extremities) and general questions of Military Field provide surgical care for wounds and injuries in peace- Surgery and Injury Surgery. The results of the survey are time, should acquire these skills(6). However, currently, given in Table 5. existing simulators cannot create an entire spectrum of scenarios on how to save the lives of severely wounded Table 5: Results for the level of knowledge tests of SMART people. course students (N=55). NUMBER It is generally agreed that the best way to improve sur- OF gical competencies is to train on living tissues. Kenneth CORRECTANSWERS INITIAL FINAL Bofford’s world-famous DSTC (Definitive Surgical QUESTIONS SECTION TEST TEST Trauma Care) course is a two-day training course on lar- ABSOLUTE % ABSOLUTE % ger animals (pigs).7 However, sometimes training on NUMBER NUMBER living tissues differs from surgeries on real patients. The Neck (n=165) 41 24,8 100* 60,6* Royal Society of Surgeons of Great Britain who teach Chest (n=165) another well-known DSTS (Definitive Surgical Trauma 60 36,4 147* 89,1* Skills) course, on the contrary, uses only cadaver material Abdomen (n=165) 83 50,3 148* 89,7* for training despite it is nearly impossible to reproduce a real pathology by such means.8 Extremities (n=165) 56 33,9 111* 67,3* General questions 87 52,7 141* 85,5* The training course "SMART" (Modern Methods and (n=165) Algorithms for the Treatment of Wounds and Traumas) TOTAL (n=825) 327 39,6 647* 78,4* combines short lectures and practical work of trainees Note: * - the differences are credible in comparison with the initial consistently on surgeon simulators, large living biologi- level of knowledge (p<0.05) cal objects and cadaver. Due to the Covid-19 pandemic in 2020, the "SMART" surgical course began in a hybrid Although the SMART course concentrates on the prac- offline-online format. Three days professors give some tical component of the training, it is complemented by lectures remotely followed by a three-day "immersion" short lectures on the most important issues of injury in practical military field surgery and injury surgery. In surgery. Final testing showed a significant increase in addition to the SMART course, there are SMART-PP the number of correct answers in individual sections: (maneuver of a severely wounded person), SMART- neck - 2.4 times (p < 0.05), chest - 2.4 times (p < 0.05), Angio (trauma of blood vessels), SMART-REBOA (per- abdomen - 1.8 times (p < 0.05), great vessels of the forming resuscitation endovascularballoon aortic extremities – twice (p < 0.05), generalquestions of occlusion - REBOA) courses.9 injury surgery - 1.6 times (p < 0.05). Thus, the general level of knowledge of students doubled (p < 0.05). CONCLUSION THE DISCUSSION OF THE RESULTS The possibility of training on living tissue and on a cadaver is limited in most countries of the world for a Treatment of the wounded in modern military conflicts number due to financial, organizationaland ethical puts higher demands on the professional qualities of reasons. However, it is obvious that military doctors tra- military surgeons, especially surgeons of the Airborne velling to the theatre of operations, as well as to sur- Forces and Special Forces. geons of trauma centers, must learn surgery in two dif- ferent ways: at the level of physiology (on living tissues) The formation and maintenance of competencies in the and the anatomical level (on cadaver material). It is also military field surgery dictates the need for professional recommended to combine surgery training with the skills development. It is necessary not only for conti- use of simulation tools which is optimal for perception nuous learning of the fundamental principles of health- by trainees. care ethics but for practicing basic life-saving surgeries. The specific nature of casualties, the decrease in the REFERENCES number of victims in trauma centers, as well as the fre- 1. SAMOKHVALOV IM, KHOLIKOV IV, GONCHAROV AV, quency of performing common surgeries force the SMITH IM, REVA VA Surgical Lessons Learned from Armed introduction of new technologies and teaching Conflict in Afghanistan (1979-1989) and The Caucasus methods. A possible solution to this problem is an inten- (1994-2002, 2008). Intern Review Armed Forces Med Serv, sive training course in military field surgery, including 2014; 87 (4): 79-85. training (under the guidance of an expert lecturer) on simulators, biological objects and cadaver material. 2. EARDLEY WG, TAYLOR DM, PARKER PJ Training tomor- row’s military surgeons: lessons from the past and chal- The creation, development and use of medical simula- lenges for the future. J. of the Royal Army Medical Corps, tion tools allow healthcare professionals to practice 2009; – 155 (4): 249–252. common surgeries repeatedly without risking lives. 3. REMICK KN The surgical resuscitation team: surgical Moreover, a simulated environment makes it possible trauma support for U.S. Army Special Operations Forces. J. to evaluate the effectiveness of medical professionals, Spec. Oper. Med, 2009; 9 (4): 20–25. VOL. their psychomotor skills and the speed of performing a 94/3 surgery. Military field surgeons, as well as doctors who 4. Military field surgery of local wars and armed conflicts: a International Review of the Armed Forces Medical Services 68 Revue Internationale des Services de Santé des Forces Armées