Surgery at Sea: Exploring the Training Gap for Isolated Military Surgeons.

OBJECTIVE: Newly-graduated military general surgeons often find themselves isolated at sea, solely responsible for all surgical care of several thousand sailors, regardless of the surgical specialty training required for any individual procedure. This educational need assessment explored trends in afloat surgical care over the last 25 years, and assessed trainees' preparedness for their expected role as an isolated surgeon. DESIGN: A sample of deidentified US Navy Ship's Surgeon case logs were reviewed to determine afloat case load trends in 5 common afloat case categories (urologic/gynecologic, anorectal, hernia, appendectomy, and hand/orthopedic/trauma) from 1990s to 2017. Individual procedures were mapped to American College of Surgeons/Military Health System Knowledge, Skills, and Attitudes line items to ensure afloat-relevant skills were identified. Recent military resident case logs were then compared with afloat cases to evaluate relevant trainee experience. SETTING: US Navy ships at sea from 1995 to 2017. PARTICIPANTS: US Navy afloat-deployed surgeons, totaling 1340 cases within the study period. RESULTS: Case log analysis of 1340 surgeries, comprising >200 months at sea, reflected 46 named procedures; 34 of 46 (74%) correlated to an intraoperative knowledge, skills, and attitudes item. The most common surgeries were vasectomy, (304 of 1340, 23%). No difference in case mix was apparent comparing pre- and post-2000 deployments (representing afloat laparoscopic integration) in 4 of 5 categories, while hernias proportionally declined. Case volume per deployment markedly declined overall (p < 0.001) and in each category. Resident case log analysis from 2012 to 2016 showed experience was limited in urologic/gynecologic, orthopedic, and open appendectomy categories. CONCLUSIONS: No formal case repository exists for afloat surgery, making detailed analysis problematic. Current training provides excellent surgical education but minimal exposure to rare-but-real cases expected on deployments, which may not translate to competency for the isolated, afloat surgeon. Military surgical leadership should embrace training for these cases and assertively invest in the development of the military's newest surgeons.

Training needs among maritime professionals: a cross sectional study.

BACKGROUND: Maritime medical practice includes assessment of fitness, management of medical emergencies and healthcare on board and ashore. A better response to seagoing professionals' health requirements can be achieved when all the respective stakeholders have a common understanding. Training is a powerful tool to raise awareness and in particular continuing professional development is very significant in sustaining competencies of these professionals. The objective of the study was to identify maritime professionals' perceived training needs. MATERIALS AND METHODS: A cross-sectional study was conducted among maritime professionals participated in the 14th International Symposium on Maritime Health. Fifty responses with the response rate of 42.7% were received with medical doctors representing 78% of the sample. Descriptive statistics were used to describe the basic characteristics of the data needs using STATA 15.1. RESULTS: Among the 23 themes, the ranking of perceived training needs was highest for fitness evaluation and examination guidelines and working conditions (both with the same percentage 86%), onboard medicine 82%, rules and regulations and health and safety at work (with the same percentage 80%). The lowest was on gender issues 32%. CONCLUSIONS: The finding suggests the planning and effective implementation of further training for the maritime health professionals in a variety of topics including financing and management issues. Highest importance of training was expressed by those over 40 years and by medical doctors with more than 10 years of practice. These findings could usefully be combined with a qualitative study to gain in-depth results and may help the respective authorities to organise relevant training.

Bleeding management in remote environment: the use of fresh whole blood transfusion and lyophilised plasma.

To mitigate medical risks in remote environments, the authors have implemented an innovative integrated medical support solution for bleeding management on board ships since 2013. Fresh whole blood transfusion (FWBT) and lyophilised plasma were put in place to address life threatening haemorrhages in maritime operations in the Arctic and Antarctica. The authors are illustrating the bleeding risks with an actual case occurring in Antarctica prior to the implementation of these procedures. They are presenting the different steps involved in the complex process of FWBT, from blood donors' qualifications to actual transfusions. The pros and cons of blood transfusion in extreme remote environment are discussed, including the training of health care professionals, equipment requirements, legal and ethical issues, decision making in complex blood group matching, medical benefits and risks.

[Marine, aviation and space physician, psychologist and physiologist (To the 90th anniversary of the birth of G. M. Zarakovskii)].

In the current paper authors discuss problems of marine and aerospace medicine and psychophysiology, which Georgii Zarakovskii (1925-2014), a prominent domestic experts in the field of military medicine, psychology and ergonomics, solved. Authors focused on methodological approaches and results of the study of psychophysiological characteristics and human capabilities took into account for design of tools and organization of flight crews, astronauts and military experts. Authors marked the contribution to the creation of a system integrating psychophysiological features and characteristics of the person neccessary for development, testing and maintenance of aerospace engineering and organization of its professional activities. The possibilities of using the methodology of psychophysiological activity analysis in order to improve the reliability of psychophysiological military specialists, are shown.

Ship's doctors qualifications required for cruise ships: Recruiter's comments on the German-Norwegian debate.

This contribution is intended to fertilise the current discussion of ship's doctors qualifications required for cruise ships. Therefore 10 points are added to the debate containing different considerations focussing on the recommendations of the German Society of Maritime Medicine, the American College of Emergency Physicians (ACEP's) Health Care Guidelines for Cruise Ship Medical Facilities and the different skills a ship's doctor should have from the perspective of the recruiter.

Simulation as a suitable education approach for medical training in marine and off-shore industries: theoretical underpinning.

Healthcare providers in marine and offshore industries must often perform high-risk procedures outside of their usual scope of practice, frequently using novel, complex telemedical technologies to perform an already unfamiliar task--often while multitasking, and sometimes in extreme environmental conditions. Given all the novelty occurring at once, the probability of medical error increases. This increase can be explained by the Cognitive Load Theory, which states that too much demand on the working memory can tax the ability of the long-term memory. This article will show that one solution to this situation is to use simulation in the medical training of offshore and marine medical practitioners. Contextualised simulation practice creates automatic schemas that reside in the long-term memory, minimising strain on the working memory--and, in a marine medical context, also minimising the risk of medical error.

[Medical Service of the Finnish Defence Forces].

Thee article is a brief description of the current state of the Finnish Defence Forces medical service and is based on the study of the open access foreign sources. At the beginning, the general information about Finland, the Finnish Defence Forces, and their medical service is presented. Then some particular features are described with more detail, namely, the organization of the inpatient and outpatient treatment, medical supply, scientific research, combat medicine, medical staff education and training, medical , service personnel income.

Devising a training programme and reviewing the lessons identified during contingency operations on board the Role 3 Maritime platform.

The deployment of the Primary Casualty Receiving Facility (PCRF) to Sierra Leone in October 2014 in support of Operation GRITROCK was a contingency operation that required a very specific training programme. This article discusses the training and how it evolved beyond its original remit into a programme used as a management tool to meet the needs of the staff. The result was the implementation of a comprehensive package from which lessons can be drawn and used when planning future operations.

[The head of the medical service must be the person...(To the 70th anniversary of N.G. Ryzhman)].

The article is devoted to contribution of major general (rear Admiral. - navy) of medical service Nikolay Grigoryevich Ryzhman (1944-2005), the chief of the medical service of the Northern fleet (1991-1999), to development of naval medicine, who would have turn 70 years this September. The constant analysis, and experience generalization of the medical services of the fleet connections and associations and aspiration to provide fighting capacity for the fleet crew - were a keynote of Ryzhman's activity concerned development and deployment of the new forms and methods of medical support and searching of ways to increase crew efficiency. The implemented methods and forms of organization of the medical support and scientific development of the medical support are used even now in the practical activities of the medical service of the Northern fleet.

Qualification of ship doctors: a German approach.

BACKGROUND: While a steady growth of cruise tourism since the 1970s created an increasing demand for ship doctors medical postgraduate specialty training did not sufficiently reflect the scope of skills and knowledge required from a physician being left to himself at sea. The German Maritime Health Association therefore tasked a working group with analysing the situation and coming up with suggestions for an adequate postgraduate training for ship doctors. MATERIALS AND METHODS: The working group consisted of 19 experts with various backgrounds in maritime medicine. A literature review was done on cruise ship epidemiology as well as an assessment of tasks and environmental factors influencing medical care on board of cruise ships. Necessary knowledge and skills were derived and compared with those imparted by standard German medical education. RESULTS: Mandatory knowledge and skills were identified as well as elements of standard medical education contributing to these goals. Those aspects that would or could not be adequately covered by German standard education were catalogued and summarised in a course curriculum. CONCLUSIONS: In 2013 after approval by its board of directors the German Maritime Health Association published a qualification and training recommendation addressing colleagues planning to muster as ship doctors.

The new NEMOs--changes to initial medical officer training.

It is desirable that a Royal Navy Medical Officer is not only medically competent but also a proficient Naval Officer with an ethos common to all Officers, irrespective of specialty or branch. In 2012 Britannia Royal Naval College (BRNC), in conjunction with the Institute of Naval Medicine (INM), modified the New Entry Medical Officer (NEMO) training course to comprise an initial phase at BRNC (15 weeks) followed by a second phase at INM (16 weeks). This is in contrast to the traditional training delivered at INM and Fort Blockhouse prior to joining BRNC for 7 weeks. The following article is a reflection of this experience.

[Shestov V I--the founder of the Department of Organisation and tactics of the naval medical services].

Vasilii Ivanovich Shestov during the Great Patriotic War performed various tasks concerning the organization of medical support in the Leningrad naval base, consulted on an issue of production and use of hospital and medical transport ships, worked on the organization of medical support in Schliessburg and etc. Shestov performed a considerable amount of research and methodological works concerning the establishment of the discipline "Organisation of naval medical support". He is considered as one of the founders of the theory of naval medical evacuation support.

Polish system of education in maritime health care and medical assistance for seafarers.

The Polish public awareness of the crucial importance of the own maritime economy to the very existenceof the national state has its historical reasons. The Polish maritime involvement has seen several dramaticcrises, but the Polish nationals have become an established group in the global marine trade workforceand are entitled to the proper health care. In this paper the main maritime health issues are mentioned.To meet the issues, also the national education system provides the opportunities for both seafarers andmedical professionals. The Polish doctors can specialise in the maritime medicine. In many cases the generalmedicine students formations include these topics as well. The psychological aspects are also takeninto account, both of the education of the seafarers and the organisational structure of the Polish healthcare system. Some recent aspects of the Polish participation in the international cooperation in the fieldof the medical support of the maritime economy are also described.

Evaluation of the educational impact of a special study module on maritime medicine for medical undergraduate students.

BACKGROUND: The hazardous occupation of seafaring brings many unique medical challenges. Despite its international nature, maritime medicine does not typically form a part of undergraduate medical studies. A unique and innovative, optional student-selected module (SSM) 'maritime medicine' was offered to medical students. A key objective was to develop students' attitudes to maritime medicine and increase their awareness of the discipline and its specialised nature. AIM: The aim of this study was to assess qualitatively and quantitatively the educational impact of the maritime medicine SSM and to improve the module content and design for future academic years. MATERIALS AND METHODS: Students' perceived relevance and knowledge before and after the module was assessed using a Likert-based questionnaire. Comparison was made with controls in the post module100 multiple choice question (MCQ) paper. Qualitative feedback was obtained from semi-structured focus student discussion groups and the questionnaire's free comments section. RESULTS: A significant increase in perceived knowledge was seen between pre and post module p < 3.45 × 10-10, matched with the module students performing significantly better than controls in the end-of-module MCQ paper (p < 8.99 × 10-20). Qualitative analysis revealed 5 main themes: teaching methods, appreciation of non-academic instructors, appreciation of maritime medicine unique requirements, timetabling and enjoyment. CONCLUSIONS: This unique and innovative maritime medicine module harnessed local expertise and raised the awareness and profile of maritime medicine among undergraduate medical students. It was very well received and had a significant educational impact. Practical teaching methods were highly valued by students, with these areas also performing best in quantitative analysis.