Fighting to Train—Implementation of a Train Like You Fight Joint Role 2 Austere Surgical Care Curriculum

INTRODUCTION: Each military service has independently developed austere resuscitative and surgical care (ARSC) team training courses that vary in use, content, duration, tactical exposure, and clinical emphasis. A 2020 Department of Defense Inspector General audit identified training deficits for ARSC teams. To close this gap, we developed ARSC curriculum standards for the Joint Force. MATERIALS AND METHODS: A work group of Tri-Service appointed multidisciplinary subject matter experts (SMEs) reviewed available Role 2 and ARSC training courses to identify common curricular elements, best practices, and training gaps. Through an iterative process, these findings were incorporated into a standard curriculum organized into modules subdivided into terminal learning objectives (TLOs) and enabling learning objectives (ELOs), which were validated against Service doctrinal ARSC capability requirements. RESULTS: Curricula from 12 different courses were identified and reviewed. Most prepared teams for Counter Insurgency operations characterized by short holding times and rapid aeromedical evacuation. Eighty-two clinical and nonclinical common curricular best practices were identified. Only four courses had 50% or more of SME-recommended curricular elements. Identified curricular gaps included prolonged holding (0% of courses), definitive austere surgical care (0%), austere critical care (25%), simulated tactical exposure (25%), night operations familiarization (37.5%), and simulated operational environment (62.5%). Ten modules were created comprised of 20 TLOs and 259 ELOs incorporating curricular best practices and identified gaps. CONCLUSION: Military medicine is preparing surgical teams for the war just fought, not the future fight and lacks a joint standard for training Role 2/ARSC surgical teams, which is a risk to force and to mission. We close this gap by creating the first Joint Role 2 forward surgical/ARSC curriculum.