Preparing the future combat surgeon: a survey of the military general surgery trainee GME experience

Introduction: Graduate medical education (GME) lacks a standardized military training program for general surgery residents, and concern exists that they may not be prepared to serve as combat surgeons on training completion. The purpose of this study was to assess military surgery trainee satisfaction with their programs. Our hypothesis was that military residents were not completely confident to care for combat casualties on completion of current GME training. Methods: We surveyed US Army, Navy, and Air Force general surgery residents and fellows between November 2023 and March 2024 to assess their confidence in managing combat injuries. Queried residents further rate their overall satisfaction with surgical training, perceived level of deployment preparedness and curriculum elements which they thought would be most beneficial to their training. Results: The survey yielded an overall 43% response rate (132/305) with a response rate of 42% (61/147) from the Army, 56% (44/79) from the Navy, and 34% (27/79) from the Air Force. Most trainees were trained in military medical treatment facility residency programs (n=91, 68.9%) and nearly half of respondents (n=64, 49%) were senior trainees (postgraduate year (PGY)4, PGY5, and fellows). Among all trainees, only two-thirds (n=88, 67%,) thought they were adequately prepared to deploy and operate on military combat casualties by the end of residency but 114 (86%) were satisfied with the training they received during general surgery residency in adult trauma, 103 (78%) in critical care, and 112 (85%) in acute care surgery. However, more than half were unsatisfied with the training they received in obstetric/gynecologic and urologic emergencies (n=72, 55%; and n=67, 51%, respectively). Conclusion: Although the majority of military surgical residents surveyed are satisfied with their training in adult trauma, critical care, and emergency general surgery, a large number of trainees thought they would not be ready to deploy and manage combat casualties. Level of evidence: Prognostic and epidemiological, Level IV.