One of the parts of my career I value most is teaching. Not as a side obligation attached to clinical work, but as work that carries its own weight and its own meaning. I hold a Professor of Surgery appointment at the F. Edward Hebert School of Medicine at the Uniformed Services University of the Health Sciences. Over four decades in trauma surgery and critical care, I have trained surgeons, residents, and military medical teams who now carry the field forward in their own careers. That continuity matters to me.
I want to share what I actually focus on when I teach, because I think it is different from what people often expect.
Clinical Skill Is the Starting Point, Not the Goal
The assumption most people bring to surgical training is that the primary goal is technical mastery. Learn the procedures. Execute them reliably under pressure. That assumption is not wrong. Technical skill is essential and non-negotiable. A surgeon who cannot perform the right intervention at the right moment has failed at the fundamental task.
But in my experience, technical skill is the threshold requirement, not the differentiating one. The surgeons who become exceptional are almost always the ones who develop something beyond technical competence. They develop judgment. They develop the capacity to make sound decisions with incomplete information, under time pressure, when the cost of error is high. That capacity is harder to teach and harder to measure, which is exactly why it receives less attention in formal training programs than it deserves.
In a combat hospital, the difference between a technically proficient surgeon and a great one shows up most clearly not in routine cases but in the cases where the clinical picture is ambiguous, where the resources are limited, and where the decision that needs to be made has no established protocol. Those are the moments that reveal whether a surgeon’s training built judgment or only built procedure knowledge.
What Cincinnati CSTARS Was Built to Address
In 2001, I helped found the Cincinnati Center for the Sustainment of Trauma and Readiness Skills, known as Cincinnati CSTARS. The program was built on a specific premise: military trauma surgeons and critical care providers need sustained exposure to high-volume civilian trauma in order to maintain the skills and judgment that combat deployments demand.
The challenge it addressed is structural. During peacetime, military medical facilities do not generate the volume of severe trauma cases necessary to keep surgical teams at combat readiness. The solution was a formal partnership with the University of Cincinnati Medical Center, one of the top trauma research programs in the country, giving military providers access to clinical volume and complexity that their home facilities could not offer.
Since 2001, Cincinnati CSTARS has served as the advanced course training center for all Air Force CCATT teams. The program has trained teams who have served across every major theater of US military operations in the past two decades. What I tried to build into it from the beginning was not just procedural training but the kind of case exposure and deliberate reflection that develops the judgment I described above. Cases that cannot be resolved by algorithm. Teams that have to communicate clearly under pressure. Decision points where the right answer is not obvious and the cost of delay is real.
Teaching Honesty About Outcomes
One of the things I emphasize with residents and junior surgeons is the habit of honest outcome review. In medicine, there is a cultural tendency to move forward after a difficult case without fully examining what happened and why. The next patient arrives. The operating room fills again. The pace of clinical work makes reflection feel like a luxury.
It is not a luxury. It is the mechanism by which clinical judgment improves over a career rather than simply accumulating experience without extracting the lessons from it. The difference between a surgeon with 20 years of experience and a surgeon who has repeated the same year 20 times is exactly this: one of them has examined their outcomes honestly and changed their practice based on what they found. The other has not.
The military’s After-Action Review process provides a structured framework for this. What was the plan? What happened? Why was there a difference? What changes next time? Applied to clinical cases with the same discipline that military units apply it to operational events, it produces the kind of iterative improvement that a career of honest self-examination generates. I have used this framework throughout my own career and tried to build it into every training program I have led.
The Responsibility That Comes With Passing Things Forward
Forty years of trauma surgery and eight combat deployments produce a specific kind of knowledge. Some of it exists in publications and protocols. More of it exists in the accumulated pattern recognition and judgment that comes from managing cases under conditions that no controlled study can fully replicate.
That knowledge does not transfer automatically. It transfers through teaching, through mentorship, through structured programs that create the conditions for the next generation to develop what they need. The CCATT program and the work at USU represent my best attempts to build those conditions at scale.
The obligation to pass things forward is one I take seriously. The field of trauma medicine is better today than it was 40 years ago in measurable, documented ways. Survival rates from injuries that were previously unsurvivable have improved. Protocols that did not exist have become standard practice. That progress came from the people who came before me contributing what they knew, and from the people I trained who extended it further.
That is the work. The clinical career is one expression of it. The teaching is another. Both matter, and the second one outlasts the first.
More on my background and career is available at jayjohannigman.co and through my writing on resilience and progress.
