Page 79 - Journal of Special Operations Medicine - Winter 2015

Garrison Clinical Setting Inadequate for
Maintenance of Procedural Skills for
Emergency Medicine Physicians

A Cross­Sectional Study

Steven G. Schauer, DO; Shawn M. Varney, MD; Kristin L. Cox, MD

ABSTRACT
Background: Emergency medicine physicians (EPs) are of- American Council for Graduate Medical Education (AC-
ten placed in far-forward, isolated areas in theater. Main- GME) guidelines. Most of the literature thus far has
2–4
tenance of their emergency intervention skills is vital to sought to evaluate the volume of procedures needed to
keep the medical forces deployment ready. The US Army obtain procedural competency. Little emergency medicine
suggests that working at a Military Treatment Facility (EM)-specific literature exists on maintenance of skills;
(MTF) is sufficient to keep emergency procedural skills thus, we have had to extrapolate from data from other
at a deployment-ready level. We sought to compare the specialties. Pediatric EM literature has demonstrated
5–7
volume of emergency procedures that providers reported low rates of critical procedures, placing physicians at
necessary to maintain their skills with the number avail- risk for skills degradation. Furthermore, compared with
8
able in the MTF setting. Methods: EPs were surveyed to civilian physicians, military physicians are unique, since
quantify the number of procedures they reported they they often deploy to locations with scarce resources, no
would need to perform yearly to stay deployment-ready. consulting services, similar if not greater demands for
We obtained procedure data for their duty stations and life-threatening interventions, and prolonged holding
compared the procedure volume with the survey responses and transport times. A study comparing the incidence
to determine if working at an MTF is sufficient to keep of cricothyrotomy (a critical procedure during deploy-
providers’ skills deployment ready. Results: The reported ment) demonstrated a much lower incidence in the MTF
necessary average numbers per year were as follows: tube compared with the deployed environment. Prehospital
9
thoracostomy (5.9), intubation (11.4), cricothyrotomy battlefield data have shown that critical care competency
(4.2), lumbar puncture (5.2), central line (10.0), focused carries mortality benefits. To the best of our knowl-
10
assessment with sonography for trauma (FAST) (21.3), re- edge, no studies exist evaluating the needs of the military
ductions (10.6), splints (10.5), and sedations (11.7). None EP to maintain procedural skills competency.
of the procedure volumes at MTFs met provider require-
ments with the exception of FAST examinations at the As joint-theater activities continue to draw down, de-
only trauma center. Conclusions: This suggests the gar- ployment experience will also decline. However, the
rison clinical environment is inadequate for maintaining need for EPs to be ready to deploy is constant and ex-
procedure skills. Further research is needed to determine panding, especially given the short notice often avail-
modalities that will provide adequate training volume. able prior to military engagements. Thus, the necessary
skills EPs sought to obtain during the current conflicts
Keywords: procedure; skills, procedural; competency, pro­ are needed to prepare them for future conflicts.
cedural; physicians, emergency medicine; skills; mainte­
nance; deployment; volume The aim of this investigation was to determine whether
residency-trained EPs perceived that clinical shifts in the
garrison setting provided sufficient exposure to main-
tain their procedural skill competency and confidence at
Introduction
a deployment-ready status.
The volume of procedural skills necessary for postdoc-
toral residency training has been explored to a limited Methods
degree in various specialities. Significant variance in the
1
volume of training necessary for establishing procedural The Brooke Army Medical Center Institutional Review
skill competency and confidence has been described, but Board, which supervises research throughout the South-
the exact number of procedures is not known despite ern Regional Medical Command (SRMC), approved this

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