MSS004: SHARPENING THE SCALPEL FOR THE NEXT FIGHT: TRAINING MILITARY SURGICAL RESIDENTS THROUGH A SIMULATION-BASED MILITARY UNIQUE CURRICULUM AT USU/WRNMMC
Mason H Remondelli, MD; Vera M Funk, MD; Kennedy Nye, MD; Megan Breckheimer, MD; Pamela Andreatta, PhD; Eric A Elster, MD, FACS, FRCSEng, Hon; Matthew J Bradley, MD, FACS; Uniformed Services University / Walter Reed National Military Medical Center
Objectives: Open surgical and diagnostic skills are essential for trauma and expeditionary surgery, yet opportunities to practice these procedures have declined due to the rise of minimally invasive techniques and the non-operative management of trauma. For military surgical residents, this gap is especially concerning, as they may be deployed immediately after graduation and are expected to independently manage complex vascular, hepatobiliary, abdominal, and extremity injuries in austere environments. Existing courses such as ASSET and ATOM are valuable for practicing surgeons but are not structured for longitudinal progression or formal evaluation of residents. A Military Unique Curriculum (MUC) of targeted simulation-based training was developed at the Uniformed Services University and Walter Reed National Military Medical Center (USU/WRNMMC) to address these readiness gaps.
Methods: Four distinct but complementary curricula were designed to address high-priority combat casualty care skill sets:
VESSELS (Vascular Emergency Surgery Simulated Exercises for Limb Salvage): Focuses on open vascular trauma, using anatomically accurate 3D-printed models to simulate shunt placement and anastomosis. Conducted in small, stratified groups across all PGY levels, the course integrates didactic, technical, and case-based components under trauma and vascular faculty mentorship.
MOSIS (Mastery of Operative Suturing/Stapling in Intestinal Surgery): Targets hand-sewn and stapled anastomoses for gastrointestinal trauma, employing validated simulators, team-based instruction, and real-time attending feedback.
EXPOSR (EXPeditionary Open Surgery for Residents): Provides four longitudinal cadaver-based modules, abdominal wall, hepatobiliary, abdominal vasculature, and extremity vasculature, layered with didactics and case-based discussions. Assessment is tiered by PGY level: interns (anatomic knowledge), junior residents (technical proficiency), and chief residents (instructional effectiveness).
SCOUT (Surgical Curriculum for Operational Ultrasound in Theater): Equips residents with core ultrasound skills for austere environments, including trauma assessment, biliary pathology, central line placement, and critical care applications, ensuring competence in scenarios where ultrasound may be the only diagnostic modality.
Results: Across curricula, outcomes measured included progressive acquisition of knowledge, procedural proficiency, instructional ability, and attitudes stratified by residency level. Residents demonstrated improved technical confidence in vascular shunting and bowel anastomosis, increased autonomy in open exposure techniques, and competence in point-of-care ultrasound for trauma and critical care.
Conclusion: The combined VESSELS, MOSIS, EXPOSR, and SCOUT curricula represent a deliberate, mastery-based framework to preserve and advance expeditionary surgical readiness. By leveraging cadaveric simulation, 3D-printed models, and ultrasound integration, these programs address critical gaps left by declining operative opportunities in residency. This scalable and longitudinal model provides a blueprint for enhancing readiness across military general surgery programs.