An Estimate of Civilian Readiness Requirements for Surgeons: A Survey of American College of Surgeons Trauma Medical Directors

BACKGROUND: The Department of Defense relies on the Joint Knowledge, Skills, and Abilities (KSA) methodology to assess general surgeon deployment readiness, yet this system lacks trauma-specific requirements. This study surveyed civilian Trauma Medical Directors (TMDs) to identify their minimum clinical requirements for trauma call eligibility and compared them to military readiness assessment practices. MATERIALS AND METHODS: TMDs at American College of Surgeons-verified trauma centers were surveyed regarding minimum procedure volumes, case types, and trauma experience required for non-trauma fellowship-trained general surgeons to serve primary trauma call. Survey items addressed 16 categories of procedures for which TMDs might establish minimum annual case log requirements, and 10 potential surrogate procedure categories if initial requirements were not met. Spearman's rank correlation assessed relationships between requirements and trauma center levels. Statistical significance was set at P < .05. RESULTS: Eighty-nine complete surveys (44 Level I, 29 Level II, 16 Level III), representing 17% of Level I, 9% of Level II, and 3% of Level III trauma centers nationwide were analyzed. An overwhelming majority (>93%) of TMDs across all levels required monthly trauma shifts for call eligibility. Additionally, 86% of Level I and 90% of Level II TMDs required yearly trauma resuscitation participation, compared to 56% of Level III TMDs. A substantial majority (>70%) of Level I-II TMDs required yearly index trauma laparotomies, hemorrhage control surgeries, and non-trauma laparotomies. Level I TMDs demonstrated the most stringent standards, accepting procedure surrogates in less than 50% of all categories. Only 2 surrogate procedures showed significant variation by trauma center level: breast procedures (P = .01) and complex solid organ laparoscopy (P = .04), with acceptance rates increasing from Level I to Level III centers. CONCLUSIONS: The overwhelming majority (>93%) of civilian trauma centers surveyed require active, ongoing trauma surgery practice for call eligibility-requirements absent from current KSA methodology. The substantial gap between military and civilian trauma community readiness standards can be narrowed by incorporating trauma-specific clinical activity requirements into military readiness evaluation standards. Future research should prioritize recruitment from Level III centers to validate their potential as more accessible military-civilian partnership sites for the general surgeon.