The Surgical Training and Assessment Tool

Our idea has been to develop and implement a technical skills assessment system for surgical trainees, called "the Surgical Training & Assessment Tool" (STAT). The system exists to assist the surgical trainee and trainer in evaluating the professionalism of the trainee and their command of the critical cognitive and technical elements of a surgical procedure, as evidenced in the actual operating room environment. STAT systematically deconstructs each operative event in such a way as to produce detailed but manageable data regarding the educational component of it. Extensive use and familiarity with the STAT system have been garnered at a leading university hospital where it was first developed and implemented (by an active duty Naval officer PBR), within General / Oncologic Surgical and within the Orthopedic Surgical departments. Previous articles document that it is both reliable and practical, and that the validity of the system and the process were strongly supported. STAT enables dyadic (paired trainee - trainer), comprehensive, transparent, multi-faceted, longitudinal, consistent, and easily performed subjective assessments of a trainee's daily operative performance throughout their surgical training process. We have also developed a methodology for implementing STAT, adapted from military aviation training and from business' managerial science, which we have called "Quality Based Surgical Training" (QBST).
The Army, Navy, and Air Force, and Marines have worldwide missions, with hundreds of thousands of troops abroad and more than a million troops back at home. The Department of Defense engages in military campaigns, performs relief and support efforts, have shipboard and overseas billets, and stateside billets. It is the DoD's responsibility to care for the active duty troops in all their various environments and circumstances, their families, retirees and veterans. Supporting the millions of beneficiaries is primarily the responsibility of Military Medicine as well as the Veteran's Affairs Health Administration. Therefore even a small incremental benefit in the training of surgeons, military and civilian, would have profound ramifications for the military and VA, both in achieving its stateside and overseas missions of supporting troops and families and veterans, and in its most daunting tasks, of expertly supporting its deployed and combat troops in austere and hostile environments.
The Army, Navy, and Air Force together graduate scores of surgical trainees supporting their global forces through every manner of surgical condition across the full spectrum of treatment scenarios. The VA graduates hundreds. Military surgeons and anesthesiologists must be extraordinarily able to function within austere environments and intense conditions, in addition to the standard duties at CONUS-based local and academic hospitals. Their training must be top-flight in order to carry out their missions. In addition to increasing the yield on their years spent in training in the immediate timeframe, in the future this system could also be applicable towards simulation training as well, which is gradually evolving presently and will need to be a key component of pre-deployment training for all military surgical and anesthesiologic practitioners as soon as may be practicable. Lastly, pioneering this educational / training system could showcase a perennial strength of military medicine: Training; and it could put our techniques in the vanguard of those of the civilian sector, providing another great contribution to civilian medicine from the military. This system need not apply to just military surgeons alone; the Veteran's Administration trains hundreds, perhaps thousands of procedurally-based residents and fellows every year. Being web-based, any interested program throughout the country could use it. It could benefit the civilian sector just as much as the military. The cost of the software is free: we made it "open source."

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