Large-Scale Combat Operation Education and Training Needs: Implications for Military and Civilian Medical Education

Introduction: Future large-scale combat operations (LSCO) with adversaries such as Russia or China are predicted to present unique challenges for medical personnel, including high casualty rates, limited resources, and austere environments. While traditionally associated with military conflict, the anticipated scale of future LSCO may overwhelm military medical systems, requiring civilian physicians to support wartime care or manage surges in casualties on the home front. Effective training early on is, therefore, critical to prepare both military and civilian physicians for these unique and demanding conditions. Methods: We used interpretive phenomenological analysis in this qualitative study to explore key competencies needed for LSCO medical readiness. The first and seniors author interviewed 27 military physicians (active duty, retired, and reservists) and one military chaplain with extensive operational medical experience in the fall of 2023 and fall of 2024. We analyzed transcripts to identify recurring themes. Data analysis was conducted by a diverse and experienced research team. Results: Five key themes emerged as essential for LSCO-focused medical training: 1) problem-solving in resource-limited environments, emphasizing critical thinking and improvisation; 2) ethical and emotional resilience, addressing psychological and moral challenges; 3) adaptive leadership, highlighting decision-making in high-stress settings; 4) mastery of core medical skills, ensuring competency in essential procedures; and 5) cultural competence and interoperability, supporting effective collaboration across military-civilian teams. Conclusion: The competencies identified in this study are relevant to both military and civilian physicians who may be called upon to provide care during large-scale combat operations. Medical education must proactively incorporate these themes to ensure readiness across both sectors. Strengthening military-civilian collaboration in training and curriculum development will enhance national preparedness for future conflicts.