MSS15: ASSISTANT SURGEON IN-SITU TRAINING (ASIST): SURVEYING THE NECESSITY FOR SURGICAL ASSISTANT TRAINING IN DEPLOYED ENVIRONMENTS
Alex R Dunaway, MD1; Gabrielle M Falco, MD2; William B Sweeney, MD3; Donald C Carmichael, MD3; Zachary A Taylor, DO4; Christopher E Dyke, MD3; 1Naval Medical Center Portsmouth; 2Brooke Army Medical Center; 3Walter Reed National Military Medical Center; 4Alexander T. Augusta Military Medical Center
Background: In recent years, deployed surgical teams have decreased in size to provide a broader geographic range of surgical capability. Smaller teams mean fewer team members have operative experience, as not all teams deploy with trained surgical technicians. Most teams undergo significant pre-deployment training; however, no recognized training for additional intraoperative assistants exists. Since the need to perform multiple procedures simultaneously is higher in combat zones, operating without a proper surgical assistant might occur more frequently with current deployable surgical teams.
Objectives: This needs assessment explored rates of surgeons deploying and operating without a proper surgical assistant.
Methods: A survey was distributed to general surgeons with deployment experience at three military treatment facilities encompassing all three medical corps. The survey utilized Likert scale, multiple-choice, and short-answer questions to query surgeons on their experiences of deploying without proper surgical assistance, their opinions on the need for training more assistants, and what that training should entail.
Results: 26 surgeons responded to the survey. 50% of the respondents had deployed at least once without a proper surgical assistant, and 46% of all respondents had operated without a proper first assistance at least once. Of those who had operated without a proper assistant, 75% of that cohort had to operate at least 3 or more times without an assistant. Commonly perceived challenges when operating without a proper first assist were increased surgical time (42.3%), higher stress levels (38.5%), and difficulty managing instruments (23.1%). 11.5% reported perceived compromised patient safety due to lack of a proper assistant. 46% of respondents stated no other team members (besides the surgeon and trained technician) had experience surgical assisting. Medics/corpsmen were the most common substitute first assistants (64%). 72% of respondents stated they would be willing to use nonmedical staff members as a first assistant if properly trained and 76% stated all members of a deployed surgical team should have basic training to assist.
Conclusion: The presence of a trained surgical assistant can impact surgeon capabilities and patient safety in the deployed setting. As surgical teams pare down the number of team members, the need for cross-training increases. This survey underscores the need for formalized training of non-surgeons to learn the basic skills of a surgical assistant. Future work involves developing a course to meet these needs.
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