Perceived Clinical Skill Degradation of Army Family Physicians After Deployment

摘要

Background and Objectives: 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.(Fam Med 2015;47(5):343-8.)During the past 13 years of continuous overseas combat operations, the United States military hasprovidedadvanced trauma and combat medicine care to over 50,000 wounded deployedsoldiers.1 Military family physicians have provided a great deal of this care while deployed alongside combat units, but this care environment is outside of their normal peacetime or traditional civilian training.2 For example, a family physician managing a diverse clinic schedule of pediatric, geriatric, and obstetric care would be trained and practicing in a variable tempo combat zone tending acute care,blast injuries, and major trauma.3In 2007,a survey was sentto all Army physicians who had previously deployed.A total of 673 providers completed the survey and reported feeling a significant decrement in their specialty clinical and procedural skills after deployment. When asked how long they felt it took them to get back to their pre-deployment surgical performance level, 30% of physicians in surgical specialties said it took at least 6 months. For clinical skills, 40% of physicians said it took 6 months or longer to return to their pre-deployment skill level. There was also a statistically significant association between the length of deployment and the time it took for providers to feel they were back to their baseline level of performance, with longer deployments being associated with longer delays in returning to baseline performance.2While individualized education for non-practicing physicians returning to practice has been described, it is diverse in its goals, implementation, and outcomes.4 However, the military family physician represents a large population in need of routine and standardized training to bring them back to routine medical practice upon return. Currently, refresher training for physicians is not mandatory after deployment, but military hospital commanders must assess training needs and provide opportunities for refresher training after at least 60 days of deployment. Physicians and clinical supervisors also identify specific