Part-time sustainment model of a military-civilian partnership in pediatric neurosurgery

Abstract: OBJECTIVE: Surgical readiness can translate to lives saved on the battlefield. Unfortunately, military surgeons today are faced with low surgical volumes at military treatment facilities (MTFs), resulting in limited surgical experience with not only trauma but also complex subspecialty surgical cases. To improve readiness, Army medicine supports military-civilian partnerships (MCPs) to allow active-duty soldiers to work in civilian institutions while on duty. The overarching goal is to increase exposure to trauma cases and provide skill maintenance for surgeons. Two models have evolved: one that includes a fully embedded military surgeon at a civilian institution and another that includes a part-time embedded military surgeon. In situations where there is a direct need for medical care in the civilian market, a part-time model, or memorandum of understanding (MOU), can provide call coverage for the local community as well as augment the military surgeon's experience. This study was performed to analyze surgical volume before and after implementation of a joint training agreement between an MTF and a civilian pediatric hospital. METHODS: The authors performed a retrospective review of a single military neurosurgeon's surgical volume before and after implementation of a joint training agreement between an MTF and the only statewide pediatric referral hospital. Surgical volume prior to the training agreement, in 2018, was obtained for a single surgeon at the MTF through the hospital's surgical database. After implementation of the training agreement, 2 years of surgical volume for the same surgeon was obtained through a prospectively maintained database. Each individual case was assigned a neurosurgical category. Average monthly case volume, percentage of pediatric versus adult case contributions, and surgical case varieties were calculated. RESULTS: The joint military training agreement, or MOU, began in January 2019. Pediatric neurosurgical volume and case complexity increased from an average of 3 cases/month at the MTF in 2018 to 5 cases/month in 2019 to 7 cases/month in 2020. More than 120 new urgent and emergency consults were produced per year after MOU implementation, 14 of which required traumatic cranial surgeries over the 2 years analyzed. In addition, the civilian pediatric hospital was able to provide 24/7 trauma and acute care neurosurgical coverage with the added military provider. CONCLUSIONS: The authors demonstrate that an MCP can successfully benefit both the civilian community via improved pediatric call coverage and the military neurosurgeon via enhanced combat surgical readiness and skills, providing a blueprint to a unique targeted strategy for successful future MCPs. The significant case volume growth and diversity seen over the first 2 years suggest greater longitudinal benefit over shorter "just-in-time" predeployment-type training opportunities at civilian institutions.