“Every Military Surgeon is a Trauma Surgeon”
This was a phrase I heard frequently as an interviewing 4th-year medical student and one that I have found myself repeating during residency. Though I think this saying holds true and reflects military medicine’s shift towards battlefield-oriented medicine for active duty physicians, one may well also counter with the phrase “not all deployments are created equal”. In my training, I have worked with surgeons that were in deployed settings and completed more than 400 major trauma operations within 6 months as well as surgeons that placed only a single chest tube during an equal amount of time deployed within the same nation. Prior publications have detailed the perishable nature of surgical skills, and the tale of these deployments highlights the unpredictable ebb and flow of operating volume that has been experienced by military surgeons while deployed for anywhere from three to 14 months.
Combat deployments for surgeons represent a microcosm of the experiences and technological developments paid for in blood during major conflicts. From the logistical lessons of Jonathan Letterman during the Civil War and subsequent development of the prehospital ambulance model to the development of the Bair hugger and REBOA catheter, US military surgical experience during times of war has improved medical care for all. Yet, military medicine has also had to relearn important lessons as evidenced by the birth, death, and resurrection of tourniquets and whole blood transfusion. The Uniformed Services University (USU) (previously the Uniformed Services University of the Health Sciences and a continuation of the ideals of the previously established Army Medical School and Medical Field Service School) was created in the wake of World War II explicitly to pass on this knowledge and prevent its dissolution in times of peace. Though USU has and continues to accomplish this, and is one of the few stalwarts of this mission, more must be done.
To improve the durability and effectiveness of USU’s mission, the role of surgeons should be extended to become academic surgeons. As leaders in their field, academic surgeons provide high-quality education to military GME trainees in addition to supplementing specialty education with lessons learned from prior conflicts. With a position centered on education and research, this could additionally provide a role for continuity of education within the military GME system that has been plagued with frequent surgeon deployments and training requirements. Academic surgeons at military GME facilities also enhance the research experience of residents.
Many military GME programs have already incorporated rotations at large, academic civilian institutions that have led to or been built upon military-civilian partnerships that also involve research and off-duty employment opportunities. While these civilian partnerships are important, we must still retain our identity as military surgeons and especially remember the past’s battlefield lessons. Change must come from within, and so a growth of academic surgeons within the military can provide a strong impetus to improve delivery of care and patient outcomes as well as remove barriers to academics that are unique to the military system. Positioning academic surgeons within GME can also create a more streamlined connection between deploying, clinical surgeons and the vast research and development network embodied by institutions such as the ISR, WRAIR, USAMRIID, NAMRU, USAMRDC, and others.
Academic surgeons are not necessarily the golden ticket to protecting military GME. However, as the military’s experience from our most recent engagements in Iraq and Afghanistan have shown, “Those who fail to learn history are doomed to repeat it.” Though successful steps have been made within military medicine to ensure our history is not forgotten we must not lose ground and continue to refine our own self-education and self-improvement process, a natural role for academic surgery.