• Vijay M Ravindra, Matthew D Tadlock, Jennifer M Gurney, Kristin L Kraus, Bradley A Dengler, Jennifer Gordon, Jonathon Cooke, Paul Porensky, Shawn Belverud, Jason O Milton, Mario Cardoso, Christopher P Carroll, Jeffrey Tomlin, Roland Champagne, Randy S Bell, Angela G Viers, and Daniel S Ikeda.
• Department of Neurosurgery, Bioskills Training Center, Naval Medical Readiness Training Command, San Diego, California, USA; Department of Neurosurgery, University of California San Diego, San Diego, California, USA; Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA.
• World Neurosurg. 2022 Nov 1; 167: e1335e1344e1335-e1344.

BackgroundThe U.S. military requires medical readiness to support forward-deployed combat operations. Because time and distance to neurosurgical capabilities vary within the deployed trauma system, nonneurosurgeons are required to perform emergent cranial procedures in select cases. It is unclear whether these surgeons have sufficient training in these procedures.MethodsThis quality-improvement study involved a voluntary, anonymized specialty-specific survey of active-duty surgeons about their experience and attitudes toward U.S. military emergency neurosurgical training.ResultsSurvey responses were received from 104 general surgeons and 26 neurosurgeons. Among general surgeons, 81% have deployed and 53% received training in emergency neurosurgical procedures before deployment. Only 16% of general surgeons reported participating in craniotomy/craniectomy procedures in the last year. Nine general surgeons reported performing an emergency neurosurgical procedure while on deployment/humanitarian mission, and 87% of respondents expressed interest in further predeployment emergency neurosurgery training. Among neurosurgeons, 81% had participated in training nonneurosurgeons and 73% believe that more comprehensive training for nonneurosurgeons before deployment is needed. General surgeons proposed lower procedure minimums for competency for external ventricular drain placement and craniotomy/craniectomy than did neurosurgeons. Only 37% of general surgeons had used mixed/augmented reality in any capacity previously; for combat procedures, most (90%) would prefer using synchronous supervision via high-fidelity video teleconferencing over mixed reality.ConclusionsThese survey results show a gap in readiness for neurosurgical procedures for forward-deployed general surgeons. Capitalizing on capabilities such as mixed/augmented reality would be a force multiplier and a potential means of improving neurosurgical capabilities in the forward-deployed environments.Published by Elsevier Inc.

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