UC San Diego

BACKGROUND: Military trauma/surgical critical care (T/SCC) surgeons perform both clinical "inside-the-tent" (ITT) and leadership/administrative "outside-the-tent" (OTT) responsibilities during forward deployments. Despite these demands, fellowship programs lack a standardized curriculum addressing the full spectrum of military-specific requirements. This study evaluates military T/SCC surgeons' perceptions of training quality, satisfaction, and confidence in managing deployment trauma situations, and readiness to assume leadership roles. METHODS: A survey was distributed to all current military T/SCC fellows and attendings to evaluate their perception of ITT and OTT skill training during fellowship. Respondents reported their satisfaction with fellowship training, as well as their confidence, satisfaction, and frequency with which they practiced on ITT and OTT skills. Attendings were additionally asked how often they utilized OTT skills and assumed key OTT leadership positions, such as unit commander or deputy commander, trauma director, or chief medical officer, during deployments. RESULTS: Ninety-four military T/SCC surgeons (80% attendings and 20% fellows) participated; 68% had deployed after fellowship. Confidence in core ITT skills, such as damage control surgery and resuscitation, was high (99% for both), but confidence was low for thoracic (58%) and complex liver trauma procedures (53%). Exposure to OTT domains-triage, systems, and tactical leadership-was limited; fewer than one-third of respondents reported frequent exposure or satisfaction with OTT training during fellowship. However, 84% of attendings frequently performed OTT functions during deployment. Previously deployed surgeons showed significantly greater confidence in disaster management (69% vs. 42%; p<0.05) and tactical decision-making (75% vs. 46%; p<0.05) OTT skills. CONCLUSIONS: While operative training was viewed favorably, many surgeons felt clinically confident but underprepared for deployment leadership roles. Greater OTT confidence among previously deployed surgeons suggests that operational experience-not fellowship training-currently drives proficiency. A military-specific curriculum is needed to prepare surgeons for leadership responsibilities in combat settings. (J Trauma Acute Care Surg. 2026;00:00-00. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Prognostic/Epidemiological, Level IV.