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Military treatment facility-assigned surgeons face numerous challenges in maintaining critical wartime skills, including the "peacetime effect" and the "dual mission." Using the field of plastic surgery to illustrate these issues, we contrast plastic surgeons' contributions to combat casualty care with primary data describing plastic surgeons' clinical practice in many military hospitals. Then, we outline the current administrative mechanisms being promoted at the enterprise-level for surgeons to gain a more mission-focused, clinical practice, while also examining significant shortcomings in these policies. Finally, we conclude with a call to action for the military surgical community to accelerate change in the development of more robust clinical practices for our surgeons, or potentially lose our ability to field a ready surgical force.
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http://dx.doi.org/10.1093/milmed/usab162 | DOI Listing |
J Am Coll Surg
May 2025
Department of Surgery, F Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD (Cannon, Holt, Potter, Gurney, Tadlock, Nealeigh, Yelon, Woodson, Elster).
The Military Health System in the US currently faces a crisis: maintaining medical readiness during a time of relative peace in the face of an increasingly hostile and unstable geopolitical environment. Collaboration through partnerships-with civilian academic medical centers, with academic medical societies and scientific journals, and with advocates for improved policy and supporting legislation-represents 1 important strategy to stave off the peacetime effect that threatens to erode our combat casualty care skills. This panel session held during the 2022 Excelsior Surgical Society Symposium at the American College of Surgeons Clinical Congress explored the way forward for the Military Health System amid these historic challenges with important action items and take home points for civilian and military surgeons alike.
View Article and Find Full Text PDFCrit Care Nurse
October 2024
Capt Roman Aguon Salas, USAF, NC, is pursuing a second master's degree at San Diego State University, California.
Background: Decreases in size, capability, clinical volumes, case mixes, and complex care opportunities in military treatment facilities contribute to the atrophy of clinical skills among medical professionals in these facilities.
Local Problem: The COVID-19 pandemic resulted in a 39% decline in admissions to a military critical care unit. The decrease in patient census contributed to skill sustainment challenges.
Mil Med
February 2024
AFSOC Office of the Command Surgeon, Hurlburt Field, FL 32544, USA.
Introduction: Organizational proficiency increases with experience, which is known as a learning curve. A theoretical peacetime effect occurs when knowledge and skills degrade during peacetime. In this study, the intertheater evacuation system was examined for evidence of a military learning curve and peacetime effect.
View Article and Find Full Text PDFMil Med
May 2024
School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
J Trauma Acute Care Surg
August 2022
From the University of Nevada Las Vegas Kirk Kerkorian School of Medicine (J.P.K., S.S., M.G., D.R.F., J.F.), Las Vegas, Nevada; Headquarters Air Force (J.J.D.), Arlington, Virginia; and University Medical Center of Southern Nevada (A.A.), Las Vegas, Nevada.
Military-civilian partnerships (MCPs) in urban American trauma centers have existed for more than 60 years to assist in the development and maintenance of wartime skills of military medical professionals. In the last 5 years, MCPs have gained congressional support, and their number and variety have grown substantially. The historical impact of these flagship trauma MCPs is well documented, with bidirectional benefit in the advancement of trauma care during the wars in Iraq and Afghanistan both deployed and stateside, and the future aim of MCPs lies primarily in mitigating the "peacetime effect.
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