From Battlefield to Bedside: Prioritizing Procedural Skills and Competency Expectations for Military Physician Assistants Through a Modified Delphi Method.

Introduction: The U.S. Army-Baylor University Doctor of Science in Physician Assistant Studies General Surgery program is an 18-month curriculum consisting of approximately 4,800 hours of training in clinical, procedural, and operative skills. Maximizing efficient use of medical providers will be paramount in future military conflicts with a high number of casualties expected in a resource-limited environment. This study was designed to ensure that fellowship-trained military physician assistants are meeting surgeon expectations in both garrison and deployed environments.

Materials and methods: This study used the Delphi method to prioritize skills and establish performance levels for fellowship-trained physician assistants. The initial survey used a 5-point Likert agreement scale to rate whether trained physician assistants should be able to perform that skill in garrison and deployed environments. The second survey also included questions on the competency level that surgeons expect a trained physician assistant to possess upon graduation, using Accreditation Council for Graduate Medical Education Surgery milestone descriptions for "patient evaluation and decision making," "intraoperative patient care technical skills," and "postoperative patient care."

Results: Consensus was reached on 18 skills in both environments. Using the surgery milestones, the average expected competency level of a trained physician assistant t is 2.7 in "patient evaluation and decision making," 2.5 for "intraoperative patient care technical skills," and 2.8 for "postoperative patient care."

Conclusions: The expert opinion garnered through this study can focus training and guide competency assessments. By acknowledging military surgeon expectations, our graduates will be better prepared to participate in interprofessional teams during future conflicts.