Timothy P Plackett, DO, MPH1, Joel R Brockmeyer, MD2, Danielle B Holt, MD3, Robert M Rush, Jr, MD4, Joy Sarkar, MD5, Steven A Satterly, MD1, Jason M Seery, MD6, Bradley R Zagol, MD7. 1Womack Army Medical Center, 2Eisenhower Army Medical Center, 3Walter Reed National Military Medical Center, 4Madigan Army Medical Center, 5Brian Allgood Army Community Hospitl, 6Martin Army Community Hospital, 7Augusta University Medical Center
Objectives: The primary objective is to quantify the operative experience of Army general surgeons while not deployed and determine their capacity to obtain mastery in the operating room while working at military hospitals. The secondary objective is to determine the effect of rank and individual hospitals on operative experience.
Methods: Average Surgeon Time reports were generated from the Surgical Scheduling System for all general surgery cases performed at seven Army medical treatment facilities (MTFs) during 2012-2016. Cases performed by non-general surgeons were excluded. Data was analyzed using the apriori definition of 10,000 hours of operative time equating with mastery. This definition is based upon Ericsson’s Deliberate Practice Model and popularized by Malcolm Gladwell. Groups were compared using a one-way ANOVA.
Results: 122 general surgeons operated at the 7 MTFs during the study period. 14 of the general surgeons were civilian employees and 6 surgeons were backfills with their primary MTF not participating in the study; these 20 surgeons were excluded from further analysis. The average surgeon performed 108 ± 68 cases per year while in garrison. The average surgeon spent 124 ± 86 hours operating annually while in garrison. At this rate, it would take over 80 years to obtain mastery of surgery. The ten highest volume surgeons averaged 218 cases per year and 291 hours of operating annual. For the ten highest volume surgeons, it would take 34 years to obtain mastery of surgery.
When stratified based upon rank, Majors averaged 102 ± 51 cases and 114 ± 76 hours of surgery per year, Lieutenant Colonels averaged 137 ± 65 cases and 168 ± 100 hours of surgery per year, and Colonels averaged 107 ± 87 cases and 136 ± 101 hours of surgery per year. Only the difference between Majors and Lieutenant Colonels was statistically significant (p<0.01).
When stratified based upon individual hospital there was significant variance in case volume and hours of surgery per year between the facilities (p<0.05). At the highest performing hospital surgeons averaged 170 ± 83 cases and 187 ± 103 minutes of surgery per year. At the lowest performing hospital surgeons averaged 71 ± 49 cases and 85 ± 56 minutes of surgery per year.
Conclusions: Obtaining mastery of general surgery is a nearly impossible proposition given the current care models at Army MTFs. Alternative staffing and patient care models should be developed if Army surgeons are to be masters at their craft.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86443
Program Number: MSS20
Presentation Session: Full-Day Military Surgical Symposium – General Surgery Presentations
Presentation Type: MSSPodium
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