Zsolt T Stockinger, MD1, Paul B Roach, MD2, Caryn A Turner, MPH1. 1Joint Trauma System, 2Lovell Federal Health Care Center
Background: Published literature suggests that skills required by deployed US Military General Surgeons are dissimilar to their CONUS practices and skills training. Furthermore, that graduating general surgery residents may have a narrower breadth and depth of experience than in previous decades. If true, this has serious implications for the training and sustainment of deployed military surgeons in the future.
Methods: Previous Joint Trauma System analyses of 189,167 documented surgical procedures performed in OIF and OEF were reviewed and compared to available literature regarding MTF and civilian surgical practice, and current surgical residency training.
Results: The most common procedural types performed in OIF/OEF were soft tissue debridement (37.5%), orthopaedic (13.8%), abdominal (13.0%), vascular (6.5%), amputation (4.5%), external fixation (4.2%) and neurosurgical (3.0%). In aggregate, 36.8% of all surgical procedures performed did not fall under core general surgery as defined by CCQAS. Less than 0.1% of all abdominal procedures were laparoscopic. In contrast, 2016 ACGME data show that graduating general surgeons perform an average of 1.5 orthopaedic, 1.1 neurosurgical, 15.8 amputation and 2.5 vascular trauma cases during residency. Of abdominal cases in residency, laparoscopic appendectomy, laparoscopy cholecystectomy, and hernia constituted 61.3% of all abdominal cases. At US civilian Level 1 trauma centers, only 18% report trauma surgeons performing full spectrum thoracic and vascular surgery, and open fracture washout or trauma neurosurgery in less than 1% of trauma centers of any level. While procedure specific stateside military surgical data were unavailable for comparison, the MHS has reported that the average military general surgery clinic generates 31% of RVUs compared to the civilian median.
Conclusions: U.S. residency training and trauma surgeon practice appear to differ substantially from what is required of the deployed military general surgeon. Surgeon productivity in U.S. military hospitals is low. These facts combined raise the question of where, if anywhere, U.S. military general surgeons can gain and sustain the skills necessary for war.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86689
Program Number: MSSP10
Presentation Session: Military iPoster (Non CME)
Presentation Type: MSSPoster