Readiness accelerators for military general surgeons: Insights from acute care surgery fellowship programs

BACKGROUND: – Maintaining expeditionary surgical readiness during peacetime is a persistent Military Health System challenge, particularly for general surgeons assigned to low-volume military treatment facilities. Knowledge, Skills, and Abilities–Clinical Activity (KSA-CA) metrics quantify procedural readiness against operational benchmarks, yet many active-duty surgeons do not meet established thresholds. The American Association for the Surgery of Trauma (AAST) Acute Care Surgery (ACS) fellowship includes a dedicated operative year with high-volume trauma and emergency general surgery exposure that could offer insights for how to accelerate procedural readiness, but its performance against KSA-CA standards has not been evaluated. METHODS: – We performed a retrospective, cross-sectional analysis of procedural case logs from fellows enrolled in AAST ACS fellowship programs between February 2021 and April 2023, limited to procedures performed during the 12-month ACS operative year. Each logged Current Procedural Terminology code was scored using the general surgery KSA-CA algorithm, which maps >2, 000 Current Procedural Terminology codes to 49 procedure groups. Readiness was defined as achieving a KSA-CA score at or above the established threshold. RESULTS: – Case logs from 26 of 32 approved AAST ACS fellowship sites contained eligible entries, representing 102 fellows and 24, 493 logged procedures. Among fellows meeting inclusion criteria (n = 73), the median cumulative KSA-CA score was 25, 464 (IQR, 7, 132–42, 415). All fellows who completed the ACS year achieved the KSA-CA readiness threshold (100%); 95% achieved readiness before the end of the year, and 93% met readiness within 6 months. Top contributing procedure groups included intra-abdominal open hollow viscus operations, thoracic (or “pneumonectomy” group in KSA nomenclature), and debridement of muscle and fascia. CONCLUSIONS: – The AAST ACS fellowship curriculum reliably meets military procedural readiness standards as measured by KSA-CA metrics in 12 months or less. The ACS fellowship sites and curricular structure have the potential to accelerate expeditionary readiness among Military Health System general surgeons. (J Trauma Acute Care Surg. 2026;000: 000–000.