Abstract：
The Military Health System (MHS) uses a readiness program that identifies the knowledge, skills, and abilities (KSAs) necessary for surgeons to provide combat casualty care. Operative productivity is assigned an objective score based on case type and complexity and totaled to assess overall readiness. As of 2019, only 10.1% of surgeons met goal readiness threshold. At one tertiary military treatment facility (MTF), leadership has taken an aggressive approach toward increasing readiness by forming military training agreements (MTAs) and allowing Off Duty Employment (ODE). We sought to quantify the efficacy of this approach.
Operative logs from 2021 were obtained from surgeons assigned to the MTF. Operations were assigned CPT codes and processed through the KSA calculator (Deloitte; London, UK). Each surgeon was then surveyed to identify time away from clinical duties for deployment or military training.
Nine surgeons were present in 2021 and spent an average of 10.1 weeks (19.5%) abroad. Surgeons performed 2,348 operations (Average [Avg] 261 ± 95) including 1,575 (Avg 175; 67.1%) at the MTF, 606 (Avg 67.3; 25.8%) at MTAs, and 167 (Avg 18.6, 7.1%) during ODE. Adding MTA and ODE caseloads increased KSA scores by 56% (17,765 ± 7,889 vs 11,391 ± 8,355). Using the MHS threshold of 14,000, 3 of 9 (33.3%) surgeons met the readiness threshold from MTF productivity alone. Including all operations, 7 of 9 (77.8%) surgeons met threshold.
Increased use of MTAs and ODE significantly augments average caseloads. These operations provide considerable benefit and result in surgeon readiness far exceeding the MHS average. Military leadership can maximize the chances of meeting readiness goals by encouraging clinical opportunities outside the MTF.
Operative logs from 2021 were obtained from surgeons assigned to the MTF. Operations were assigned CPT codes and processed through the KSA calculator (Deloitte; London, UK). Each surgeon was then surveyed to identify time away from clinical duties for deployment or military training.
Nine surgeons were present in 2021 and spent an average of 10.1 weeks (19.5%) abroad. Surgeons performed 2,348 operations (Average [Avg] 261 ± 95) including 1,575 (Avg 175; 67.1%) at the MTF, 606 (Avg 67.3; 25.8%) at MTAs, and 167 (Avg 18.6, 7.1%) during ODE. Adding MTA and ODE caseloads increased KSA scores by 56% (17,765 ± 7,889 vs 11,391 ± 8,355). Using the MHS threshold of 14,000, 3 of 9 (33.3%) surgeons met the readiness threshold from MTF productivity alone. Including all operations, 7 of 9 (77.8%) surgeons met threshold.
Increased use of MTAs and ODE significantly augments average caseloads. These operations provide considerable benefit and result in surgeon readiness far exceeding the MHS average. Military leadership can maximize the chances of meeting readiness goals by encouraging clinical opportunities outside the MTF.
摘要：
背景：军事卫生系统（MHS）使用识别知识的准备程序，技能,以及外科医生提供战斗伤亡护理所需的能力（KSA）。根据病例类型和复杂性为操作生产率分配客观评分，并进行总计以评估总体准备情况。截至2019年，只有10.1％的外科医生达到了目标准备阈值。在一个三级军事治疗设施(MTF)，领导层采取了积极的方法，通过形成军事训练协议（MTA）和允许下班就业（ODE）来提高准备程度。我们试图量化这种方法的功效。
方法：2021年的手术记录来自分配到MTF的外科医生。操作被分配了CPT代码，并通过KSA计算器(德勤；伦敦，英国）。然后对每位外科医生进行调查，以确定远离临床职责进行部署或军事训练的时间。
结果：2021年有9名外科医生在场，在国外平均花费10.1周（19.5％）。外科医生在MTF进行了2,348次手术（平均[平均值]261±95），包括1,575次（平均175次；67.1%），606（平均67.3；25.8%），以MTA计算，ODE期间为167（平均18.6，7.1%）。添加MTA和ODE案件量使KSA得分增加了56％（17,765±7,889比11,391±8,355）。使用14,000的MHS阈值，仅从MTF生产率来看，9名外科医生中有3名（33.3％）达到了准备阈值。包括所有操作，9名外科医生中有7名（77.8％）达到阈值。
结论：增加MTA和ODE的使用显著增加了平均病例数。这些操作提供了相当大的益处,并且导致外科医生准备远远超过MHS平均值。军事领导可以通过鼓励MTF以外的临床机会来最大程度地实现准备目标的机会。
方法：2021年的手术记录来自分配到MTF的外科医生。操作被分配了CPT代码，并通过KSA计算器(德勤；伦敦，英国）。然后对每位外科医生进行调查，以确定远离临床职责进行部署或军事训练的时间。
结果：2021年有9名外科医生在场，在国外平均花费10.1周（19.5％）。外科医生在MTF进行了2,348次手术（平均[平均值]261±95），包括1,575次（平均175次；67.1%），606（平均67.3；25.8%），以MTA计算，ODE期间为167（平均18.6，7.1%）。添加MTA和ODE案件量使KSA得分增加了56％（17,765±7,889比11,391±8,355）。使用14,000的MHS阈值，仅从MTF生产率来看，9名外科医生中有3名（33.3％）达到了准备阈值。包括所有操作，9名外科医生中有7名（77.8％）达到阈值。
结论：增加MTA和ODE的使用显著增加了平均病例数。这些操作提供了相当大的益处,并且导致外科医生准备远远超过MHS平均值。军事领导可以通过鼓励MTF以外的临床机会来最大程度地实现准备目标的机会。
