1
|
Saberi RA, Parker GB, Mohsin N, Gilna GP, Cioci AC, Urrechaga EM, Buzzelli MD, Schulman CI, Proctor KG, Garcia GD. Advanced Surgical Skills for Exposure in Trauma (ASSET) course improves military surgeon confidence. Am J Disaster Med 2024; 19:45-51. [PMID: 38597646 DOI: 10.5055/ajdm.0469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Active duty military surgeons often have limited trauma surgery experience prior to deployment. Consequently, military-civilian training programs have been developed at high-volume trauma centers to evaluate and maintain proficiencies. Advanced Surgical Skills for Exposure in Trauma (ASSET) was incorporated into the predeployment curriculum at the Army Trauma Training Detachment in 2011. This is the first study to assess whether military surgeons demonstrated improved knowledge and increased confidence after taking ASSET. DESIGN Retrospective cohort study. SETTING Quaternary care hospital. PATIENTS AND PARTICIPANTS Attending military surgeons who completed ASSET between July 2011 and October 2020. MAIN OUTCOME MEASURE(S) Pre- and post-course self-reported comfort level with procedures was converted from a five-point Likert scale to a percentage and compared using paired t-tests. RESULTS In 188 military surgeons, the median time in practice was 3 (1-8) years, with specialties in general surgery (52 percent), orthopedic surgery (29 percent), trauma (7 percent), and other disciplines (12 percent). The completed self-evaluation response rate was 80 percent (n = 151). The self-reported comfort level for all body regions improved following course completion (p < 0.001): chest (27 percent), neck (23 percent), upper extremity (22 percent), lower extremity (21 percent), and abdomen/pelvis (19 percent). The overall score on the competency test improved after completion of ASSET, with averages increasing from 62 ± 18 percent pretest to 71 ± 13 percent post-test (p < 0.001). CONCLUSIONS After taking the ASSET course, military surgeons demonstrated improved knowledge and increased confidence in the operative skills taught in the course. The ASSET course may provide sustainment of knowledge and confidence if used at regular intervals to maintain trauma skills and deployment readiness.
Collapse
Affiliation(s)
- Rebecca A Saberi
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of Miami/Ryder Trauma Center at Jackson Memorial Hospital, Miami, Florida
| | - Graham B Parker
- Department of Medicine, Los Angeles General Medical Center, Los Angeles, California. ORCID: https://orcid.org/0000-0002-0446-3446
| | - Noreen Mohsin
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Gareth P Gilna
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of Miami/Ryder Trauma Center at Jackson Memorial Hospital, Miami, Florida
| | - Alessia C Cioci
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of Miami/Ryder Trauma Center at Jackson Memorial Hospital, Miami, Florida
| | - Eva M Urrechaga
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of Miami/Ryder Trauma Center at Jackson Memorial Hospital, Miami, Florida
| | - Mark D Buzzelli
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of Miami/Ryder Trauma Center at Jackson Memorial Hospital, Miami, Florida
| | - Carl I Schulman
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of Miami/Ryder Trauma Center at Jackson Memorial Hospital, Miami, Florida; Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Kenneth G Proctor
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care; United States Army Trauma Training Detachment, University of Miami/Ryder Trauma Center at Jackson Memorial Hospital, Miami, Florida
| | - George D Garcia
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care; United States Army Trauma Training Detachment, University of Miami/Ryder Trauma Center at Jackson Memorial Hospital, Miami, Florida
| |
Collapse
|
2
|
Dewar CD, Sindelar BD, Hooten KG. Answering Our Nation's Call: A Solution for Military Neurosurgery Wartime Readiness Through Civilian Collaboration. Neurosurgery 2023; 93:e153-e158. [PMID: 37449858 DOI: 10.1227/neu.0000000000002595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/10/2023] [Indexed: 07/18/2023] Open
Abstract
Military-civilian partnerships have built the foundation for US neurosurgery as we see it today. Each conflict throughout history has led to expansion within the field of neurosurgery, benefiting civilian patients and those in uniform. Despite the field's growth during wartime, military neurosurgical case volume declines during peacetime, and as a result, important knowledge gained is at risk of being lost. The current landscape of military neurosurgery reflects the relative peacetime for the US-World relationship. Because of this peacetime, the surgical case volume and experience of the military neurosurgeon are declining rapidly. In addition to providing a history of military-civilian partnerships in neurosurgery, we have analyzed the declining case volume trends at a single military treatment facility with neurosurgical capabilities. We compared the case volume of a military neurosurgeon at a civilian partnered location with their previous volume at a military treatment facility and analyzed current trends in wartime readiness by Neurosurgery Knowledge, Skills and Abilities metrics. We believe that military civilian partnerships hold the key to scaffolding the experience to maintain the wartime readiness in the military neurosurgical community.
Collapse
Affiliation(s)
- Callum D Dewar
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda , Maryland , USA
| | - Brian D Sindelar
- Department of Neurosurgery, University of North Carolina Hospitals, Chapel Hill , North Carolina , USA
| | - Kristopher G Hooten
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda , Maryland , USA
| |
Collapse
|
3
|
Fawaz R, Dagain A, Pons Y, Haen P, Froussart F, Caruhel JB. Head Face and Neck Surgeon Deployment in the New French Role 2: The Damage Control Resuscitation and Surgical Team. Mil Med 2023; 188:e2868-e2873. [PMID: 36308315 DOI: 10.1093/milmed/usac329] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/01/2022] [Accepted: 10/11/2022] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION High-intensity conflict is back after decades of asymmetric warfare. With the increase in the incidence of head, face, and neck (HFN) injuries, the French Medical Military Service has decided to deploy HFN surgeons in the new French Role 2: the Damage Control, Resuscitation, and Surgical Team (DCRST). This study aims to provide an overview of HFN French surgeons from their initial training, including the surgical skills required, to their deployment on the DCRST. MATERIALS AND METHODS The DCRST is a tactical mobile medico-surgical structure with several configurations depending on the battlefield, mission, and flux of casualties. It represents the new French paradigm for the management of combat casualties, including HFN injuries. RESULTS The HFN's military surgeon training starts during residency with rotation in the different subspecialties. The HFN surgeon follows a training course called "The French Course for Deployment Surgery" that provides sufficient background to manage polytrauma, including HFN facilities on modern warfare. We have reviewed the main surgical procedures required for an HFN military surgeon. CONCLUSION The systematic deployment of HFN surgeons in Role 2 is a specificity of the French army as well as the HFN surgeon's training.Currently, the feedback from an asymmetric conflict is encouraging. However, it will have to innovate to adapt to modern warfare.
Collapse
Affiliation(s)
- Rayan Fawaz
- Department of Neurosurgery, Percy Military Teaching Hospital, Clamart Cedex 92140, France
| | - Arnaud Dagain
- Department of Neurosurgery, Sainte Anne Military Teaching Hospital, Toulon Cedex 83000, France
| | - Yoann Pons
- Department of ENT and Maxillo Facial Surgery, Percy Military Teaching Hospital, Clamart Cedex 92140, France
| | - Pierre Haen
- Department of Maxillo Facial Surgery, Laveran Military Teaching Hospital, Marseille Cedex 13384, France
| | - Françoise Froussart
- Department of Ophthalmology, Percy Military Teaching Hospital, Clamart Cedex 92140, France
| | - Jean Baptiste Caruhel
- Department of ENT and Maxillo Facial Surgery, Percy Military Teaching Hospital, Clamart Cedex 92140, France
| |
Collapse
|
4
|
Borg TM, Cavale N, Abu-Sittah G, Ghanem A. Plastic and Maxillofacial Training for War-Zones - A Systematic Review. Craniomaxillofac Trauma Reconstr 2023; 16:154-162. [PMID: 37222978 PMCID: PMC10201192 DOI: 10.1177/19433875221083416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Study Design Injuries sustained in war-zones are variable and constantly developing according to the nature of the ongoing conflict. Soft tissue involvement of the extremities, head and neck often necessitates reconstructive expertise. However, current training to manage injuries in such settings is heterogenous. This study involves a systematic review. Objective To evaluate interventions in place to train Plastic and Maxillofacial surgeons for war-zone environments so that limitations to current training can be addressed. Methods A literature search of Medline and EMBase was performed using terms relevant to Plastic and Maxillofacial surgery training and war-zone environments. Articles that met the inclusion criteria were scored then educational interventions described in included literature were categorised according to their length, delivery style and training environment. Between-group ANOVA was performed to compare training strategies. Results 2055 citations were identified through this literature search. Thirty-three studies were included in this analysis. The highest scoring interventions were over an extended time-frame with an action-oriented training approach, using simulation or actual patients. Core competencies addressed by these strategies included technical and non-technical skills necessary when working in war-zone type settings. Conclusions Surgical rotations in trauma centers and areas of civil strife, together with didactic courses are valuable strategies to train surgeons for war-zones. These opportunities must be readily available globally and be targeted to the surgical needs of the local population, anticipating the types of combat injuries that often occur in these environments.
Collapse
Affiliation(s)
- Tiffanie-Marie Borg
- Academic Plastic Surgery Group, Barts and the London School of
Medicine and Dentistry, Queen Mary University of London, London,
UK
- Department of Surgery, Queen’s Hospital, London, UK
| | | | | | - Ali Ghanem
- Academic Plastic Surgery Group, Barts and the London School of
Medicine and Dentistry, Queen Mary University of London, London,
UK
| |
Collapse
|
5
|
Adebusoye FT, Awuah WA, Alshareefy Y, Wellington J, Mani S, Ahmad AO, Tenkorang PO, Abdul‐Rahman T, Denys O. Craniomaxillofacial trauma in war-torn nations: Incidence, management gaps, and recommendations. Acute Med Surg 2023; 10:e877. [PMID: 37528889 PMCID: PMC10387589 DOI: 10.1002/ams2.877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/26/2023] [Accepted: 07/10/2023] [Indexed: 08/03/2023] Open
Abstract
Craniomaxillofacial trauma (CMFT) is a type of injury that affects the face, neck, and scalp, and includes facial bone fractures, dentoalveolar trauma, and soft tissue injuries. Work, traffic accidents, sports, and daily activities commonly cause these injuries. However, they are widespread in war-torn countries where armed conflict leads to a high incidence of CMFT. The lack of resources, health care infrastructure, and surgical personnel in these areas result in subpar treatment and poor patient outcomes, contributing to the high mortality and morbidity rates among war victims. The importance of a multidisciplinary approach to CMFT management cannot be overstated, but current obstacles, such as a lack of access to proper medical care and rehabilitation services, impede the development of effective treatments. CMFT treatment is complex and prohibitively expensive for war-torn nations to afford, necessitating international intervention to provide life-saving surgical procedures for those suffering from CMFT in conflict zones. Despite efforts to improve CMFT treatments in war-torn countries, more must be done to improve treatment outcomes. Data collection and research must also be improved in order to develop effective evidence-based treatment methods.
Collapse
Affiliation(s)
| | | | - Yasir Alshareefy
- Faculty of MedicineSchool of MedicineTrinity CollegeDublinIreland
| | - Jack Wellington
- Faculty of Medicine, School of MedicineCardiff UniversityCardiffUK
| | - Shyamal Mani
- Faculty of MedicineSumy State UniversitySumyUkraine
| | | | | | | | | |
Collapse
|
6
|
Establishment of a combat damage control surgery training platform for explosive combined thoraco-abdominal injuries. Chin J Traumatol 2022; 25:193-200. [PMID: 35331606 PMCID: PMC9252934 DOI: 10.1016/j.cjtee.2022.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 12/31/2021] [Accepted: 01/18/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE It is challenging to prepare military surgeons with the skills of combat damage control surgery (CDCS). The current study aimed to establish a damage control surgery (DCS) training platform for explosive combined thoraco-abdominal injuries. METHODS The training platform established in this study consisted of 3 main components: (1) A 50 m × 50 m square yard was constructed as the explosion site. Safety was assessed through cameras. (2) Sixteen pigs were injured by an explosion of trinitrotoluene attached with steel balls and were randomly divided into the DCS group (accepted DCS) and the control group (have not accepted DCS). The mortality rate was observed. (3) The literature was reviewed to identify the key factors for assessing CDCS, and testing standards for CDCS were then established. Expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards. Then, a 5-day training course with incorporated tests was used to test the efficacy of the established platform. In total, 30 teams attended the first training course. The scores that the trainees received before and after the training were compared. SPSS 11.0 was employed to analyze the results. RESULTS The high-speed video playback confirmed the safety of the explosion site as no explosion fragments projected beyond the wall. No pig died within 24 h when DCS was performed, while 7 pigs died in the control group. After a literature review, assessment criteria for CDCS were established that had a total score of 100 points and had 4 major parts: leadership and team cooperation, resuscitation, surgical procedure, and final outcome. Expert questionnaire results showed that the scientific score was 8.6 ± 1.25, and the feasibility score was 8.74 ± 1.19. When compared with the basic level, the trainees' score improved significantly after training. CONCLUSION The platform established in this study was useful for CDCS training.
Collapse
|
7
|
Beckett A, Parker P, Williams P, Tien H. Effect of special operational forces surgical resuscitation teams on combat casualty survival: A narrative review. Transfusion 2022; 62 Suppl 1:S266-S273. [PMID: 35765916 DOI: 10.1111/trf.16969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 04/30/2022] [Accepted: 05/01/2022] [Indexed: 11/28/2022]
Abstract
IMPORTANCE The most common cause of preventable death on the conventional battlefield or on special operations force (SOF) missions is hemorrhage. SOF missions may take place in remote and austere locations. Many preventable deaths in combat occur within 30 min of wounding. Therefore, SOF damage control resuscitation (DCR) and damage control surgery (DCS) teams may improve combat casualty survival in the SOF environment. OBJECTIVE To determine the effect of SOF DCR and DCS teams on combat casualty survival. Also, to describe commonalities in team structure, logistics, and blood product usage. DESIGN A narrative review of the English literature used a Medline and Embase search strategy. The authors were contacted for more details as required. The risk of bias was assessed using the Cochrane Collaboration's ROBINS-I tool. Pooling of data was not done to the heterogeneity of studies. RESULTS Weak evidence was identified showing a clinical benefit of SOF DCR and DCS teams. Conflicting evidence from less rigorous studies was also found. The overall risk of bias using ROBINS-I was serious to critical. Several commonalities in team structure, training, and logistics were found. CONCLUSIONS AND RELEVANCE There is conflicting evidence regarding the effect SOF DCR and DCS teams have on combat casualty survival. There is no strong evidence that SOF DCR and DCS teams cause harm. More robust data collection is recommended to evaluate these teams.
Collapse
Affiliation(s)
- Andrew Beckett
- Royal Canadian Medical Services, Canadian Army, Toronto, Canada.,Trauma Program, St. Michaels Hospital, Toronto, Canada
| | - Paul Parker
- Royal Army Medical Corps, British Army, Birmingham, UK
| | - Phillip Williams
- Division of General Surgery, University of Toronto, Toronto, Canada
| | - Homer Tien
- Royal Canadian Medical Services, Canadian Army, Toronto, Canada.,Trauma Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| |
Collapse
|
8
|
Haag A, Cone EB, Wun J, Herzog P, Lyon S, Nabi J, Marchese M, Friedlander DF, Trinh QD. Trends in Surgical Volume in the Military Health System-A Potential Threat to Mission Readiness. Mil Med 2021; 186:646-650. [PMID: 33326571 DOI: 10.1093/milmed/usaa543] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/15/2020] [Accepted: 11/26/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The Military Health System (MHS) is tasked with a dual mission both to provide medical services for covered patients and to ensure that its active duty medical personnel maintain readiness for deployment. Knowledge, skills, and attitudes (KSA) is a metric evaluating the transferrable skills incorporated into a given surgery or medical procedure that are most relevant for surgeons deployed to a theatre of war. Procedures carrying a high KSA value are those utilizing skills with high relevance for maintaining deployment readiness. Given ongoing concerns regarding surgical volumes at MTFs and the potential adverse impact on military surgeon mission readiness were high-value surgeries to be lost to the civilian sector, we evaluated trends in the setting of high-value surgeries for beneficiaries within the MHS. METHODS We retrospectively analyzed inpatient admissions data from MTFs and TRICARE claims data from civilian hospitals, 2005-2019, to identify TRICARE-covered patients covered under "purchased care" (referred to civilian facilities) or receiving "direct care" (undergoing treatment at MTFs) and undergoing seven high-value/high-KSA surgeries: colectomy, pancreatectomy, hepatectomy, open carotid endarterectomy, abdominal aortic aneurysm (AAA) repair, esophagectomy, and coronary artery bypass grafting (CABG). Overall and procedure-specific counts were captured, MTFs were categorized into quartiles by volume, and independence between trends was tested with a Cochran-Armitage test, hypothesizing that the proportion of cases referred for purchased care was increasing. RESULTS We captured 292,411 cases, including 7,653 pancreatectomies, 4,177 hepatectomies, 3,815 esophagectomies, 112,684 colectomies, 92,161 CABGs, 26,893 AAA repairs, and 45,028 carotid endarterectomies. The majority of cases included were referred for purchased care (90.3%), with the proportion of cases referred increasing over the study period (P < .01). By procedure, all cases except AAA repairs were increasingly referred for treatment over the study period (all P < .01, except esophagectomy P = .04). On examining volume, we found that even the highest-volume-quartile MTFs performed a median of less than one esophagectomy, hepatectomy, or pancreatectomy per month. The only included procedure performed once a month or more at the majority of MTFs was CABG. CONCLUSION On examining volume and referral trends for high-value surgeries within the MHS, we found low surgical volumes at the vast majority of included MTFs and an increasing proportion of cases referred to civilian hospitals over the last 15 years. Our findings illustrate missed opportunities for maintaining the mission readiness of military surgical personnel. Prioritizing the recapture of lost surgical volume may improve the surgical teams' mission readiness.
Collapse
Affiliation(s)
- Austin Haag
- Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Eugene B Cone
- Brigham and Women's Hospital, Division of Urological Surgery, Harvard Medical School, Boston, MA 02114, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Jolene Wun
- Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Peter Herzog
- Brigham and Women's Hospital, Division of Urological Surgery, Harvard Medical School, Boston, MA 02114, USA
| | - Samuel Lyon
- Brigham and Women's Hospital, Division of Urological Surgery, Harvard Medical School, Boston, MA 02114, USA
| | - Junaid Nabi
- Brigham and Women's Hospital, Division of Urological Surgery, Harvard Medical School, Boston, MA 02114, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Maya Marchese
- Brigham and Women's Hospital, Division of Urological Surgery, Harvard Medical School, Boston, MA 02114, USA
| | - David F Friedlander
- Brigham and Women's Hospital, Division of Urological Surgery, Harvard Medical School, Boston, MA 02114, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Quoc-Dien Trinh
- Brigham and Women's Hospital, Division of Urological Surgery, Harvard Medical School, Boston, MA 02114, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02114, USA
| |
Collapse
|
9
|
Abstract
ABSTRACT The role of physician assistants (PAs) in the United States extends to the Army National Guard; Air National Guard; and reserves of the Army, Navy, Air Force, and Coast Guard (collectively known as reserve components). To understand the duality of civilian-military PA roles, a census of the armed forces was undertaken, drawing on knowledgeable senior PA medical officers in each of the services. The survey was supplemented with data from the National Commission on Certification of Physician Assistants. In 2020, there were 1,944 PAs in the five military reserve components with the majority (1,597) in the Army. Most National Guard, Air National Guard, and Reserve PAs fill medical officer roles, drill with units, and are subject to active duty. As soldiers, sailors, and airmen, military PAs are trained in health, safety, warfare readiness, casualty, trauma, and crisis response. The tenure of a reserve component PA in the military ranged between 10.2 and 17.8 years. In their civilian roles, most PAs are licensed and clinically active-the majority report they work in family/general medicine, emergency medicine, general surgery, or orthopedic medicine and surgery. This dual-career role and responsibility suggests the utility and flexibility of the PA is broader than previously reported. The findings set the stage for additional research on healthcare professionals during times of domestic and international emergencies.
Collapse
Affiliation(s)
- Roderick S Hooker
- Roderick S. Hooker is a health services researcher and an adjunct professor of health policy at Northern Arizona University's Phoenix Biomedical Campus. Andrzej Kozikowski is director of research at the National Commission on Certification of Physician Assistants in Johns Creek, Ga. Col. Johnny Paul is chair of the Department of Combat Medic Training at Fort Sam Houston in Texas. The authors have disclosed no potential conflicts of interest, financial or otherwise
| | | | | |
Collapse
|
10
|
Hurst ND, Durning SJ, Cervero RM, Morrison Ponce D. Train for the Game: What Is the Learning Environment of Deployed Navy Emergency Medicine Physicians? AEM EDUCATION AND TRAINING 2021; 5:e10521. [PMID: 34041430 PMCID: PMC8138097 DOI: 10.1002/aet2.10521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/29/2020] [Accepted: 08/08/2020] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Medicine is a practice characterized by ongoing learning, and unique qualities of the operational learning environment (LE) may affect learner needs. When physicians move between differing practice environments learners may encounter situations for which they are unprepared. Using a conceptual framework specific to the LE, we therefore asked the following research question: what is the difference in LE for Navy emergency medicine (EM) physicians who practice in U.S. hospitals but serve an operational environment, and how do these differences shape their learning needs? METHODS We interviewed Navy EM physicians who recently deployed to explore their perceptions of the deployed LE, how it differed from the LE they practice in stateside, and the perceived effect this difference had on their learning needs. We used the constant comparative method to gather and analyze data until thematic saturation was achieved. RESULTS We interviewed 12 physicians and identified six interconnected themes consistent with the LE framework in the literature: 1) patient care is central to the learning experience; 2) professional isolation versus connectedness; 3) a sense of meaningful practice engages the learner in the LE; 4) physicians as educators shape the LE; 5) team trust impacts the LE; and 6) the larger military organization impacts the LE. CONCLUSIONS Our themes span the conceptual framework put forth by previous work and did not find themes outside this framework. These interconnected themes describe the difference in LE between the stateside and deployed setting and impact the learning needs of Navy EM physicians. These results inform strategies to position the deployed medical unit for success.
Collapse
Affiliation(s)
- Nicole D. Hurst
- Uniformed Services University of the Health SciencesBethesdaMDUSA
| | | | | | | |
Collapse
|
11
|
Choufani C, Barbier O, Demoures T, Mathieu L, Rigal S. Evaluation of a fellowship abroad as part of the initial training of the French military surgeon. BMJ Mil Health 2020; 167:168-171. [PMID: 32015183 DOI: 10.1136/jramc-2019-001303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 08/31/2019] [Accepted: 09/02/2019] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Military surgery requires skills that in general cannot be easily learnt in civilian training. Participation in a fellowship abroad adapted to the particular operating conditions of the foreign deployment is one route that might secure the necessary supplementary training. We therefore assessed the relevance of such a fellowship in the preparedness of young military surgeons in their first deployment. METHODS This study included all active military surgeons who had completed a fellowship abroad during their initial training from 2004 to 2017 in Tchad or Senegal or Djibouti. The collection of data was performed using a questionnaire. The main judgement criterion was the rate of positive answers awarded to the relevance of this fellowship in the preparedness of respondents' first foreign deployment. RESULTS Sixty-nine of 73 surgeons answered. Sixty-one estimated the fellowship had allowed them to feel more operational during their first mission, with 83.61% rating this feeling as important. Also, 61 recommended the use of a fellowship for war surgery training. The grade assigned to the surgical benefit was 8.48/10. CONCLUSION A fellowship abroad permits one to become familiar with surgical practice under austere circumstances and the particularities of the surgical structures at the front. Current trainees' feedback confirms its relevance.
Collapse
Affiliation(s)
- Camille Choufani
- Orthopaedic Surgery, Military Training Hospital Begin, Saint Mande, France
| | - O Barbier
- Orthopedic and Traumatology, Hopital d'Instruction des Armees Begin, Saint Mande, France
| | - T Demoures
- Orthopaedic Surgery, Military Training Hospital Begin, Saint Mande, France
| | - L Mathieu
- Department of Orthopaedic, Trauma and Reconstructive Surgery, HIA Percy, Clamart, France
| | - S Rigal
- Department of Traumatology and Orthopedics, HIA Percy, Clamart, France
| |
Collapse
|
12
|
Coventry CA, Holland AJA, Read DJ, Ivers RQ. Australasian general surgical training and emergency medical teams: a review. ANZ J Surg 2019; 89:815-820. [PMID: 31066168 DOI: 10.1111/ans.15158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/24/2019] [Accepted: 02/26/2019] [Indexed: 01/09/2023]
Abstract
Emergency medical teams (EMTs) have provided surgical care in sudden-onset disasters in low- and middle-income countries. General surgeons have been heavily involved in many EMTs due to their traditional broad set of surgical skills and experience. With the increased subspecialization of general surgical training in many high-income countries, including Australia and New Zealand, finding general surgeons with adequately broad experience is becoming more challenging. Furthermore, it is now considered standard for EMTs deploying to a sudden-onset disaster to have undergone credentialing, demonstrating sufficient training of their deployed members. The purpose of this review was to highlight the challenges and potential solutions facing those involved in training and recruiting general surgeons for EMTs in Australasia.
Collapse
Affiliation(s)
- Charles A Coventry
- Children's Hospital at Westmead Clinic School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew J A Holland
- Children's Hospital at Westmead Clinic School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - David J Read
- National Critical Care and Trauma Response Centre, Darwin, Northern Territory, Australia
| | - Rebecca Q Ivers
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
13
|
Choufani C, Barbier O, Mayet A, Rigal S, Mathieu L. Preparedness Evaluation of French Military Orthopedic Surgeons Before Deployment. Mil Med 2019; 184:e206-e212. [PMID: 29901771 DOI: 10.1093/milmed/usy134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/19/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Camille Choufani
- Department of Orthopaedic Surgery and Traumatology, Begin Military Teaching Hospital, Saint-Mandé, France
| | - Olivier Barbier
- Department of Orthopaedic Surgery and Traumatology, Begin Military Teaching Hospital, Saint-Mandé, France
| | - Aurélie Mayet
- Department of Epidemiology and Public Health, Camp de Sainte Marthe, Marseille, France
| | - Sylvain Rigal
- Department of Orthopaedic, Traumatology and Reconstructive surgery, Percy Military Teaching Hospital, Clamart, France.,Department of Surgery, French Military Health Service Academy, Ecole du-Val-de-Grâce, Paris, France
| | - Laurent Mathieu
- Department of Orthopaedic, Traumatology and Reconstructive surgery, Percy Military Teaching Hospital, Clamart, France.,Department of Surgery, French Military Health Service Academy, Ecole du-Val-de-Grâce, Paris, France
| |
Collapse
|
14
|
Breeze J, Combes JG, DuBose J, Powers DB. How are we currently training and maintaining clinical readiness of US and UK military surgeons responsible for managing head, face and neck wounds on deployment? J ROY ARMY MED CORPS 2018; 164:183-185. [DOI: 10.1136/jramc-2018-000971] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 04/22/2018] [Indexed: 11/03/2022]
Abstract
IntroductionThe conflicts in Iraq and Afghanistan provided military surgeons from the USA and the UK with extensive experience into the management of injuries to the head, face and neck (HFN) from high energy bullets and explosive weaponry. The challenge is now to maintain the expertise in managing such injuries for future military deployments.MethodsThe manner in which each country approaches four parameters required for a surgeon to competently treat HFN wounds in deployed military environments was compared. These comprised initial surgical training (residency/registrar training), surgical fellowships, hospital type and appointment as an attending (USA) or consultant (UK) and predeployment training.ResultsNeither country has residents/registrars undertaking surgical training that is military specific. The Major Trauma and Reconstructive Fellowship based in Birmingham UK and the Craniomaxillofacial Trauma fellowship at Duke University USA provide additional training directly applicable to managing HFN trauma on deployment. Placement in level 1 trauma/major trauma centres is encouraged by both countries but is not mandatory. US surgeons attend one of three single-service predeployment courses, of which HFN skills are taught on both cadavers and in a 1-week clinical placement in a level 1 trauma centre. UK surgeons attend the Military Operational Surgical Training programme, a 1-week course that includes 1 day dedicated to teaching HFN injury management on cadavers.ConclusionsMultiple specialties of surgeon seen in the civilian environment are unlikely to be present, necessitating development of extended competencies. Military-tailored fellowships are capable of generating most of these skills early in a career. Regular training courses including simulation are required to maintain such skills and should not be given only immediately prior to deployment. Strong evidence exists that military consultants and attendings should only work at level 1/major trauma centres.
Collapse
|
15
|
Abstract
John B Holcomb summarizes recent conceptual and practical advances in trauma care, in both military and civilian settings, and presents directions for future research.
Collapse
Affiliation(s)
- John B. Holcomb
- Center for Translational Injury Research, Department of Surgery, McGovern Medical School, UT Health, Houston, Texas, United States of America
- * E-mail:
| |
Collapse
|
16
|
Smith JE, Withnall RDJ, Rickard RF, Lamb D, Sitch A, Hodgetts TJ. A pilot study to evaluate the utility of live training (LIVEX) in the operational preparedness of UK military trauma teams. Postgrad Med J 2016; 92:697-700. [DOI: 10.1136/postgradmedj-2015-133585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 12/22/2015] [Accepted: 04/17/2016] [Indexed: 11/04/2022]
|
17
|
Smith JE, Le Clerc S, Hunt PAF. Challenging the dogma of traumatic cardiac arrest management: a military perspective. Emerg Med J 2015; 32:955-60. [PMID: 26493124 DOI: 10.1136/emermed-2015-204684] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 09/28/2015] [Indexed: 11/04/2022]
Abstract
Attempts to resuscitate patients in traumatic cardiac arrest (TCA) have, in the past, been viewed as futile. However, reported outcomes from TCA in the past five years, particularly from military series, are improving. The pathophysiology of TCA is different to medical causes of cardiac arrest, and therefore, treatment priorities may also need to be different. This article reviews recent literature describing the pathophysiology of TCA and describes how the military has challenged the assumption that outcome is universally poor in these patients.
Collapse
Affiliation(s)
- J E Smith
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Birmingham, UK Emergency Department, Derriford Hospital, Plymouth, UK
| | - S Le Clerc
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Birmingham, UK Emergency Department, James Cook University Hospital, Middlesbrough, UK
| | - P A F Hunt
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Birmingham, UK Emergency Department, James Cook University Hospital, Middlesbrough, UK
| |
Collapse
|
18
|
Abstract
This White Paper summarizes the state of readiness of combat surgeons and provides action recommendations that address the problems of how to train, sustain, and retain them for future armed conflicts. As the basis for the 2014 Scudder Oration, I explored how to secure an improved partnership between military and civilian surgery, which would optimize learning platforms and embed military trauma personnel at America's academic medical universities for trauma combat casualty care (TCCC). To craft and validate these recommendations, I conducted an integrative and iterative process of literature reviews, interviews of military and civilian leaders, and a survey of military-affiliated surgeons. The recommended action points advance the training of combat surgeons and their trauma teams by creating an expanded network of TCCC training sites and sourcing the cadre of combat-seasoned surgeons currently populating our civilian and military teaching hospitals and universities. The recommendation for the establishment of a TCCC readiness center or command within the Medical Health System of the Department of Defense includes a military and civilian advisory board, with the reformation of a think tank of content experts to address high-level solutions for military medicine, readiness, and TCCC.
Collapse
|
19
|
Mathieu L, Joly B, Bonnet S, Bertani A, Rongiéras F, Pons F, Rigal S. Modern teaching of military surgery: why and how to prepare the orthopaedic surgeons before deployment? The French experience. INTERNATIONAL ORTHOPAEDICS 2015; 39:1887-93. [PMID: 25804207 DOI: 10.1007/s00264-015-2741-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 03/04/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Improved survival of combat casualties in modern conflicts is especially due to early access to damage control resuscitation and surgery in forward surgical facilities. In the French Army, these small mobile units are staffed with one general surgeon and one orthopaedic surgeon who must be able to perform any kind of trauma or non trauma emergency surgery. METHODS This concept of forward surgery requires a solid foundation in general surgery which is no longer provided by the current surgical programs due to an early specialization of the residents. Obviously a specific training is needed in war trauma due to the special pathology and practice, but also in humanitarian care which is often provided in military field facilities. RESULTS To meet that demand the French Military Health Service Academy created an Advanced Course for Deployment Surgery (ACDS), also called CACHIRMEX (Cours Avancé de CHIRurgie en Mission EXtérieure). Since 2007 this course is mandatory for young military surgeons before their first deployment. Orthopaedic trainees are particularly interested in learning war damage control orthopaedic tactics, general surgery life-saving procedures and humanitarian orthopaedic surgery principles in austere environments. CONCLUSION Additional pre-deployment training was recently developed to improve the preparation of mobile surgical teams, as well as a continuing medical education for any active-duty or reserve surgeon to be deployed.
Collapse
Affiliation(s)
- Laurent Mathieu
- Clinic of Traumatology and Orthopaedics, Percy Military Teaching Hospital, Clamart, France
| | - Benjamin Joly
- Clinic of Traumatology and Orthopaedics, Percy Military Teaching Hospital, Clamart, France
| | - Stéphane Bonnet
- Clinic of Abdominal, Thoracic and Vascular Surgery, Percy Military Teaching Hospital, Clamart, France.,French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France
| | - Antoine Bertani
- Clinic of Traumatology and Orthopaedics, Desgenettes Military Teaching Hospital, Lyon, France
| | - Frédéric Rongiéras
- Clinic of Traumatology and Orthopaedics, Desgenettes Military Teaching Hospital, Lyon, France.,French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France
| | - François Pons
- French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France
| | - Sylvain Rigal
- Clinic of Traumatology and Orthopaedics, Percy Military Teaching Hospital, Clamart, France. .,French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France. .,Service de Chirurgie Orthopédique, Traumatologie et Chirurgie Réparatrice des Membres, 101 avenue Henri Barbusse, 92140, Clamart, France.
| |
Collapse
|