Training for War: Teaching and Skill-Retention

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In Afghanistan and Iraq in 2008 the daily surgical workload can be enormous with the surgical case-mix involving skills out with those of the normal NHS Consultant [1-8]. The historical priorities of the Defence Medical Education and Training Agency (DMETA)–now the Joint Medical Command (JMC) have been of elective secondary care provision to the pre-deployment military force. This imperative may not now be compatible with the acquisition and maintenance of the necessary deployed trauma skills for asymmetric war. Table 1 outlines the suggested skills that the deployed team should possess [9]. It is probably impossible now for a single surgeon to possess every surgical skill required: Two surgeons are a minimum requirement but three may now be optimal. The question remains however as to how best to train our surgeons for the application of these skill sets, given that they may be breast surgeons no longer on a general surgical on-call rota or a hand or plastic surgeon. Surgical training courses such as the Definitive Surgical Trauma Skills Course (DSTS) run by the Royal College of Surgeons of England are vital. These are now seen as an almost mandatory part of pre-deployment training, but it is unclear whether these two to three day intensive courses are effective–and if they are, for how long the skill sets are retained.