title: Challenges in the training of military surgeons: experiences from Dutch combat operations in southern Afghanistan.
abstract: BACKGROUND
  To improve care for battle casualties, we analyzed the surgical workload during the Dutch deployment to Uruzgan, Afghanistan. This surgical workload was compared with the resident surgical training and the pre-deployment medical specialist program.
  
  
  METHODS
  Patient data from the trauma registry (2006-2010) at the Dutch Role 2 Medical Treatment Facility (MTF) were analyzed. The case logs of chief residents (n = 15) from the general surgery training program in the Netherlands were used for comparison.
  
  
  RESULTS
  The trauma registry query yielded 2,736 casualties, among whom 60 % (1,635/2,736) were classified as disease non-battle casualties and 40 % (1,101/2,736) as battle casualties. During the study period, 1,427 casualties (336 pediatric cases) required 2,319 surgical procedures. Each graduating chief resident handled an average of 1,444 cases, including 165 laparotomies, 19 major vessel repairs, 28 amputations, and 153 fracture stabilizations, during their residency. Residents had limited exposure to injuries requiring a thoracotomy, craniotomy, nephrectomy, IVC repair, or external genital trauma.
  
  
  CONCLUSIONS
  The injuries treated at the Dutch Role 2 MTF were often severe, and exposure to pediatric cases was much higher than reported for other combat hospitals in Iraq and in Afghanistan. The current civilian resident training does not equip the trainees with the minimally required competences of a fully trained military surgeon. The recognition in the Netherlands of military surgery as a subspecialty within general (trauma) surgery, with a formal training curriculum, should be considered. The introduction of a North Atlantic Treaty Organization Military (and Disaster) Surgery standard may facilitate the achievement of this aim.
authors.affiliation: Department of Surgery, Leiden University Medical Centre, K6-50, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands. r.hoencamp@lumc.nl.
authors.forename: R
authors.initials: R
authors.lastname: Hoencamp
authors.affiliation: Department of Surgery-Trauma Surgery, Radboud University Medical Center , Nijmegen, The Netherlands. edward.Tan@radboudumc.nl.
authors.forename: E C T H
authors.initials: EC
authors.lastname: Tan
authors.affiliation: Department of Surgery, Medical Centre Haaglanden, The Hague, The Netherlands. florisidenburg@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Idenburg
authors.affiliation: Royal British Legion Centre for Blast Injury Studies, Imperial College London, London, UK. a.ramasamy09@imperial.ac.uk.
authors.forename: A
authors.initials: A
authors.lastname: Ramasamy
authors.affiliation: Department of Surgery, Medical Centre St. Elisabeth, Tilburg, The Netherlands. t.v.egmond@elisabeth.nl.
authors.forename: T
authors.initials: T
authors.lastname: van Egmond
authors.affiliation: Department of Surgery, University Medical Centre, Utrecht, The Netherlands. l.p.h.leenen@umcutrecht.nl.
authors.forename: L P H
authors.initials: LP
authors.lastname: Leenen
authors.affiliation: Department of Surgery, Leiden University Medical Centre, K6-50, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands. j.f.hamming@lumc.nl.
authors.forename: J F
authors.initials: JF
authors.lastname: Hamming
keywords: Disaster; Dutch Armed Forces; Military; Surgery
references.citation: Arch Pediatr Adolesc Med. 2006 Sep;160(9):972-6
references.pmid: 16953022
references.citation: J Trauma Acute Care Surg. 2012 Aug;73(2 Suppl 1):S64-70
references.pmid: 22847097
references.citation: Mil Med. 2012 Sep;177(9):1058-64
references.pmid: 23025135
references.citation: J Am Coll Surg. 2012 Jan;214(1):53-60
references.pmid: 22075109
references.citation: N Engl J Med. 2004 Dec 9;351(24):2471-5
references.pmid: 15590948
references.citation: J Trauma. 2011 Jul;71(1 Suppl):S103-8
references.pmid: 21795867
references.citation: J Am Coll Surg. 2012 Sep;215(3):432-7
references.pmid: 22683071
references.citation: J Trauma. 1974 Mar;14(3):187-96
references.pmid: 4814394
references.citation: J R Army Med Corps. 2000 Oct;146(3):199-203
references.pmid: 11143689
references.citation: Ned Tijdschr Geneeskd. 2012;155(35):A4233
references.pmid: 22929743
references.citation: Injury. 2012 Aug;43(8):1301-6
references.pmid: 22440530
references.citation: World J Surg. 2014 Jul;38(7):1713-8
references.pmid: 24481991
references.citation: J Am Coll Surg. 2010 Nov;211(5):658-62
references.pmid: 20869271
references.citation: Injury. 2010 May;41(5):435-6
references.pmid: 20116057
references.citation: Am J Surg. 2011 May;201(5):666-72
references.pmid: 21545919
references.citation: Eur J Trauma Emerg Surg. 2012 Oct;38(5):543-51
references.pmid: 23162671
references.citation: Langenbecks Arch Surg. 2011 Apr;396(4):507-22
references.pmid: 21384192
references.citation: Injury. 2010 May;41(5):453-9
references.pmid: 20022003