With the numbers of service members requiring rehabilitation following combat-related amputation decreasing since 2011, provider skills to treat and rehabilitate amputee patients will atrophy if active steps are not taken to mitigate against skill erosion. The authors identify core competencies in which skills should be maintained and improved so that the military medical community is prepared for future conflict and increased patient volume.

Core Competencies for Amputation Rehabilitation

Jason Michel Etchegaray, Heather Krull, Stephanie Brooks Holliday, Lea Xenakis, Bernard D. Rostker, Nahom M. Beyene, Sangeeta C. Ahluwalia, Tepring Piquado, Edward W. Chan, Angela K. Clague

ResearchPublished Jun 3, 2019

Since September 11, 2001, the Department of Defense (DOD) has rehabilitated more than 2,000 service members and veterans who experienced one or more deployment-related amputation(s), with the number of new amputations peaking in 2011. As a consequence of lower deployment, the number of new amputations has shrunk in each subsequent year, bringing with it the risk that provider skills will atrophy. In order to prevent this and to capture best practices, knowledge, and skills that were developed by DOD during the conflicts in Iraq and Afghanistan, RAND Arroyo Center researchers interviewed providers working in military treatment facilities to identify a set of services that are integral to optimal amputation rehabilitation. These services are behavioral health, biomedical engineering, case management, diet/nutrition, occupational therapy, orthopaedic surgery, physical therapy, physical medicine and rehabilitation, and prosthetics and orthotics. For those nine services, the researchers defined and documented the core competencies that are needed by health care provides who offer those services, as well as behaviors that demonstrate that a provider has the competency. The competencies common to all nine services fall into the following categories: teamwork, patient and family education, military and other cultural awareness, patient-centered care, evidence-based practice, and ethical and professional behavior. Using technical expert surveys, researchers asked providers in each service area to discuss their use and understanding of the core competencies, along with means for evaluating them, and then developed recommendations for how to adopt and implement them in the military health setting.

Key Findings

After September 11, 2001, the military sought to build a new system of care for combat amputees

  • The system included a new team approach to patient care.
  • The system included establishment of three advanced rehabilitation centers and the Extremity Trauma and Amputation Center of Excellence.
  • The system included the goals of returning patients to their pre-injury level of activity and giving them the option to remain on active duty.

Interviews with providers who have provided care to patients with amputation revealed six key competencies and associated behaviors, which can be used as a basis for further training, education, and professional development

  • These key competencies are teamwork, patient and family education, military and other cultural awareness, patient-centered care, evidence-based practice, and ethical and professional behavior.

These core competencies apply to nine services

  • These services are behavioral health, biomedical engineering, case management, diet/nutrition, occupational therapy, orthopaedic surgery, physical therapy, physical medicine and rehabilitation, and prosthetics and orthotics.

Recommendations

  • Core competencies need to be formally accepted by those leading and working in military health care settings. In order for this to occur, the competency framework must become part of standard operating procedure and include a common agreement for how it should be used in military provider settings.
  • Once competencies are accepted, those in military health care settings must decide how to use them. Performance appraisals are one key area, and Medical Command's existing competency assessment files can be adapted for this purpose.
  • Military health system leadership should adopt a proficiency framework for assessing individual and system-wide competencies to determine which levels and combinations of skills are appropriate for various installations and the system as a whole.
  • Metrics and assessment time frames associated with competencies must be validated for military health care settings. Linking metrics to patient outcomes and conducting assessments in such a way that patient outcomes are a focus, especially by including patients and family members in those assessments, will yield improvements in the quality of care.
  • Once optimal skill mix has been identified, mitigation strategies for competency gaps need to be developed. Here, partnerships between military and civilian sites can help expose military health care providers to more patients rehabilitating from amputations.

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Document Details

  • Copyright: RAND Corporation
  • Availability: Available
  • Year: 2019
  • Print Format: Paperback
  • Paperback Pages: 160
  • Paperback Price: $33.00
  • Paperback ISBN/EAN: 978-1-9774-0223-3
  • DOI: https://doi.org/10.7249/RR2898
  • Document Number: RR-2898-A

Citation

RAND Style Manual
Etchegaray, Jason Michel, Heather Krull, Stephanie Brooks Holliday, Lea Xenakis, Bernard D. Rostker, Nahom M. Beyene, Sangeeta C. Ahluwalia, Tepring Piquado, Edward W. Chan, and Angela K. Clague, Core Competencies for Amputation Rehabilitation, RAND Corporation, RR-2898-A, 2019. As of September 11, 2024: https://www.rand.org/pubs/research_reports/RR2898.html
Chicago Manual of Style
Etchegaray, Jason Michel, Heather Krull, Stephanie Brooks Holliday, Lea Xenakis, Bernard D. Rostker, Nahom M. Beyene, Sangeeta C. Ahluwalia, Tepring Piquado, Edward W. Chan, and Angela K. Clague, Core Competencies for Amputation Rehabilitation. Santa Monica, CA: RAND Corporation, 2019. https://www.rand.org/pubs/research_reports/RR2898.html. Also available in print form.
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The research described in this report was sponsored by the U.S. Army Medical Command and conducted by the Personnel, Training, and Health Program within the RAND Arroyo Center.

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