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Acquisition and retention of military surgical competencies: a survey of surgeons’ experiences in the UK Defence Medical Services
  1. Matthew R Cant1,
  2. D N Naumann2,
  3. C Swain2,
  4. A J Mountain3,
  5. J Baden4 and
  6. D M Bowley2
  1. 1 RMO, 3 Medical Regiment, Fulwood Barracks, Preston, UK
  2. 2 Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
  3. 3 Department of Military Trauma and Orthopaedics, Royal Centre for Defence Medicine, Birmingham, UK
  4. 4 Department of Military Plastic and Reconstructive Surgery, Royal Centre for Defence Medicine, Birmingham, UK
  1. Correspondence to Col D M Bowley, Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham B15 2TH, UK; doug.bowley586{at}


Introduction The acquisition and retention of militarily relevant surgical knowledge and skills are vital to enable expert management of combat casualties on operations. Opportunities for skill sustainment have reduced due to the cessation of combat operations in Iraq and Afghanistan and lack of military-relevant trauma in UK civilian practice.

Methods A voluntary, anonymous online survey study was sent to all UK Defence Medical Services (DMS) surgical consultants and higher surgical trainees in Trauma and Orthopaedics, Plastic and Reconstructive, and General and Vascular surgical specialties (three largest surgical specialties in the DMS in terms of numbers). The online questionnaire tool included 20 questions using multiple choice and free text to assess respondents’ subjective feelings of preparedness for deployment as surgeons for trauma patients.

Results There were 71 of 108 (66%) responses. Sixty-four (90%) respondents were regular armed forces, and 46 (65%) worked in a Major Trauma Centre (MTC). Thirty-three (47%) had never deployed on operations in a surgical role. Nineteen (27%) felt they had sufficient exposure to penetrating trauma. When asked How well do you feel your training and clinical practice prepares you for a surgical deployment?’ on a scale of 1–10, trainees scored significantly lower than consultants (6 (IQR 4–7) vs 8 (IQR 7–9), respectively; p<0.001). There was no significant difference in scores between regular and reservists, or between those working at an MTC versus non-MTC. Respondents suggested high-volume trauma training and overseas trauma centre fellowships, simulation, cadaveric and live-tissue training would help their preparedness.

Conclusions There was a feeling among a sample of UK DMS consultants and trainees that better preparedness is required for them to deploy confidently as a surgeon for combat casualties. The responses suggest that UK DMS surgical training requires urgent attention if current surgeons are to be ready for their role on deployed operations.


Data availability statement

Data are available upon reasonable request.

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  • Contributors MRC initiated the project, designed and analysed the survey, and composed the manuscript. DNN and CS provided ongoing advice and guidance, and contributed to manuscript revisions. AM and JB provided specialist advice and contributed to manuscript revisions. DMB provided specialist advice and general oversight to the project, and contributed to manuscript revisions.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.