Authors
Talia R Arcieri, Michael D Cobler-Lichter, Jessica M Delamater, Ana M Reyes, Callie L Spohn, Nicholas Namias, Vincente S Nelson, Mark D Buzzelli, Kenneth G Proctor, Carl I Schulman, Paul J Wetstein
Published in
Military medicine. Jul 22, 2026. Epub Jul 22, 2026.
Abstract
Maintaining clinical readiness of military surgeons is essential for optimal combat casualty care, yet limited exposure to high-acuity trauma in military treatment facilities (MTFs) contributes to skill degradation during peacetime. Military-civilian partnerships (MCPs) have emerged as a key strategy to address this gap by embedding military surgeons within high volume civilian trauma centers. However, objectively measuring whether clinical experience translates into readiness remains challenging because of the disconnect between civilian billing-based documentation using current procedural terminology (CPT) codes and military readiness frameworks such as the United States (U.S.) Army General Surgeon Individual Critical Task List (ICTL). This study aimed to develop a CPT-to-ICTL mapping framework to quantify U.S. Army surgeon readiness within a long established MCP.
A retrospective observational study was conducted at a single urban academic Level I trauma center MCP from May 2020 through September 2024. CPT codes from the CPT 2024 Professional Edition were categorized as definitively or potentially satisfying an individual critical task (ICT), with the latter requiring operative or procedural documentation review for confirmation. Billing logs for 2 MCP embedded U.S. Army surgeons (Surgeons A and B) were analyzed, excluding non-procedural and non-critical care codes. During the study period, Surgeon A contributed 48 months of clinical time while Surgeon B contributed 42 months because of periods of deployment and offsite military training. CPT codes were grouped by encounter, mapped to ICTs, and counted once per encounter to avoid duplication. Descriptive statistics were used to summarize ICT frequency. The study was approved by the local Institutional Review Board with a waiver of informed consent.
The CPT-to-ICTL mapping framework identified 1,239 CPT codes corresponding to 1,772 CPT-to-ICT associations. Open abdominal and thoracic procedures accounted for the largest proportion of mapped codes. Surgeon A and Surgeon B completed 2,020 and 1,358 ICTs, respectively. The most frequently performed ICT was the Focused Assessment with Sonography in Trauma (FAST) examination, with laparotomy as the most common operative task. Additional commonly performed ICTs included tube thoracostomy, trauma resuscitation, and critical care management.
This novel approach to quantifying military surgical readiness links administrative billing data to readiness-defined tasks. The findings support MCPs as effective environments for generating exposure to combat-relevant clinical activities while highlighting the feasibility of using CPT-based frameworks for objective readiness assessment. This framework has important implications for readiness reporting, program evaluation, and policy development within the Military Health System. Future work should validate this approach across diverse settings, incorporate non-procedural aspects of care, and align readiness metrics with clinical outcomes and deployment performance.
PMID:
42485277
Bibliographic data and abstract were imported from PubMed on 23 Jul 2026.
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