MEDCOM Updates
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Transcript of MEDCOM Updates
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MEDCOM Updates
Christopher A. Dillon MD
COL, MC
Accessions/Recruiting Liaison to OTSG
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Current Issues in Medical Education
• Increase in Medical School Enrollment
AAMC reports nearly 30% from 2002
80% of MD schools
75% initiatives encouraging primary care
• 112th Congress Deficit Reduction
60% reduction ($3.9B) in Medicare payments to teaching hospitals
ACGME concerned re: # trainees & education
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Current Issues in Medical Education
• Control Act of 2011
Eliminates interest subsidies on Stafford Loans
– Graduate & Professional Students begin July 1, 2012
– Still have access to same amount of loans ($40,500 for medical students)
– Since unsubsidized, estimates increase loan costs by $10,000-$20,000 per student
• Physician Salaries https://www.aamc.org/download/48732/data/compensation.pdf
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Current Issues in Medical Education
• National Match 2014- MD applicants will equal positions offered
– GME slots up 6%/5 yrs but applicants up 9.5%/5 yrs
– Only 52% of civilians got 1st choice
14,000 non-U.S. senior applicants
Match will be more competitive (>900 U.S. senior medical students didn’t match last year)
• Military Match Smaller, better chance to match 1st or 2nd
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GRADUATE MEDICAL EDUCATION STATS
• Number, specialty distribution, subspecialty options programmed to meet the needs of the Army.- 137 Programs 72 residencies, 59 fellowships, 6 transitional internships).
- 22 Specialties. - 11 Teaching hospitals. - 57% of programs with 5 yr. accreditation; 20% with 4 yr. accreditation (3.95 yr is civilian average; Army average 4.3 yrs).
• Majority of Army physicians in GME train in in-house programs. - 1466 in training (1355 in-house programs and 111 Army sponsored civilian training). 30 in educational delay/FAP.
- Comprises 31% of active duty Medical Corps end strength.
• 93% first time board pass rate.
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Army GME Success Stories
• Brooke AMC and Walter Reed AMC General Surgery Two of only 10 surgery programs in the country (250 programs total)
to have a 100% first time pass rate on both written and oral boards over the last 5 years
• Emergency Medicine Residents at Darnall ACH, Brooke AMC and Madigan AMC have
scored in the top 10 nationwide on the annual EM in-service exam for the past 11 years
• Internal Medicine WRAMC IM residents (13) achieved a 100% pass rate on the 2007
ABIM certification exam. The national average for first-time takers between 2002 and 2006 is 91%. The Walter Reed average for first-time takers for the past 10 years is 98%.
• Ophthalmology The Army had the first residency program in the US to get the virtual
reality ophthalmic surgical simulator. 100% of our ophthalmology residency programs are sim-inclusive.
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Medical Research
• The U.S. Army Aeromedical Research Laboratory (USAARL), Fort Rucker, Alabama
• U.S. Army Institute of Surgical Research (USAISR), Fort Sam Houston, Texas
• U.S. Army Medical Research Institute of Chemical Defense (USAMRICD), Aberdeen Proving Ground, Maryland
• U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Maryland
• U.S. Army Research Institute of Environmental Medicine (USARIEM), Natick, Massachusetts
• Walter Reed Army Institute of Research (WRAIR), Forest Glen, Maryland U.S. Army Dental Research Detachment
U.S. Army Medical Research Detachment
Armed Forces Research Institute of Medical Sciences-Thailand (AFRIMS)
U.S Army Medical Research Unit- Europe
U.S Army Medical Research Unit- Kenya
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Regional Medical CommandsTeaching Hospitals
Walter Reed AMC Womack AMC DeWitt ACH Keller ACH (West Point)Eisenhower AMC Martin ACH Darnall AMC Brooke AMCWilliam Beaumont AMC Madigan AMC Tripler AMC
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SPECIALTY SAUSHEC EAMC MAMC TAMC NCC WBAMC WAMC DARNALL MARTIN VA-DoDEmergency Medicine X X X XFamily Medicine X X X X X X XGeneral Surgery X X X X X XGS Neurosurgery X XGS Urology X X X X XInternal Medicine X X X X X XNeurology X XChild Neurology XOB-GYN X X X XOrthopaedics X X X X X XOtolaryngology X X X XPathology X X XPediatrics X X X XPsychiatry X XPsychiatry/Internal Medicine XTransitional X X X X XPrelim Aerospace Medicine XPrelim Anesthesiology X X X X X XPrelim Dermatology X X X XPrelim Ophthalmology X X X X X XPrelim Physical Medicine X XPrelim Preventive Medicine X XPrelim Radiation Oncology XPrelim Radiology(DIAG) X X X X X
SAUSHEC –Brooke Army Medical Center, Fort Sam Houston, TX/Wilford Hall Medical Center, Lackland AFB, TX/University of Texas, San Antonio, TXNCC –Walter Reed Army Medical Center, Washington, DC/DeWitt Army Community Hospital, Fort Belvoir, VANational Naval Medical Center, Bethesda, MD/Malcolm Grow Medical Center, Andrews AFB, MD/USUHS
ARMY FIRST YEAR GRADUATE MEDICAL EDUCATION (FYGME) PROGRAMS - (PGY-1)
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Residencies
• Internal Medicine
• Family Medicine
• Emergency Medicine
• Pediatrics
• Obstetrics/Gynecology
• General Surgery*
• Neurosurgery
• Orthopaedics
• Urology
• Otolaryngology
• Preventive Medicine/ Occupational Medicine*
• Dermatology
• Radiology
• Radiation Oncology
• Anesthesiology
• Aerospace Medicine*
• Neurology and Child Neuro
• Pathology
• Psychiatry
• Physical Medicine and Rehabilitation
• Ophthalmology
* Specialty does not offer continuous contract; must reapply for PGY-2 year.
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PGY-1 Categorical Specialties
• Emergency Medicine
• Family Medicine
• General Surgery
• Internal Medicine
• Neurology
• Neurosurgery
• OB-GYN
• Orthopaedics
• Otolaryngology
• Pathology
• Pediatrics
• Psychiatry
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Designated Preliminary/Pre-Select Specialties
• General Surgery* o Urology
• Transitional Year Undesignated
Designatedo Aerospace Medicine*
o Anesthesiology
o Dermatology
o Ophthalmology
o Physical Medicine
o Preventive Medicine/Occupational Medicine*
o Radiation Oncology
o Radiology (Diagnostic)
* Specialty does not offer continuous contract; must reapply for PGY-2 year.
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Applications For FYGMEApplicants Per Approved Positions
SPECIALTY (#slots 2011) 2006 2007 2008 2009 2010 2011
Emergency Medicine (28) 1.25 1.23 1.63 1.15 1.14 1.36
Family Medicine (44) 1.09 0.80 0.58 0.56 0.88 1.07
General Surgery (26) 1.29 1.10 0.92 1.65 1.84 1.65
GS Neurosurgery (3) 0.50 1.00 1.00 7.00 1.50 1.33
GS Urology (7) 1.57 1.00 1.17 1.57 0.57 0.71
Internal Medicine (58) 0.84 1.06 0.75 0.65 0.71 0.66
Neurology (6) 1.20 0.60 0.33 1.20 0.50 0.83
Child Neurology (1) 0.00 0.00 0.00 0.00 0.00 1.00
OB-GYN (17) 1.53 1.13 1.20 1.20 0.59 0.83
Orthopaedics (19) 1.36 1.95 1.84 1.47 0.89 1.21
Otolaryngology (7) 1.28 4.00 1.14 1.00 1.71 1.33
Pathology (6) 1.16 0.50 1.17 1.00 1.00 1.17
Pediatrics (26) 1.20 0.88 0.92 0.62 0.62 0.92
Psychiatry (15) 0.83 1.07 0.64 0.71 0.87 0.88
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Applications For FYGME (continued)Applicants Per Approved Positions
SPECIALTY (#slots 2011) 2006 2007 2008 2009 2010 2011
Psychiatry/Internal Medicine (0) 0.50 1.50 0.50 1.50 2.00 0.00
Transitional (15) 0.27 0.06 0.20 0.13 0.13 0.13
Prelim Aerospace Medicine (1) 0.50 0.50 0.00 0.00 1.00 0.00
Prelim Anesthesiology (12) 1.33 1.42 1.25 1.50 0.83 1.25
Prelim Dermatology (7) 1.62 1.29 0.57 1.29 1.29 0.71
Prelim Ophthalmology (7) 1.42 1.14 0.72 1.57 0.86 0.43
Prelim Physical Medicine (3) 1.66 2.00 3.33 1.00 1.33 2.00
Prelim Preventive Medicine (2) 0.25 0.67 0.75 0.50 0.50 1.00
Prelim Radiation Oncology (1) 2.00 0.00 2.00 1.00 0.00 1.00
Prelim Radiology (Diag) (15) 1.25 1.00 1.67 1.00 0.87 0.87
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VA-DoD Training Opportunities
• Intern year in Army program
• Remainder of residency in VA-sponsored program
Radiology – Medical College of Georgia; UT San Antonio
Urology – UT San Antonio; Duke University
Neurosurgery* – University of Florida; UT San Antonio
*Entirety of training in VA-sponsored program
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2010 Army GMESB Selection Summary Report Fellowship Training
Selects
Inservice
Military
Selects
Deferred
Selects
Civilian
Sponsored
Total
Selects
Non-
Selects
Total
Applicants
Inservice
Select
Rate
Overall
Select
Rate
Utilization/
Field46 0 26 72 23 95 48% 76%
Interns 0 0 0 0 0 0 0% 0%
Current
Deferred1 0 0 1 6 7 14% 14%
Current
Residents30 0 29 59 57 116 26% 51%
Civilian 1 0 0 1 2 3 33% 33%
Totals 78 0 55 133 88 221 35% 60%
Female 19 0 10 29 22 51 37% 57%
Minorities 21 0 12 33 26 59 36% 56%
Totals 40 0 22 62 48 110 36% 56%
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Fellowships 2012
Aerospace Med Hyperbaric Med CIV 1
Anesthesiology Acute Pain/Regional Anesth NCC 1
Critical Care Anesth NCC 1
Pain Management NCC 2
Pediatric Anesth CIV 1
Dermatology Dermatologic Surgery CIV 1
Emergency Med Wilderness Med MAMC 1
Emergency Med Cardiology CIV 1
Emergency Med Services SAUSHEC 1
Emergency Toxicology CIV 1
Pediatric Emergency Med CIV 1
Sports Med CIV 1
Ultrasound SAUSHEC/MAMC/Darnell 3
Family Medicine Faculty Development MAMC 3
GI/Colonoscopy MAMC 1
Hospitalist CIV 1
OB/GYN Darnall/CIV 2
Sports Med NCC/CIV 3
General Surgery Plastic Surgery CIV 2
Other Surgery Advanced Laproscopy CIV 3
Trauma/Critical Care Surgery SAUSHEC/CIV 2
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Fellowships 2012
Internal Medicine Cardiology SAUSHEC(2)/NCC(3) 5
Cards Interventional CIV 1
Critical Care Med SAUSHEC 1
Endocrinology NCC 1
Gastroenterology SAUSHEC(3)/NCC(2) 5
GI Invasive Endoscopy CIV 1
General Internal Med WBAMC 1
Hematology/Oncology SAUSHEC(1)/NCC(2) 3
Infectious Diseases SAUSHEC(2)/NCC(1) 3
Nephrology NCC 1
Pulmonary/CCM SAUSHEC(1)/NCC(2) 3
Rheumatology NCC 1
Neurology Child Neurology NCC 1
Clinical Neurophysiology NCC 1
Headache Medicine CIV 1
Neuro Critical Care CIV 1
OB/GYN Maternal and Fetal Medicine MAMC/CIV 2
Gyn Minimally Invasive Surgery NCC 1
Reproductive Endocrinology NCC/CIV 2
Ophthalmology Glaucoma CIV 1
Ophthalmic Pathology CIV 1
Retinal Surgery CIV 2
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Fellowships 2012
Orthopedics Childrens Ortho CIV 1
Feagin Sports Med Keller 2
Hand Surgery NCC 2
Orthopedic Trauma CIV 2
Shoulder Surgery CIV 1
Spine Surgery CIV 2
Total Joint/Recnstructive Surg CIV 1
Otolaryngology Facial/Plastic/Reconstruct Surg CIV 1
Head and Neck Surgery CIV 2
Pediatric Otolaryngology CIV 1
Sleep Med and Surgery CIV 1
Pathology Clinical Molecular Genetics CIV 1
Forensic Pathology AFIP 1
Neuro Pathology CIV 1
Pathology Infomatics CIV 1
Pediatrics Developmental Peds MAMC 2
Neonatology SAUSHEC(1)/NCC(1) 2
Pediatric Cardiology CIV 1
Pediatric Endocrinology NCC(1)/CIV(1) 2
Pediatric Gastroenterology NCC 1
Pediatric Infectious Diseases NCC 1
Pediatric Pulmonary CIV 1
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Fellowships 2012
Physical Medicine Pain Management NCC 2
Prevent/Public Health Medical Toxicology CIV 1
Occupational Medicine NCC 2
Preventive Medicine NCC 1
Psychiatry Addiction Psychiatry TAMC 1
Child/Adolescent Psych TAMC(3)/NCC(3) 6
Forensic Psychiatry NCC 1
Preventive Psychiatry NCC 1
Psychosomatic/Geriatric Psych NCC 1
Radiology Musculoskeletal Imaging CIV 3
Neuroradiology CIV 1
Trauma Radiology SAUSHEC 1
Vascular/Interventional Rad CIV 1
Urology Stone/Laproscopy Disease CIV 1
Trauma/Reconstructive Uro CIV 1
Specialty Immaterial Adolescent Medicine SAUSHEC 1
Allergy NCC 3
Clinical Pharmacology WRAIR 2
Clinical Research SAUSHEC 2
Critical Care Ultrasound SAUSHEC 1
Geriatric Medicine MAMC 2
Medical Genetics CIV 1
Nuclear Medicine NCC 2
Sleep Disorders SAUSHEC(3)/NCC(2) 5
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Fellowships 2012
Degree Programs Epidemiology USUHS 1
Medical Information Systems MAMC 1
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Leadership Develop. Health Care Admin CIV 2
Health Care Admin-Baylor CIV 2
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HPSP
• 80% of all active duty physicians
• Full assistance (tuition, books, equipment and monthly stipend of $2,088)
• Available to: physicians, dentists, veterinarians, clinical psychologists, pharmacists and optometrists
• Reasons to take scholarship
Debt free after med school (avg. debt is $160,000)
GME opportunities and subspecialty training
Unlimited practice opportunites in
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Reasons to Apply for HPSP
• Debt free after Medical school+ $20k bonus
Median education debt is $160,000
• Outstanding GME opportunities in Army programs and subspecialty training
• Unlimited practice opportunities in academic, operational, clinical medicine and research
• Excellent benefits while on AD and retirement*
• Selfless service
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HPSPHPSP MODEL
Scholarship Length
YEAR OUTPUT 1 YR 2 YR 3 YR 4 YR MAX
11 12 13 14 15
10 0 30 255 INPUT 295
2010 232 283 324 300 255 TOTAL 1162
5 0 30 255 INPUT 290
2011 283 329 300 285 255 TOTAL 1169
0 0 20 255 INPUT 275
2012 329 300 285 275 255 TOTAL 1115
0 0 20 255 INPUT 275
2013 300 285 275 275 255 TOTAL 1090
0 0 20 255 INPUT 275
2014 285 275 275 275 255 TOTAL 1080
0 0 20 255 INPUT 275
2015 275 275 275 275 255 TOTAL 1080
0 0 20 255 INPUT 275
2016 275 275 275 275 255 TOTAL 1080
0 0 20 255 INPUT 275
2017 275 275 275 275 255 TOTAL 1080
0 0 20 255 INPUT 275
2018 275 275 275 275 255 TOTAL 1080
0 0 20 255 INPUT 275
2019 275 275 275 275 255 TOTAL 1080
0 0 20 255 INPUT 275
2020 275 275 275 275 255 TOTAL 1080
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HPSP Changes
• MAC (Minimal Acceptance Criteria):
GPA >/= 3.2 undergrad
MCATs >/= 24 with no score <8
• AAC (Automatic Acceptance Criteria):
NO LONGER
• Average MCAT for HPSP matriculants is 29.3 and average GPA is 3.62
• Waivers: 103 requests, 19 approved
Virtually all approved were for combined programs
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More HPSP Notes
• Residency Competition for Army will peak in 2012-2013
• Most scholarships are 4 years
3-year scholarships mostly rollovers
• HPSP students expected to take BOLC after 1st year medical school
2nd year prepare for part 1 of boards
3rd and 4th years to ADT at Army hospitals
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HPSP Plan of Attack
• New Approach
USAREC and MEDCOM working together
Adjustments in requirements
Improvement in Quality
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Attrition Rates
Year Overall Academic
2007 5.4% 1.7%
2008 4.6% 3.3%
2009 6.4% 4.7%
2010 4.0% 3.1%
2011 3.2% 1.2%
National 4.0% 1.4%
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HPSP Plan
• Target:
Undergraduate universities
Universities with large number of medical school matriculants
Universities with large number of matriculants to out-of-state and private medical schools
Pre-health clubs, Medical Honor societies, advisors & ROTC
Target financial aid advisors at medical schools and staff with access to accepted students
• Provide SME at all events involving at least major universities (Top 65)
• Provide regular training to recruiters from GME and deliver readily available POC
• Provide visibility to leaders and AARs
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STATE University Location Top MD Top DO
Afr. Am. Hispanic Asian
AL Oakwood College Huntsville
AZ U. of Arizona Tucson
Arizona State U. Tempe
CA UCLA Los Angeles
UC Berkeley Berkeley
UC San Diego La Jolla
UC Irvine Irvine
UC Davis Davis
Stanford Stanford
U. of Southern Calif. Los Angeles
CO U. of Colorado Boulder Boulder
CT Yale New Haven
DC Howard U. Wash DC
FL U. of Florida Gainesville
U. of Miami Coral Gables
u. OF South Florida Tampa
Florida State U. Tallahassee
U. of Central Florida Orlando
Florida International U. Miami
GA U. of Georgia Athens
Emory U. Atlanta
Spelman College Atlanta
Morehouse College Atlanta X
Georgia State U. Atlanta X
IL U. of Illinois Champaign Champaign
LEGEND Top 10 Next 11-20 Next 21-30 Next 31-40 Next 41-47
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Northwestern U. Evanston
U. of Illinois Chicago Chicago
Loyola U Chicago Chicago
IN U. of Notre Dame Notre Dame LEGEND
Indiana U. Bloomington Top 10
Next 11-20
LA Louisana State U. Baton Rouge Next 21-30
Xavier U. New Orleans Next 31-40
Next 41-47
MA Harvard U. Cambridge
Boston U. Boston
MD Johns Hopkins U. Baltimore
U. of Maryland College Park College Park
MI U. of Michigan Ann Arbor Ann Arbor
Michigan State U. Lansing
MN U. of Minnesota Mineapolis
MO Washington U. St. Louis
NC Duke U. Durham
U. of North Carolina Chapel Hill
NJ Rutgers U. New Brunswick
NM U. of New Mexico Albuquerque
NY Cornell U. Ithaca
New York U. New York
Columbia U. New York
Stony Brook U. Stony Brook
STATE University Location Top MD Top DOAfr. Am. Hispanic Asian
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STATE University Location Top MD Top DOAfr. Am. Hispanic Asian
OH Ohio State U. Columbus
OK U. of Oklahoma Norman
PA Penn State U. University Park
U. of Penn Philadelphia
RI Brown U. Providence
TN Vanderbilt U. Nashville
TX U. of Texas Austin Austin
Baylor U. Waco
U. of Texas Pan American Edinburg
Texas A&M College Station
U. of Texas San Antonio San Antonio
UT BYU Provo
VA U. of Virginia Charlottesville
Hampton U. Hampton
Virginia Polytech Blacksburg
WA U. of Washington Seattle
WI U. of Wisconsin Madison Madison
PR U. of Puerto Rico-Rio Pedras Rio Pedras
U. of Puerto Rico-Mayaguez Mayaguez
Can. U. of Toronto Toronto
LEGEND Top 10 Next 11-20 Next 21-30 Next 31-40 Next 41-47
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Medical Professional Career Tracks
• Clinical
• Academic
• Research
•Operational
•Multiple Levels of Hooah!
•Command – Leadership
•Corporate Level Management
Arm
y U
niq
ue
Same for Civilian
and Army**
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• Integration of Professional Medical Education and Professional Military Education as the three pillars of leader development:
-Military training/GME
-Self development
-Operational assignments
• Designed to provide guidelines for completion of courses, career integration at specific ranks and career points
• http://www.army.mil/usapa/epubs/xml_pubs/p600_4/head.xml
Life Cycle Model Is:
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FYGME RESIDENCY FELLOWSHIP
Successful Completion of Internship and ResidencyUtilization TourClinician
BN/BDE/DIVSurgeonMEDCOM StaffDCCSMEDCEN StaffMEDDAC StaffResidency DirectorProduct Line MgrDivision ChiefClinician
Corps/MACOM SurgeonCommanderJoint AssignmentsDCCSMECEN StaffDeputy ChiefDir Med EdUSUHS FacultyDepartment ChairResearch Area Dir.
COL LTCMAJCPT
YEARS 0 6 12 30
Rank
Professional Military Education
Additional Training
Self Development
DEVELOPMENTAL & UTILIZATION ASSIGNMENTS
CBRNE SHORT COURSES
Continuing Medical Education / Board Recertification
Typical Assignments
License by yr. 2 Board Certification Subspecialty Board Certification
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MPH MBA TWI ADVANCED SCIENCE DEGREE
ADV. TRAUMA MANAGEMENT, ADV. TRAUMA LIFE SUPPORT, COMBAT CASUALTY MGT
Successful Completion of FellowshipTOE/TDA PhysicianCompany CommanderClinic OICTeaching StaffResearch AssistantClinician
BOLC CCC INTERMEDIATE LEVEL ED SENIOR SVC. COLLEGE
EXECUTIVE SKILLS COURSE
Medical Corps Officer Career Progression
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• An Army Officer
• Training and mentoring junior soldiers/physicians in your specialty.
• Opportunities to lead sooner than civilian practices
• Your professional recommendations are more valued, and you have the autonomy within your practice without third-party interference
• Full-spectrum of leadership opportunities from service/department chief to Surgeon General
Leadership Opportunities
The “Right” Career?
• 4300 career “rabbit paths”• Clinical competence is paramount• Meet the requirements• Stack the deck in your chosen path
– Assignments– Schools– “A” designator– OER Support Forms
• Understand the consequences and accept responsibility
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Retention
• MC Retention Issues Deployment / Family
Length of deployment – Down to 4.5 months for physicians
AHLTA/admin issues
• Initial ADSO Retention FY11=70% FY10 = 63%
FY09 = 59%
57% - 65% over the past 5 years
• Continuation rate beyond initial ADSO > 90%
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OEF/OIF: Rapid Integration of Lessons Learned
• Force Health Protection
Behavioral Health
– Interventions to Enhance Psychological Resilience and Prevent Psychiatric Casualties.
– Pentagon Post-Disaster Health Assessment
– PTSD
Immunizations
– Vaccine Healthcare Centers Network (VHC)
– Myocarditis and Oral Vaccine with Smallpox Vaccine
• Battlefield Medicine
Training of Medics: 91W
Use of Blood Transfusions, Whole Blood, Factor VII
Hemostasis: Tourniquets and HemCon Bandages
Pain Control & Regional Anesthesia: pain pumps
• Home Station/Garrison Care
Amputee Care & Rehabilitation: Intrepid Center
Deployment Health Practice Guideline
Community Based Warrior Transition Unit: CBWTU
Traumatic Brain Injury (TBI)
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Battlefield Survival
• Forward surgical/resuscitation capabilities
• Advanced evacuation capabilities
• Body Armor
• Advanced surgical techniques
• Advances in antibiotic tx
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70.7
78.2 76
87.193
0
10
20
30
40
50
60
70
80
90
100
WW II Korea Vietnam OEF OIF
Survivability (%)
Survivability = 100% - (KIA% + DOW%)
WWII
ODS
SOMALIA
OEF
OIF
Transforming for Success
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Army Medicine
Serving the nation since 1775
China 1944 44th MASH, Korea 1954
Radiology residents 1968
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The Army’s Home for Health…Saving Lives and Fostering Healthy and Resilient People
~ Partnerships Built on Trust