The AMEDD’s Central Simulation Committee (CSC)

1. The AMEDD’s Central Simulation Committee (CSC) Robert M. Rush, Jr,. MD, FACS Chief of Surgery Madigan Healthcare System Specialty Advisor in Surgery to the CSC

2. Vital Statistics • Inception: 2007 • 11 Army Medical Centers (to include the Uniformed Services University) • Total square footage: • 30,645 (range 585 – 8,000) • Learners: 108,869 (thru CY 2011) • Hours trained: 555,633 • Budget: $10s of millions

3. CSC Focus • Graduate Medical Education • Allied Health Education • FORSCOM medical educational support • Needs and gap assessments • Standardized curricula • Centralized simulator procurement • Research in education • The “Silos” meet at CSC Sim Centers

4. The 3 ARMS of Army Medical Training • AMEDD Center and School – policy and official POIs • Medical Simulation Training Centers – MSTC – 68W sustainment training • CSC simulation centers – platforms for all medical personnel to train and perform research in education

5. Each CSC Site – falls under the DME (Director of Graduate Medical Education) • Medical Director • Administrative officer • IT technician • Nurse educator • Department advisors and/or lead users

6. Educational Platform…minus the “live human patient”

7. “Going Under the Knife? Ask Your Surgeon How Much He Drank Last Night”

8. Or maybe “how long has it been since you last did the type of surgery you are proposing to do on me?” • Deployments • Maternity leave/OA • Re-integration plan • Metrics • Is there a decrement for a seasoned provider? • What is a seasoned provider?

10. Moto and Mission US Army Medical Command: “Conserve the Fighting Strength”

11. What does this mean? Go and do “trauma care” care in support of our of our armed forces…

12. …in the most austere places…

13. …in the most dangerous environments and extreme weather conditions…

15. …and “trauma” care also means taking care of civilians and children – for non-traumatic illnesses…

16. …and set up a developing country’s medical infrastructure…

17. …and you will only get a handful of people to do it…

18. …and because you don’t have that many people, you all have 10 jobs

20. Problem defined – what next? What are the implied tasks of doing all this? • They are enormous, numerous, detailed and cross all possible venues: • Force Protection • Logistics – medical and necessities for life • Individual trauma care • Team trauma care • Evacuation • And more

22. Individual Tasks – the Cycle • Provide healthcare to service members and families at home • Prepare to deploy • Deploy – provide health care to service members “down range” • Redeploy • Provide healthcare to service members and families at home • REPEAT

23. Individual Tasks – the Cycle • Provide healthcare to service members and families at home • Get ready to deploy • Deploy – provide health care to service members “down range” • Redeploy • Provide healthcare to service members and families at home • REPEAT

24. Where and how do we intervene in the cycle? • Pre-deployment? • During deployment? • At the end of the deployment?

25. Perceived Effects of Deployment on Surgeon and Physician Skills in the Army Medical DepartmentRobert M. Rush, Jr., MD, FACSChief of Surgery, Madigan Army Medical Center Shad H. Deering, MD, FACOG Richard N. Lesperance, MD Bernard J. Roth, MD, FAAP The Andersen Simulation Center AMEDD Central Simulation Committee Madigan Army Medical Center

26. Background • Afghanistan, Iraq, and other GWOT deployments have stressed the military medical system • Most physicians are deployed in 6-12 month increments, many multiple times • Skill sets and practice vary greatly between deployment & home duties • A “needs assessment”

27. 250 FST Data - OEF1

29. Methods • Command-initiated survey sent to 1500 eligible staff physicians • Questions developed by consensus from the Army Central Simulation Committee (CSC) leadership • Specialty, length of deployment(s), and skill utilization / deterioration. • Descriptive and statistical analysis performed

30. Survey Questions • Topics covered in surgery: • Specialty and deployed assignment • Years out of training and board certification • Time away from clinical practice and type of practice while deployed • Perceived skills degradation or improvement in trauma and at-home specialty • Clinical skills = cognitive skills • Surgical skills = technical skills

31. Results • 673 responses (45% response rate) • Respondents: • 7 surgical specialties • 16 non-surgical specialties • Most respondents were non-surgeons

32. Respondents (Surgeon vs other)

33. Respondents by Specialty

34. Respondents by Specialty

41. worse skills better skills

44. worse skills better skills

45. Pertaining to GS only: % time while deployed spent in specialty/61J sub-specialty

48. Questions not asked: • “Is there any type of re-deployment training that you would need/prefer?” • Options: • Mentored cases (“Assist on a few cases then have partner on standby”) • Early case selection • CME review courses • Technical • Cognitive • Mini-fellowship • Fellowship

49. The Lethal Triad of the Military Surgeon/Physician/Nurse/Medic/Corpsman Deployed Variable clinical experience No family time Individual Refresher Training 4 2 Team Training 3 Skills Maintenance Working hard at home Making up for degraded skills Limited family time Train-up for deployment Variable value No family time (usually done at remote sites) 1 Individual Trauma Training

50. The Lethal Triad of the Military Surgeon/Physician/Nurse/Medic/Corpsman Deployed Variable clinical experience No family time Individual Refresher Training 4 2 Team Training 3 Skills Maintenance Working hard at home Making up for degraded skills Limited family time Train-up for deployment Variable value No family time (usually done at remote sites) 1 Individual Trauma Training