{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:27:34Z","timestamp":1786120054858,"version":"build-2736575974"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"Supplement_1","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"US Army Medical Research and Material Command","award":["W81XWH-15-9-001"],"award-info":[{"award-number":["W81XWH-15-9-001"]}]},{"name":"US Army Medical Research and Material Command","award":["#MTEC-21-06-MPAI-072"],"award-info":[{"award-number":["#MTEC-21-06-MPAI-072"]}]},{"DOI":"10.13039\/100021976","name":"Medical Technology Enterprise Consortium","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100021976","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Combat casualty care requires standardized proficiency criteria to ensure readiness in austere environments, yet gaps persist in defining performance thresholds for critical trauma skills. The Combat Medical Skills Sustainment Consortium (CMSSC), a novel military-civilian collaboration, aimed to validate competency thresholds for 21 Department of Defense-identified trauma skills.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>A prospective cohort study (2022-2025) enrolled 1,495 military and civilian personnel across five academic centers, stratified by experience (novice, intermediate, expert). Skills, including cricothyroidotomy, whole blood transfusion, and ultrasound-guided vascular access, were assessed using validated checklists in Role 2-congruent simulations. Statistical analysis compared checklist performance against participant experience with a priori checklist scores estimated at 40% (novices) and 90% (experts).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Competency thresholds were established, ranging from 77% (mechanical ventilation) to 100% (handoff). Experts achieved 85%-98% proficiency across most skills, with novices at 34%-97%. A ceiling effect was observed for less complex skills consistent with the power law of practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The Combat Medical Skills Sustainment Consortium validated standardized assessment tools, with potential to address readiness gaps through military-civilian synergy. Findings support consortium-guided curriculum development and highlight the need for longitudinal skill decay studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact<\/jats:title>\n                    <jats:p>This study sets a benchmark for trauma care skills assessment, facilitating rapid adoption across military and civilian settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usag118","type":"journal-article","created":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T12:50:11Z","timestamp":1772283011000},"page":"435-443","source":"Crossref","is-referenced-by-count":0,"title":["Military-Civilian Partnership to Advance Standards of Performance for Simulated Combat Trauma Medical Skills: Validation of Competency Thresholds"],"prefix":"10.1093","volume":"191","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2580-0667","authenticated-orcid":false,"given":"Bhavesh M","family":"Patel","sequence":"first","affiliation":[{"name":"Mayo Clinic Department of Critical Care Medicine, MC Military Medicine, , Phoenix, AZ 85054,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susannah E","family":"Nicholson","sequence":"additional","affiliation":[{"name":"University of Texas Health Science Center Department of Surgery, , San Antonio, TX 78229,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffany S","family":"Okerman","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Department of Emergency Medicine and Anesthesiology, , Pittsburgh, PA 15213,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph O","family":"Lopreiato","sequence":"additional","affiliation":[{"name":"Uniformed Services University of the Health Sciences Department of Pediatrics and School of Medicine, , Bethesda, MD 20814,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Tisherman","sequence":"additional","affiliation":[{"name":"University of Maryland Department of Surgery, , Baltimore, MD 21201,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Frisch","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Department of Emergency Medicine and Anesthesiology, , Pittsburgh, PA 15213,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Noel","sequence":"additional","affiliation":[{"name":"Mayo Clinic Department of Critical Care Medicine, MC Military Medicine, , Phoenix, AZ 85054,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald","family":"Poropatich","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Department of Emergency Medicine and Anesthesiology, , Pittsburgh, PA 15213,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul E","family":"Phrampus","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Department of Emergency Medicine and Anesthesiology, , Pittsburgh, PA 15213,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the CMSS Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Andreatta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janhave","family":"Athale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Bacik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachelle Babbitt","family":"Jonas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shari","family":"Brand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Bowyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duke","family":"Butterfield","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannelisa","family":"Callisen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugh","family":"Connacher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvonne","family":"Chung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Colquist","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blake","family":"Davisson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Gerhardus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lavana","family":"Fitzgerald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Frisch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Phrampus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheralyn","family":"Hendrix","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Janicki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilla","family":"Knott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Kunze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Lopreiato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Low","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"McLeish","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"McQuillan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessie","family":"Milaski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mallory","family":"Mushaben","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Neustein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susannah","family":"Nicholson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Noel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffany","family":"Okerman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhavesh","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Peterson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald","family":"Poropatich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmine","family":"Proctor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Puche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janice","family":"Rorabeck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayan","family":"Sen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Seamans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Shusko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig","family":"Sisson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Skolnick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Sorto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Tetzlaff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Thurman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Tillman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Tisherman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soojie","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"2026080616031687200_usag118-B1","doi-asserted-by":"publisher","first-page":"89","DOI":"10.55460\/0SE6-Q7TF","article-title":"Manikin human-patient simulator training","volume":"17","author":"Horn","year":"2017","journal-title":"J Spec Oper Med"},{"key":"2026080616031687200_usag118-B2","doi-asserted-by":"publisher","first-page":"95","DOI":"10.55460\/T63H-3OXX","article-title":"Quality assurance in tactical combat casualty care for medical personnel training 16 April 2020","volume":"20","author":"Greydanus","year":"2020","journal-title":"J Spec Oper Med."},{"key":"2026080616031687200_usag118-B3","author":"TRADOC G2 USA TaDC","year":"2024"},{"key":"2026080616031687200_usag118-B4","doi-asserted-by":"publisher","first-page":"1258","DOI":"10.1016\/j.jamcollsurg.2016.03.031","article-title":"Saving the military surgeon: maintaining critical clinical skills in a changing military and medical environment","volume":"222","author":"Edwards","year":"2016","journal-title":"J Am Coll Surg"},{"key":"2026080616031687200_usag118-B5","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1007\/s11606-007-0283-4","article-title":"Simulation technology for skills training and competency assessment in medical education","volume":"23","author":"Scalese","year":"2008","journal-title":"J Gen Intern Med"},{"key":"2026080616031687200_usag118-B6","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1007\/s11096-016-0257-x","article-title":"How to use the nominal group and Delphi techniques","volume":"38","author":"McMillan","year":"2016","journal-title":"Int J Clin Pharm"},{"key":"2026080616031687200_usag118-B7","doi-asserted-by":"publisher","first-page":"1103","DOI":"10.1001\/jamasurg.2021.4412","article-title":"A novel paradigm for surgical skills training and assessment of competency","volume":"156","author":"Bowyer","year":"2021","journal-title":"JAMA Surg"},{"key":"2026080616031687200_usag118-B8","doi-asserted-by":"publisher","first-page":"e346","DOI":"10.1097\/AS9.0000000000000346","article-title":"Measuring competency: improving the validity of your procedural performance assessments","volume":"4","author":"Andreatta","year":"2023","journal-title":"Ann Surg Open"},{"key":"2026080616031687200_usag118-B9","doi-asserted-by":"publisher","first-page":"996","DOI":"10.1097\/acm.0000000000000289","article-title":"Five steps to develop checklists for evaluating clinical performance: an integrative approach","volume":"89","author":"Schmutz","year":"2014","journal-title":"Acad Med"},{"key":"2026080616031687200_usag118-B10","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1097\/SIH.0000000000000097","article-title":"Cognitive load theory for the design of medical simulations","volume":"10","author":"Fraser","year":"2015","journal-title":"Simul Healthc"},{"key":"2026080616031687200_usag118-B11","doi-asserted-by":"publisher","first-page":"116","DOI":"10.5662\/wjm.v11.i4.116","article-title":"Delphi methodology in healthcare research: how to decide its appropriateness","volume":"11","author":"Nasa","year":"2021","journal-title":"World J Methodol"},{"key":"2026080616031687200_usag118-B12","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.7205\/MILMED-D-13-00081","article-title":"Creation of a criterion-referenced military optimal performance challenge","volume":"178","author":"Crowder","year":"2013","journal-title":"Mil Med"},{"key":"2026080616031687200_usag118-B13","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1093\/milmed\/usae147","article-title":"Survey of current simulation based training in the US military health system","volume":"189","author":"Bacik","year":"2024","journal-title":"Mil Med"},{"key":"2026080616031687200_usag118-B14","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1136\/jrnms-104-173","article-title":"The \u2018walker Dip\u2019","volume":"104","author":"Walker","year":"2018","journal-title":"J R Nav Med Serv"},{"key":"2026080616031687200_usag118-B15","doi-asserted-by":"publisher","first-page":"S16","DOI":"10.1097\/ta.0000000000003704","article-title":"Military-civilian partnerships and the clinical readiness mission: a preliminary study from the military health system and the American college of surgeons","volume":"93","author":"Grabo","year":"2022","journal-title":"J Trauma Acute Care Surg"},{"key":"2026080616031687200_usag118-B16","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1016\/j.jpeds.2017.03.055","article-title":"Development of reliable and validated tools to evaluate technical resuscitation skills in a pediatric simulation setting: resuscitation and emergency simulation checklist for assessment in pediatrics","volume":"188","author":"Faudeux","year":"2017","journal-title":"J Pediatr"},{"key":"2026080616031687200_usag118-B17","doi-asserted-by":"publisher","first-page":"1308","DOI":"10.3758\/s13423-015-0811-x","article-title":"Piecewise power laws in individual learning curves","volume":"22","author":"Donner","year":"2015","journal-title":"Psychon Bull Rev"},{"key":"2026080616031687200_usag118-B18","doi-asserted-by":"publisher","DOI":"10.4324\/9780203728178","article-title":"Mechanisms of skill acquisition and the law of practice","author":"Newell","year":"1981","journal-title":"Cognitive Skills and Their Acquisition"},{"key":"2026080616031687200_usag118-B19","doi-asserted-by":"publisher","first-page":"1034","DOI":"10.1097\/ACM.0000000000000681","article-title":"Learning curves in health professions education","volume":"90","author":"Pusic","year":"2015","journal-title":"Acad Med"},{"key":"2026080616031687200_usag118-B20","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1207\/s15516709cog1202_4","article-title":"Cognitive load during problem solving: effects on learning","volume":"12","author":"Sweller","year":"1988","journal-title":"Cogn Sci"},{"key":"2026080616031687200_usag118-B21","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1002\/jhm.12979","article-title":"Implementation of the I-PASS handoff program in diverse clinical environments: a multicenter prospective effectiveness implementation study","volume":"18","author":"Starmer","year":"2023","journal-title":"J Hosp Med"},{"key":"2026080616031687200_usag118-B22","doi-asserted-by":"publisher","first-page":"S70","DOI":"10.1097\/00001888-200410001-00022","article-title":"Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains","volume":"79","author":"Ericsson","year":"2004","journal-title":"Acad Med"},{"key":"2026080616031687200_usag118-B23","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1017\/CBO9780511816796.019","volume-title":"The Cambridge Handbook of Expertise and Expert Performance","author":"Norman","year":"2006"},{"key":"2026080616031687200_usag118-B24","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1097\/ACM.0b013e318217e119","article-title":"Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence","volume":"86","author":"McGaghie","year":"2011","journal-title":"Acad Med"},{"key":"2026080616031687200_usag118-B25","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1037\/0033-295x.100.3.363","article-title":"The role of deliberate practice in the acquisition of expert performance","volume":"100","author":"Ericsson","year":"1993","journal-title":"Psychol Rev"},{"key":"2026080616031687200_usag118-B26","doi-asserted-by":"publisher","first-page":"S7","DOI":"10.1097\/SIH.0000000000000282","article-title":"Role of scientific theory in simulation education research","volume":"13","author":"Pusic","year":"2018","journal-title":"Simul Healthc"},{"key":"2026080616031687200_usag118-B27","doi-asserted-by":"publisher","first-page":"S42","DOI":"10.1097\/SIH.0b013e318222fde9","article-title":"Evaluating the impact of simulation on translational patient outcomes","volume":"6","author":"McGaghie","year":"2011","journal-title":"Simul Healthc"},{"key":"2026080616031687200_usag118-B28","doi-asserted-by":"publisher","first-page":"97","DOI":"10.3109\/0142159X.2011.550971","article-title":"Implementation science: addressing complexity in medical education","volume":"33","author":"McGaghie","year":"2011","journal-title":"Med Teach"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/191\/Supplement_1\/435\/70491210\/usag118.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/191\/Supplement_1\/435\/70491210\/usag118.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T20:03:25Z","timestamp":1786046605000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/191\/Supplement_1\/435\/8752132"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":28,"journal-issue":{"issue":"Supplement_1","published-online":{"date-parts":[[2026,8,6]]},"published-print":{"date-parts":[[2026,8,1]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usag118","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7]]},"published":{"date-parts":[[2026,7]]}}}