title: Perceived clinical skill degradation of Army family physicians after deployment.
abstract: OBJECTIVE
  Deployment away from regular clinical practice is necessary for Army family physicians, but no current information identifies specific procedures or clinical encounters where they feel less comfortable after deployment. This study identifies specific clinical areas and amount of perceived degradation in skills after deployment to combat zones.
  
  
  METHODS
  Active duty Army family physicians were invited to participate in a web-based and anonymous survey rating comfort level performing clinical encounters or procedures prior to and after military deployment. Participants rated their comfort level using a 5-point Likert scale. The analysis included descriptive statistics about each physician's deployment history. The composite data for each clinical encounter or procedure were analyzed with McNemar's Chi-Square test.
  
  
  RESULTS
  A total of 179 eligible Army family physicians (54% of total) fully completed the instrument, with 39% deploying once and 10% deploying more than five times in their career. Deployments ranged from 1 to >24 months, with 42% having a last deployment of 12 months duration. With statistical significance, providers reported being less comfortable post-deployment with managing first-trimester bleeding, ACLS codes, acute abdominal pain, asthma exacerbations, central line placement, chest pain, COPD exacerbations, CVA/hypertensive emergency, lumbar puncture, neonatal fevers, pediatric codes, sepsis/septic shock, and vaginal delivery. These physicians reported statistically significant increased comfort with the care of major trauma after deployment.
  
  
  CONCLUSIONS
  Family physicians deploying to support combat operations feel less comfortable with critical clinical skills across the spectrum of care. Refresher training could be provided with standardized approach to these needs with a goal of maintaining full scope primary care providers.
authors.affiliation: Madigan Army Medical Center, Tacoma, WA.
authors.forename: Tyler R
authors.initials: TR
authors.lastname: Reese
authors.forename: Shad H
authors.initials: SH
authors.lastname: Deering
authors.forename: Laurie B
authors.initials: LB
authors.lastname: Kavanagh
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Maurer
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D006801:Humans; D008887:Military Medicine / Q000379:methods / Q000458:organization & administration; D010559:Personnel Management / Q000379:methods / Q000592:standards; D010821:Physicians, Family / Q000523:psychology / Q000592:standards; D062707:Return to Work / Q000523:psychology*; D020377:Self Efficacy; D014481:United States