northeast Orthopaedics and Sports Medicine, San Antonio, TX 78217, USA
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Ruggero JM, Farnand AW, Roach PB, Starr F, Tadlock MD, Bokhari F. Initial Assessment of a Regional Military-Civilian Partnership on Trauma Surgery Skills Sustainment. Mil Med 2022; 188:usac229. [PMID: 35880592 DOI: 10.1093/milmed/usac229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/01/2022] [Accepted: 07/21/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION 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. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- John M Ruggero
- Department of Trauma, Cook County Health, Chicago, IL 60612, USA
- Navy Medicine Readiness and Training Command Great Lakes, North Chicago, IL 60064, USA
| | - Alex W Farnand
- Navy Medicine Readiness and Training Command Great Lakes, North Chicago, IL 60064, USA
| | - Paul B Roach
- Navy Medicine Readiness and Training Command Great Lakes, North Chicago, IL 60064, USA
| | - Frederic Starr
- Department of Trauma, Cook County Health, Chicago, IL 60612, USA
| | - Matthew D Tadlock
- 1st Medical Battalion, 1st Marine Logistics Group, Camp Pendleton, CA 92055, USA
| | - Faran Bokhari
- Department of Trauma, Cook County Health, Chicago, IL 60612, USA
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Lee JJ, Hall AB, Carr MJ, MacDonald AG, Edson TD, Tadlock MD. Integrated military and civilian partnerships are necessary for effective trauma-related training and skills sustainment during the inter-war period. J Trauma Acute Care Surg 2022; 92:e57-e76. [PMID: 34797811 DOI: 10.1097/ta.0000000000003477] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Joseph J Lee
- From the Department of Surgery (J.J.L., M.J.C., M.D.T.), Navy Medicine Readiness & Training Command, San Diego, California; 96th Medical Group (A.B.H.), US Air Force Regional Hospital, Eglin AFB, Florida; Uniformed Services University of the Health Sciences (A.G.M.), Bethesda, Maryland; and 1st Medical Battalion (T.D.E.), 1st Marine Logistics Group, Camp Pendleton, California
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Hall A, Qureshi I, Brumagen K, Glaser J. Maintaining vascular trauma proficiency for military non-vascular surgeons. Trauma Surg Acute Care Open 2020; 5:e000475. [PMID: 32596506 PMCID: PMC7312323 DOI: 10.1136/tsaco-2020-000475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 11/11/2022] Open
Abstract
Background Vascular injuries in combat casualty patients are common and remain an ongoing concern. In civilian trauma centers, vascular surgeons are frequently available to treat vascular injuries. Within the military, vascular surgeons are not available at all locations where specialty expertise may be optimal. This study aims to determine if a visiting surgeon model, where a general surgeon can visit a civilian trauma center, would be practical in maintaining proficiency in vascular surgery. Methods All vascular trauma relevant cases done by any surgical service were identified during a 2-year period at Saint Louis University Hospital between October 1, 2016 and September 30, 2018. These included cases performed by trauma/general, thoracic, vascular, and orthopedic surgery. Predictions on the number of call days to experience an operative case were then calculated. Results A total of 316 vascular cases were performed during the time period. A surgeon on call for five 24-hour shifts would experience 2.1 urgent vascular cases with 95% certainty. To achieve five cases with 95% certainty, a surgeon would have to be on call for 34 24-hour shifts. Discussion A visiting surgeon model would be very difficult to maintain to acquire or maintain proficiency in vascular surgery. High-volume trauma centers, or centers with significant open vascular cases in addition to trauma, may have more reasonable time requirements, but would have to be evaluated using these methods. Level of evidence Economic and value-based evaluations, level II.
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Affiliation(s)
- Andrew Hall
- Surgery, 96th Medical Group, US Air Force Regional Hospital, Eglin AFB, Florida, USA
| | - Iram Qureshi
- Biomaterials and Epidemiology, Naval Medical Research Unit San Antonio, San Antonio, Texas, USA
| | - Kegan Brumagen
- Surgery, Keesler Air Force Base, Biloxi, Mississippi, USA
| | - Jacob Glaser
- Austin Shock Trauma, St. David's South Austin Medical Center, Austin, Texas, USA.,Naval Medical Research San Antonio, San Antonio, Texas, USA
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